Parliamentary Debate on MediShield Life Review Committee Report – Speech by Senior Minister of State Dr Amy Khor

Preamble

1.      Madam Speaker, the recommendations put forward by the MediShield Life Review Committee led by Mr Bobby Chin were the result of intensive deliberations and consultation with the public.

2.      These are important recommendations that will ensure that MediShield Life is designed to provide better lifelong protection for all Singaporeans.

3.      The Committee also called on the Government to step up outreach and public education efforts on healthcare finance.

4.      I would like to say a few words about how we intend to help Singaporeans achieve a better understanding of our healthcare financing system and, the impact the recommendations of the MediShield Life Review Committee will have.

Insights from the Committee’s public engagement efforts

5.      More than 1,500 Singaporeans shared their feedback and concerns about health insurance and MediShield Life with the Committee over the past seven months. Many had personal stories and experiences to share about the healthcare system. 

6.      Some had benefited, and explained how subsidies and insurance helped them pay for their bills.  Some came with the view that insurance was not useful, until they realised through the discussions that they were the lucky ones who had not fallen sick.  I was encouraged to know that most of them left the focus groups with a better understanding of how insurance can protect them against large hospital bills.     

7.      What was clear, however, was that many Singaporeans only have a very rudimentary understanding of the healthcare financing system. As Ms Ellen Lee mentioned, many Singaporeans do not fully understand how Government subsidies, Medisave, MediShield and Medifund work together, to keep healthcare costs affordable. To be fair, the issues are complex and require effort to grasp.  Most Integrated Shield Plan policyholders also do not understand how MediShield and Integrated Shield Plans work together.  Questions raised through the media, dialogue sessions and via online channels such as the MediShield Life and REACH microsites after the release of the Committee’s Report further indicate the lack of knowledge of how the system works.

Lessons from the Pioneer Generation Package

8.      I would like to share some of my experiences with the Pioneer Generation taskforce, which I co-chair with Senior Minister of State, Mrs Josephine Teo.  The Pioneer Generation Package brings many benefits to our Pioneers and will give them stronger assurance about healthcare affordability. However, we have had to make major investments in outreach and communications in order to reach out to our Pioneers. 

9.      Our Pioneers are a very diverse group. Some did not have the luxury to go through formal education and might not be able to even read or write.  Our Pioneers, whether they are Chinese, Malay or Indian mainly use dialect or their own vernacular  to communicate with their families and friends.  But at the other end of the spectrum, we also have Pioneers who are well-educated, constantly on Facebook, and want to know each and every aspect of the Pioneer Generation Package!

10.  Reaching out to our Pioneers has thus not been easy.  The taskforce has been innovating and experimenting with new communication means. 

11.  For the first time, as the House has heard earlier, we produced online videos in Hokkien, Teochew and Cantonese. I hear these videos have been well-received by the community, with the fortune teller Hokkien video, which was the first to be launched, having received a respectable 110,000 views by the middle of June.  Quite clearly, using such heartland languages strike a deep chord. The latest batch of videos has Pioneer Generation DJ. Brian Richmond, commentating on a soccer match.  In the video, a player receives a yellow card, but when the referee turns it around, it is actually a Pioneer Generation card! I actually thought it was quite funny, until I heard feedback that some Pioneers now think that the Pioneer Generation card they will receive is yellow in colour (or ‘Ng sek’, in Hokkien)! I would like to clarify to Members that the Pioneer Generation card is red and white, not yellow, and there is certainly no penalty associated with the PG Card!

12.  Critically, we identified that our frontline and service touchpoints are where we will interact with our Pioneers the most, and sometimes in their more vulnerable moments, when they are sick or seeking help. We have invested significant effort to train our hospital frontliners and engage our GP partners and ILTC providers. More than 1,000 healthcare frontline staff at the polyclinics and Specialist Outpatient Clinics in public hospitals have been briefed on the Pioneer Generation Package. We will continue to brief frontline staff at these public healthcare institutions up until 1 September, when the enhanced subsidies kick in.   Engagements with the GP community will also help spread the word about CHAS benefits under the Pioneer Generation Package.   We also intend to work closely with our grassroots, to adopt more targeted, face-to-face outreach through their networks. 

13.  So far, the feedback we have received about our outreach efforts for the Pioneer Generation Package has been positive, and we will adopt the learning lessons for MediShield Life. 

How MediShield Life will benefit the Pioneer Generation

14.  Soon, our outreach for the Pioneer Generation Package will be expanded to incorporate more information about MediShield Life and how the enhancements will benefit our Pioneers. 

15.  All our uninsured Pioneers today, estimated at 110,000, will have coverage under MediShield Life, including those who previously could not join because of the age cap. They will have greater lifelong protection against large hospital bills through the removal of lifetime claim limits and larger MediShield Life payouts.  Existing coverage exclusions, if any, will be removed, although they may need to pay a loading on their premiums.    

16.  The most important message we want all Pioneers to know is “You will pay less, for better protection. Your MediShield Life premiums will be lower than what you pay for MediShield today.” For the older Pioneers aged 80 and above in 2014, they will have their MediShield Life premiums fully covered through the MediShield Life subsidies and Medisave top-ups; they will not have to worry about whether they can afford the premiums. 

17.  To sum up, our Pioneers will spend less, yet get more value.

Integrated Shield Plans

18.  I will now speak briefly about Integrated Shield Plans.  About 60% of Singaporeans have purchased more benefits and coverage through Integrated Shield Plans (IPs).  One key focus of our outreach is to enhance awareness of how Integrated Shield Plans work.  Everyone who has an IP is already on MediShield, but not many people know this.  Today, these plans build on MediShield to offer greater choices and coverage for policyholders.  When MediShield Life is launched, the MediShield tier of Integrated Shield Plans will be replaced by MediShield Life.  In other words, MediShield Life will provide the ‘base’, Integrated Plans will provide the ‘icing’ on top. This ‘icing’ takes the form of enhanced benefits like better ward classes, and is provided by a private insurer.

19.  Many Singaporeans value the additional choices that IPs offer.  But they may not be aware that they are paying much higher premiums, which rise significantly with age.  In absolute dollars, the premiums for MediShield and IPs are fairly similar when the policyholder is young.  However, the premiums go up with age, and many realise this only when they are in their silver years, when premiums rise sharply and the Medisave Withdrawal Limit becomes insufficient, making it necessary to top up their premium payments with cash.   Medisave withdrawal limits are sufficient to cover MediShield and MediShield Life premiums.  But as IP premiums are significantly higher, the withdrawal limits are only able to help pay for a portion of the difference.   

20.  We will help IP policyholders understand how their plans work with MediShield Life.  With MediShield Life’s comprehensive benefits, Singaporeans with IPs might want to consider whether the ‘base’ coverage offered by MediShield Life is sufficient to meet their needs, or whether they still need the ‘icing’ on top.   A better understanding of how MediShield Life and IPs work is needed, in order to help Singaporeans make informed decisions about their healthcare insurance.   

21.  We will work with employers and union leaders through the SNEF and NTUC to help them better understand how MediShield Life and/or Integrated Shield Plans interact with existing employer medical benefits.  The eventual aim is to help workers understand better why the lifelong coverage provided by MediShield Life benefits them, and why it is important for them and their families to have portable medical benefits that last beyond a single employer. It will also help employers understand how they can start to think about restructuring their medical benefits, in ways that are cost-effective and beneficial for their employees.

22.  SNEF, NTUC and the Government have formed a tripartite work group to look at the issue of portable employer medical benefits, and the Government will consider strengthening incentives beyond the current additional 1% tax deduction on employee remuneration, for companies willing to provide portable medical benefits for their employees. These could be through employers providing additional Medisave contributions, or paying part or all of their employees’ MediShield Life premiums. 

Next steps for MediShield Life Communications and Outreach

23.  Madam Speaker, many members of this house have spoken about the importance of communications and outreach to prepare Singaporeans for the rollout of MediShield Life.  We will leverage on multiple communications and media platforms over a sustained period to raise awareness and understanding of our healthcare financing system.  

24.  First, as Ms Penny Low has pointed out, it is important to reach out face-to-face to Singaporeans, even into the heartlands, to communicate the benefits of MediShield Life and explain our healthcare financing system.  To do this, the grassroots are critical.  Over the next few months, we will hold a series of briefings for grassroots leaders across the island.  We hope that through this network, the general awareness of the various healthcare schemes and its benefits, amongst grassroots leaders will be enhanced, and they in turn will help us explain the schemes to their residents.

25.   Second, we will work closely with the private insurance industry.  As more than half of Singaporeans are on IPs, many depend on the touchpoints with their Integrated Shield Plan provider as key sources of information and advice on their health insurance coverage. Private insurers will take a more active role to explain details about MediShield Life to their clients, such as how MediShield Life and their IPs work together; as well as how IP policyholders will receive their subsidies.  This is so that their clients can make informed decisions on the appropriate plans that meet their needs and means.  MOH will work with the IP insurers to ensure responsible marketing of their products, including proper disclosure.

26.  Community organisations and self-help groups like CDAC, Mendaki, Sinda and the Eurasian Association can also be our multipliers to reach out to different communities of Singaporeans, including those who are non-English speaking.   We will be producing advertorials and interstitials in the mainstream media – print, radio and TV, and easy to understand collaterals to reach out to Singaporeans.   For those who prefer online platforms, we intend to use platforms such as the MOH and CPF websites, as well as the REACH micro-site on Medishield Life to reach out to Singaporeans.  We welcome other suggestions that Members may have as well. 

27.  The outreach efforts will be carried out in phases.  In the initial phase, the focus will be on the general benefits of MediShield Life and the healthcare financing system.  In subsequent phases, we will focus on more details like how Singaporeans will get their premium subsidies, how to make claims and more information on how IPs work with MediShield Life.  

28.  Our outreach efforts go beyond merely explaining the technical details of our healthcare financing system, which some may find difficult to understand or may not want to know.  It is also about clarifying misconceptions and giving assurance.  For instance, Ms Mary Liew and Ms Tin Pei Ling raised concerns about premium affordability for housewives and single parents, while Mrs Lina Chiam raised concerns about premium affordability after the transitional subsidies expire. Today, housewives who do not have any Medisave balance have their premiums paid by their husbands or working children.  For housewives from low to middle income families, they will be eligible for premium subsidies, which are a permanent feature of the scheme and cover up to two thirds of the population. So even after the transitional subsidies have ended, two thirds of the population from low to middle income will continue to benefit from premium subsidies. Government will also continue to top up Singaporean’s Medisave Account, for example through Workfare.  For the very needy, additional premium support will also be available.  Through a combination of targeted Government help and family support, they do not have to worry about premiums.  Just to reiterate and reassure Mrs Lina Chiam, no one will drop out of MediShield Life due to inability to pay.

29.  Additionally, we have from time to time to also clarify certain misconceptions such as that relating to pensioners that Mr Png Eng Huat spoke at length about earlier. In fact, for the pensioners, just last week, the Government has actually announced that they will help the pensioners with their MediShield premiums so that they will not be worse off. We need to clarify this misconception with pensioners and reassure them.

30.  Additionally, our communication effort is also about putting a human face to the message.  This will allow our fellow Singaporeans to know that help is at hand should they need it. Indeed, we hope that this outreach effort would lead to a  stronger community and  enhance our sense of “togetherness”.  This sense of collective responsibility and inclusiveness is truly at the heart of what Medishield Life aims to achieve.

Conclusion

31.  To conclude, I would like to say that the task of communicating MediShield Life effectively will be a challenging one, perhaps even more so than for the Pioneer Generation Package. But only when we succeed in getting our message across can we truly say we have taken heed and accepted the MediShield Life Review Committee’s observation that the Government needs to step up outreach and public education efforts on healthcare finance to enable Singaporeans to better plan for their healthcare needs. And we intend to do so.

32.   Madam Speaker, I support the Motion. 

END