HEALTH-CARE FINANCING; Review will be forward-looking

21 March 2013

3Ms are outdated, says professor

LUPUS actually means "wolf" in Latin. Many patients with lupus have a rash on the face seen in some wolves ("MediShield should be more inclusive" by Ms Linda Woo; last Saturday).

I have been "romancing the wolf" for the past 40 years and wrote my first published scientific paper 40 years ago.

Lupus, or to use its full medical term, systemic lupus erythematosus, is not a single disease.

Some patients with lupus have only skin and joint symptoms, and need only aspirin, while others have kidney, brain and heart involvement and can perish within a few months without proper treatment.

With proper medical treatment, even those with serious illness can lead normal, productive lives like Ms Woo.

To deny such people medical insurance is a travesty of the very concept of an inclusive health-care system.

Many new and effective drugs for lupus are now available, like Mycophenolate Mofetil and biologic agents. And although they are expensive, they keep such patients well and productive.

Nothing is more expensive than a chronically sick patient needing constant care at home and repeated admissions to hospital.

The 3Ms - Medisave, MediShield and Medifund - are out of date and there is a need to revamp the whole health funding system.

They were relevant 10 to 20 years ago, but medicine has changed beyond recognition in that period.

There is now personalised medicine, genomic medicine and targeted treatment, and Singapore has to move with the times.

The same thing can be said of another common rheumatic disease, namely, rheumatoid arthritis.

There are excellent reference points within the medical academia like the Chapter of Rheumatology within the Academy of Medicine, and patient support groups like the Lupus Association Singapore.

They are ever willing to work with any government agency or health insurance bodies to formulate a win-win formula that can be a model within the region.

Change is the only constant within the rapidly developing health-care field.

Feng Pao-Hsii (Professor)

Emeritus Chairman National Arthritis Foundation Singapore

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21 March 2013

Yes, it's time to review MediShield

I EARNESTLY encourage the Health Ministry to re-examine the pre-existing conditions clause for MediShield, while evaluating the role insurance should play in health-care financing ("What price peace of mind for Singapore's patients?"; March 13).

The exclusion clause limits the usefulness of MediShield for the most vulnerable.

My aged parents have no understanding of financial planning and, hence, lack proper insurance coverage that can insulate them from the large bills arising from repeated specialist and hospital visits for their chronic conditions.

It is too late for me to get coverage for them as their conditions will be excluded.

I am sure this is set to become increasingly common as the baby boomers age.

It is timely for the ministry to review the MediShield scheme as part of the health-care financing framework, taking the opportunity to strike a better balance between helping those who have fallen through the cracks, and safeguarding the interests of other Singaporeans.

The ministry may consider the moratorium underwriting approach, where pre-existing conditions without any claim for a certain number of years will be accepted.

However, we must be careful not to impose more onerous conditions, such as automatically excluding common critical illnesses, in return for such coverage.

I understand that the clause is in place to keep premiums in check.

If my suggestion results in a large rise in premiums, the increased health-care funding can go into Medisave accounts to pay for them, with larger top-ups for the lower-income groups.

In fact, this is more cost-effective than increasing direct subsidies, as the money is risk-pooled and can be invested as a fund to increase its value.

Also, as an individual's income tends to increase and peak in his 40s before declining, the ministry may want to consider shaping premiums in a similar manner to encourage prudence and reduce the financial stress on Singaporeans in their twilight years.

Koh Tze Hock

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16 March 2013

MediShield should be more inclusive

I HAVE had lupus since 1988, when I was 17. This led to kidney failure in 1989. And when MediShield was introduced as a national insurance scheme the next year, I was denied coverage ("What price peace of mind for Singapore's patients?"; Wednesday). I had an organ transplant in 2000 and have been doing well since.

I have appealed to the Health Ministry to review the cases of "uninsurable" people like me, who were still teenagers when MediShield was introduced. It was through no fault of ours that we became burdened with a chronic disease.

Each letter I wrote was met with a rejection based on the increased costs of insuring people like me. I was told that the 3Ms - Medisave, MediShield and Medifund - were in place to help people who could not afford medical treatment.

But that is not the point.

I am gainfully employed and can pay the premiums to be included in MediShield. I do not need handouts and will not seek help from Medifund, and perhaps deprive a more needy person of financial assistance.

But no matter how much I explained, I always got the same answer from the ministry.

Thus, I cannot understand what the Government means when it says it wants to be inclusive, yet repeatedly overlooks a segment of people that needs insurance the most.

If the cost is too high, even with risk pooling, how can the affected people manage on their own? Yet, again and again, I am pointed in the direction of social welfare.

I really hope to see changes to the Government's MediShield policy within my lifetime.

Linda Woo (Ms)

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27 March 2013

HEALTH-CARE FINANCING; Review will be forward-looking

WE REFER to Professor Feng Pao-Hsii's letter ("3Ms are outdated, says professor"; last Thursday), as well as several other letters on health-care financing.

Medisave helps patients save up for their future health-care needs, while MediShield provides Singaporeans with insurance coverage for catastrophic illnesses. And Medifund offers direct financial assistance to needy patients.

The 3Ms framework, together with heavy government subsidies at public health-care institutions, has served us well so far, by keeping our overall health-care costs low while delivering good outcomes.

Nevertheless, the demographic of the population and our health-care needs will change significantly going forward.

The Ministry of Health is therefore undertaking a fundamental review now to address future challenges, particularly that of an ageing population profile.

We understand the concerns of Prof Feng, Dr Leong Choon Kit ("Prevention key to lower costs"; Monday), Mr Koh Tze Hock ("Yes, it's time to review MediShield"; last Thursday) and Ms Linda Woo ("MediShield should be more inclusive"; March 16), and thank them for their feedback.

We continue to welcome suggestions as we undertake the review to strengthen our health-care financing framework. Those who wish to share their views can do so via the Ministry of Health's Our Singapore Conversation channels (MOH_OSC2013_myviews@moh.gov.sg) or write to MOH_info@moh.gov.sg.

Bey Mui Leng (Ms)

Director, Corporate Communications Ministry of Health