Issues that have cropped up with insurance providers under the Integrated Shield Plans (IP) of late are symptoms of an “overly complex” healthcare financing system, said Singapore Democratic Party (SDP) chairman Paul Tambyah.
Responding to an article by Lianhe Zaobao via a Facebook post on Sunday (25 Apr), Dr Tambyah said he found it striking that Singapore has a national health insurance scheme such as MediShield Life that is supposed to provide “peace of mind”, yet have nearly 70 per cent of the population finding it inadequate.
The basic MediShield Life scheme does not cover pre- and post-hospitalisation bills, which may place a heavy burden on patients who require ongoing treatment for chronic severe illnesses such as cancer.
Coverage for surgery under MediShield Life also has a cap of S$2,600.
Dr Tambyah noted that because the basic Medishield Life scheme is insufficient to cover such medical costs, many have opted to take up the Integrated Shield Plans (IP).
“Now these plans are under attack with the rules changing rapidly apparently to benefit insurers and ensure their profitability at the expense of both patients and doctors,” he observed.
Even with IP, the Life Insurance Association Singapore (LIA) earlier this month warned that premiums could “rise significantly” if insurers decide to “recklessly increase” the number of doctors on IP panels.
Instead of increasing panel sizes, insurers could explore other ways to reduce costs such as by increasing premiums or co-payments or by pre-approving treatments, said LIA Singapore.
LIA Singapore was responding to a position statement on IPs released by the Singapore Medical Association (SMA), in which SMA lamented the limited number of private specialists on the said panels and the low fees they receive, near the tail end of the fee benchmarks set by the Ministry of Health (MOH).
The medical association claimed that they are faced with higher costs than before due to an increase in management expenses and commission costs for insurers rather than higher claims.
LIA Singapore said this could be the Health Insurance Task Force’s recommendations being implemented, which not only skyrocketed insurers’ expenses in recent years but also had moderated claims growth.
The task force had in 2016 recommended that patients foot a portion of their bills, as well as for panels of approved healthcare providers to be set up and fee benchmarks to be set.
Netizens have commented on how increasing the number of doctors on IP panels will cause patients to “ultimately bear the cost” with the current system, and that it is a sign that the insurance contract is profit-driven rather than focusing on “providing care for the insured”.
One opined that only the government appears to be benefiting from the whole scheme despite compulsory medical insurance being implemented to address rising healthcare costs.
While Dr Tambyah acknowledged MOH’s efforts to set up a committee to address the problem, he opined that it is unclear as to how the ministry will solve the issue “as there are no easy solutions without dealing with the fundamental problems with Medishield Life”.
“These problems have resulted in one of the high-income world’s worst problems, with inequality approaching the level of the United States, which probably has the most dysfunctional system in the high-income world,” he said.
Socioeconomic gaps between Singaporeans with secondary education and below compared to those with post-secondary education, Dr Tambyah added, is one of the key “social determinants of health” that need to be addressed urgently.
“The outgoing health minister, Gan Kim Yong revealed in Parliament that there is a striking five and a half year gap in life expectancy between Singaporeans who are 25 years old who have secondary education and below compared with those with post-secondary education,” he said.
Even taking into account multiple confounders such as age, gender, ethnic groups, and educational levels for chronic conditions, men and women who have secondary education level or below were more likely to have hypertension, diabetes and high cholesterol compared to their counterparts with post-secondary education.
Dr Tambyah reiterated SDP’s proposal for a national universal healthcare scheme that is “simple and based on a single-payer system”.
“We are happy to meet with (incoming Health) Minister Ong (Ye Kung) to explain it to him and suggest ways that he can overhaul our healthcare system to meet the basic healthcare needs of all Singaporeans,” he said.
Introducing the SDP Plan in May 2019, Dr Tambyah said that the SDP Plan will ensure that the funds in Medisave would be returned to the people’s Central Provident Fund (CPF) accounts.
These complex schemes would be replaced with the National Health Investment Fund (NHIF), to which everyone Singaporean contributes an average of S$50 a month — depending on income levels — through their CPF.
This amount is lower than the current Medishield Life premiums.
The rest of the healthcare budget under the NHIF would be paid for through taxes collected by the government.
The NHIF would cover every Singaporean for basic healthcare including accidents and pregnancy.
Under the NHIF, a patient would only be required to pay 10 per cent of the hospital bill and the amount is capped at S$2,000 per year. The remainder will be paid by the NHIF.
Dr Tambyah said that patients will co-pay hospital bills to “emphasise personal responsibility and reduce abuse by providers”.
The SDP Plan differs from the PAP’s system in one crucial aspect. The latter runs hospitals as profit-making ventures which consistently collect surpluses far in excess of the money spent taking care of patients.
“Healthcare is treated like a commodity where people avoid important primary healthcare services because of the costs and end up spending a lot of money treating complications that could have been prevented,” Dr Tambyah said.
“As a medical professional, I feel that this is not right. We should ensure that there is equal treatment for all, care based on clinical need and not on ability to pay.”