Between personal responsibility and providing for the common good

Broadening the use of Medisave

Jeremy Lim: I don’t think it will be useful (to raise Medisave contribution rates). The entire scheme is very “lumpy”, and there will be Singaporeans with relatively little and others who have very much ... There is almost S$60 billion locked up within Medisave ... that’s five years’ worth of national healthcare spending. I would urge policymakers to think about how to harness the money that has been locked up, because it’s a huge sum and, clearly, there (is a) significant number of Singaporeans struggling to pay the bills today.

Patrick Kee: I fully agree with Jeremy ... this is the failure of the Medisave and MediShield schemes. We are individualising the insurance (burden) when we should be pooling our resources for the common good.

Tan Tze Lee: There are merits to the current scheme. Of course, no system is perfect and we have to tweak it, but I am concerned that, if we use Medisave for various kinds of costs as they come up, you may deplete it very quickly.

Prevention is better than cure

Patrick: We need to redefine what we mean by health. Health is not the absence of disease. Health is a total way of living; it involves our relationships with our family or friends, and at work and with ourselves. Stress is also an importance cause of disease, so I think we need to look at health from a broader perspective than just the prevention of medical illness.

Henry Lim: Good mental health can lead to good physical health. Education is one (way of getting the young to start thinking about their health). Within the work environment, employers should give a helping hand to encourage their workers to place emphasis on their overall health and not just focus on their career.

Jeremy: The ideal healthcare financing system should do two things. First, it should provide citizens with peace of mind ... that whether they are afflicted with major illnesses or relatively minor illnesses, it won’t lead to financial hardship. The second point is that the model should encourage citizens to remain healthy and, if they are not very healthy, to take measures.

This broadens the definition of healthcare to beyond healthcare services. Because of the way the system has been built, there are genuine financial concerns and, in a sense, this encourages people to be more prudent and sensible when it comes to healthcare.

‘Over-consumption’ of healthcare services

Jeremy: There will always be the small group that will over-consume. But the more measures we take to control this group means everyone else (will feel) more anxious. The right balance will need to be struck.

Tze Lee: You have people who overindulge or smoke or don’t do a lot of exercise, and then they change (their lifestyle) and, after six months, they lose weight, their blood pressure is down. At this point, we could say they are less unhealthy than before, and they should be rewarded for it, because now they are a better insurance risk.

Patrick: We must recognise that, sometimes, people don’t have full control over their health. They may be living (healthily) but can still get struck down with cancer.

We must be careful of not categorising people as not being responsible for their health.

Steven Lee: I think the Government should make it compulsory for companies to convert their current health insurance schemes into portable ones ... for example, my company provided some form of insurance, but it does not contribute to MediShield, and I have to buy insurance on my own. In a sense, it’s like “double coverage”, so why don’t we get companies to pay for MediShield premiums?

Dr Jeremy Lim is Principal Consultant at Insights Health Associates and has held positions in the public and private healthcare sectors. Dr Tan Tze Lee is a general practitioner. Dr Patrick Kee is a specialist in palliative medicine.

Catch the one-hour extended encore telecast of this week’s VoicesTODAY episode “A fairer healthcare system — what does it mean to Singaporeans” at 5.30pm today on Channel 5.