Affordability a key point raised in debate on MediShield Life
The revised MediShield Life scheme will offer better protection, including care received entirely outside the premises of a medical institution, when the new recommendations kick in progressively from April 2025.
The amendments in the MediShield Life Scheme Bill were approved in Parliament on Nov 11, with seven MPs raising various points on issues such as the affordability of premiums, rising healthcare costs, and support for asset-rich but cash-poor individuals.
In mid-October, the MediShield Life Review Committee had recommended higher inpatient claim limits and enhanced outpatient coverage, as well as the coverage of clinically effective and cost-effective high-cost treatments such as cell, tissue and gene therapy products.
These recommendations come as healthcare delivery shifts towards outpatient, community and home-based care amid rising costs and an ageing population.
This means that premiums will inevitably rise, but they will be capped at 35 per cent, and progressively phased in evenly over three years from April 2025.
The Government has accepted the recommendations.
The higher claim limits, for instance, will allow the mandatory health insurance scheme to fully cover nine in 10 subsidised bills in public healthcare institutions as it was originally designed to do, said the Ministry of Health (MOH).
In putting forth a point on financial sustainability, Dr Wan Rizal (Jalan Besar GRC) said there must be careful oversight of the use of advanced and often high-cost treatments or services, as a surge in claims could increase premiums and affect affordability.
He also said there is a need to consider new healthcare needs, such as mental health, which has become increasingly pertinent, and ensure they remain affordable.
Given the newly recommended claim limits for high-cost treatments, Ms Ng Ling Ling (Ang Mo Kio GRC) asked how MOH is addressing concerns about the sustainability of covering such treatments in the long run.
She asked about the selection criteria of outpatient services included under MediShield Life, and the safeguards in place to control cost increases resulting from a higher volume of outpatient claims.
She also wanted to know how MOH plans to balance the inclusion of a wide range of outpatient services while preventing over-utilisation, which may drive up overall healthcare costs in the long term.
In response to the questions, Minister of State for Health Rahayu Mahzam said MOH has been redesigning the healthcare system to better support right-siting of care, from acute hospitals to other settings such as outpatient community and home settings, where one can receive the same care at lower cost.
Right-siting of care refers to the treatment of patients in the most appropriate locations by medically competent teams at the lowest possible cost.
MOH also rigorously assesses if a new treatment is clinically effective and cost-effective before extending financing coverage to it, and is focusing increasingly on preventative care, Madam Rahayu added.
In her speech in Parliament on Nov 11, she touched on the amendments needed to expand coverage to new models of care, as well as strengthen provisions to support premium recovery efforts.
She said MOH has put in place measures to facilitate the payment of premiums, but some individuals – around 1 per cent of policyholders – who can afford their premiums choose not to pay and become defaulters.
If their premiums are left unrecovered, their debts will have to be shouldered by other policyholders in the form of higher premiums, she added.
Responding to Mr Yip Hon Weng (Yio Chu Kang), Ms Jessica Tan (East Coast GRC) and Mr Gerald Giam (Aljunied GRC) on the support for asset-rich but cash-poor lower-income individuals who live in or own properties with a high annual value, Madam Rahayu gave the assurance that no one will lose MediShield Life coverage because of an inability to pay.
Those who need more help or are facing extenuating circumstances may appeal for more assistance, which would be assessed on a case-by-case basis, she said.
“Premiums will need to go up, but we have provided a significant package of support that offsets premium increases for more than nine in 10 Singaporeans over the next three years,” said Madam Rahayu.
“The Government will continue to work with the MediShield Life Council to review the scheme regularly to ensure that it remains a source of assurance for large healthcare bills and that its premiums remain affordable for Singaporeans.”
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