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MPs call for fundamental changes to make healthcare affordable

SINGAPORE — Calling for a fundamental shift in the healthcare system to make it more affordable, the Government Parliamentary Committee for Health yesterday added its weight behind earlier calls to tilt the healthcare financing framework — comprising Medisave, MediShield and Medifund — towards preventive healthcare and care in the community setting, away from the traditional focus on hospitalisation care.

SINGAPORE — Calling for a fundamental shift in the healthcare system to make it more affordable, the Government Parliamentary Committee for Health yesterday added its weight behind earlier calls to tilt the healthcare financing framework — comprising Medisave, MediShield and Medifund — towards preventive healthcare and care in the community setting, away from the traditional focus on hospitalisation care.

Notably, it stressed the need to ensure the relevance of MediShield — a national catastrophic insurance scheme primarily for larger inpatient bills — citing feedback that some doctors are even advising their patients to allow their MediShield coverage to lapse because the premiums were too high. Instead, they recommend their patients to apply for Medifund — an endowment fund set up by the Government to help needy Singaporeans who cannot pay for their medical expenses.

The healthcare financing framework is currently under review.

Yesterday, the committee — chaired by Sengkang West Member of Parliament (MP) Lam Pin Min and comprising seven other MPs — released a report with a slew of recommendations aimed at improving healthcare affordability. In a letter to Dr Lam, Health Minister Gan Kim Yong said his ministry is studying the suggestions.

While the majority of the report focused on the 3M system, it also called for better integration of social care with medical care to reduce Singaporeans’ utilisation of hospitals. To serve as a check and balance and allow the public to make better-informed choices, it also recommended that the Health Ministry or Singapore Medical Council conduct annual surveys on professional fees and medical costs and make public the information.

General practitioners also have a greater role to play as part of the primary healthcare system, the report said, and medical assistance schemes should be expanded to cover all chronic diseases and people of all ages.

On the 3M system, the committee suggested that Medisave usage be liberalised to include, for instance, health screening, essential dental procedures, physiotherapy and occupational therapy.

The limits on Medisave usage should be reviewed regularly to be “in line” with rising medical costs and be tiered according to age groups, the committee said. At the same time, the Government should look into creating safeguards to prevent individuals from depleting their Medisave accounts to pay for their family members’ medical expenses. And when this happens despite the safeguards, the Government should provide financial support.

Similarly, for MediShield, the Government should step in to “guarantee” coverage for Singaporeans who cannot afford to pay the premiums.

Citing a TODAY report last month which surveyed 50 young working adults and found an overwhelming majority were willing to pay higher premiums to reduce the burden on the elderly, the committee also proposed a “reversed premium structure” where an individual pays a lower premium as he gets older.

A Singaporean or permanent resident aged between 21 and 30 currently pays an annual premium of S$66. At the other end of the spectrum, a Singaporean or PR aged between 86 and 90 pays S$1,190 a year.

While the policy intent of MediShield is clear, the committee said that “realities pale in comparison with its actual intent”. It added that some Singaporeans have allowed their coverage to lapse because premiums “have risen so high during their old age, it has become impossible for (them) to maintain their coverage”.

The committee said: “Even periodic top-ups by the Government to the Medisave meant as payment for MediShield premiums were in vain as these were utilised for hospital bill payments.” It also suggested removing the age limit of 90 years and extending MediShield coverage to social and community care.

Welcoming the committee’s suggestions, healthcare financing experts TODAY spoke to felt that the proposed changes were overdue.

Professor Phua Kai Hong of the Lee Kuan Yew School of Public Policy said it was crucial to align the healthcare financing system to support step-down care. “Now we are moving to different levels of care ... the financing mechanism should support that,” he said.

Dr Jeremy Lim, Principal Consultant at Insights Health Associates, said by asking the Government to step in to guarantee MediShield coverage for those who cannot afford premiums, the committee was “in essence asking for (the scheme) to be nationalised”. “This is a good thing. Every Singaporean should have the ‘peace of mind’ that health insurance can provide,” he said.

Dr Lim noted that an “important thrust” of healthcare reforms is how they can change the way the system delivers care. For example, because of the way some insurance policies are structured, a patient might prefer to stay overnight in hospital instead of seeking outpatient treatment, hence unnecessarily taking up bed space.

KEY RECOMMENDATIONS Right siting of care -Standardise restrictions on use of Medisave across care options, ensure that Eldershield payout is sufficient for social care options Manage rising healthcare costs -Regularly review and expand standard drug list to include more essential drugs -Survey and make public information on professional, medical fees across healthcare industry Strengthen the 3M framework -Enhance the scope of Medisave usage and regularly review withdrawal limits -Prevent premature depletion of Medisave through inter-generational use -Ensure affordability of MediShield premiums, especially for elderly, possibly by getting the young to pay higher premiums Remove MediShield age ceiling, strengthen and expand coverage to community and social costs -Review and rationalise medical assistance schemes and frameworks -Remove age criterion for Community Health Assist Scheme -Expand the Chronic Disease Management Programme and raise Medisave limits on usage -Tap on GPs as nodes in the primary care system

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