Thumbs up for MediShield Life

How far will the proposed new MediShield Life scheme address concerns about rising healthcare costs in an ageing population? What other healthcare financing issues remain to be tackled?

Jean-Michel Dumont
Chairman
Ruder Finn Asia

THE key healthcare challenges today relate largely to expanding capacity and developing a system to meet the demands of an ageing population. The new MediShield Life Scheme, keeping premiums affordable for all Singaporeans, shows that the government is taking on more of the risks and the necessary costs of the increase in healthcare capacity and manpower. This is a good first step and should lead to consideration of other healthcare financing issues. Premiums need to be affordable and still fully payable within Medisave withdrawal limits and contributions.

The frail and disabled elderly and their caregivers need financial relief for the costs of hospitalisation and outpatient treatment. The costs involved in caring for the elderly who may require assistance with their daily activities need to be addressed. The current support for long-term care is mainly through means-tested subsidies and this may not be an accurate reflection of current needs. Middle-income families may be stretched, especially if there are several dependants requiring financial aid.

Christophe Duchatellier
CEO
Adecco Asia

WE applaud the new MediShield Life scheme as it certainly addresses the rising healthcare costs in an increasingly ageing population. These new proposals answer the needs of the elderly and the financially dependent. Perhaps we can also rethink the way we look at medical assistance here in Singapore.

Suggestions would be to allow earlier withdrawals of the funds for various medical needs which also include outpatient treatments.

While priority would be for the elderly, we should consider letting younger Singaporeans have the option to also use their available funds, perhaps by implementing internal limits to the amount they can use. The costs of medical care are rising and it is a real concern for many Singaporeans, young and old. Several discussions have taken place and it is heartening to note that this is a priority for the Singapore government.

Dora Hoan
Co-Chairman/Group CEO
Best World International Ltd

THE proposed MediShield Life scheme will go very far in protecting a majority of Singaporeans against large medical bills. They will also have peace of mind if they live beyond the age of 90. Nevertheless, there are some who may be concerned about the cash payment for the premiums, especially those who do not have a CPF account. Allowing their family members to buy MediShield Life for them can help to alleviate their concerns. While the scheme is highly beneficial, it does not cover health screening.

As early detection and treatment can save lives and prevent big medical bills in the future, perhaps the government can consider allowing Singaporeans to use their Medisave funds for this purpose. Alternatively, insurers can give rebates in the form of health screening vouchers to those who do not make any claim. This will not only help to reduce costs but also encourage Singaporeans to take good care of their health.

Khoo Kah Siang
CEO (Singapore)
Great Eastern Life

GREAT Eastern supports the recommendations by the MediShield Life Review Committee which provide greater protection for all Singaporeans. We look forward to working closely with the government, the health sector and other stakeholders to bridge the protection gap.

The Integrated Shield Plan (IP) is a good complement to MediShield Life for those who want enhanced benefits such as coverage for stays in Class A/B1 of restructured hospitals or wards in private hospitals.

Although it is premature at this juncture to comment on specifics, Great Eastern is committed to ensuring that our IP plan remains competitively priced and affordable for all.

It is worth noting that premium rates are calculated based on future consumption trends, medical inflation rate and past claims experience. The pricing of IP plans is predominantly driven by the costs of medical healthcare, which include doctors' charges, hospital charges and drug fees, all of which are beyond what insurers alone can effectively control.

In this regard, greater public awareness and education is needed that the public has a key role to play. Each of us must take personal charge of our health and take personal responsibility to reduce over-consumption of healthcare services so that costs can be controlled. It is also important to start saving up early for future healthcare needs.

Now is also an opportune time to review the utilisation of all forms of medical facilities and services, as well as look at innovative models in healthcare provision, to enhance system efficiency and ensure that overall medical cost inflation is well contained.

Ultimately, as responsible insurers, we need to look at how best to contain costs to make IP plans affordable in the long run as well as provide value-added services to customers to further differentiate IP plans from the basic MediShield Life.

Ng Wai Chong
Medical Director
Hua Mei Centre for Successful Ageing (Tsao Foundation)

IN the course of Tsao Foundation's work that supports ageing-in-place in the past 21 years, we find that our elders are worried about healthcare costs and about being a burden to their children.

While MediShield Life focuses on hospital care, a great deal of our elders' concerns are about day-to-day costs of care that escalate with increasing frailty in later years. It is challenging for them to fully comprehend the details in the plethora of relief schemes and social resources in order to help themselves. Either the schemes have to be designed to be more user-friendly, or there must be easy access to community care management services.

In addition, although the lower cost of hospital and specialist care is helpful for disadvantaged elders, it may not be sustainable in the long run. There is still an urgent need to ramp up primary care.

Mike Muller
President, Asia Pacific
Avaya

SOARING healthcare costs impose enormous pressure on governments, healthcare providers and consumers due to issues related to an ageing population (many with chronic diseases), the cost of care-givers, imbalanced access to care and disruptive technologies.

From a holistic perspective, the goal is to provide quality healthcare to all Singaporeans. Besides financial aid, subsidies and increasing premiums based on affordability, the government can also consider technologies and innovations that help improve the quality of care, reduce costs and, most important, improve patient outcomes.

We are working with healthcare providers in Singapore and across the region, looking at a combination of programmes and initiatives which have the ability to make a significant difference in all these areas. These include technology to support:

(1) Proactive patient outreach: to improve patient outcomes and increase public awareness;

(2) Workflow automation: to reduce process inefficiency and deliver cost and time savings, resulting in faster response to patient needs;

(3) Mobile collaboration: equip staff with next-gen communications capabilities that help accelerate all aspects of care-giving;

(4) Telemedicine: helps remove geographic barriers and make care available to all;

(5) Big Data analytics: to help anticipate macro trends and accelerate individual diagnosis; and

(6) A secure, flexible and reliable network infrastructure: the backbone of effective 21st century healthcare provision.

Laletha Nithiyanandan
Managing Director
Talent Design Potential

I BELIEVE the enhanced benefits will address previous concerns with regard to healthcare costs. The result of higher premiums is a small price to pay, particularly considering that the government will provide assistance. As an employer, the one percentage-point increase in Medisave contributions can amount to quite a significant cost. On the flip side, however, employers could end up paying a lot more than this one percentage-point in employee health costs, with an ageing population.

The advantage here is that insurance tends to give us collective savings on costs; also, knowing this now gives us (both employers and individuals) lead time to start planning. I believe that we can further ease the rising costs by using this as an opportunity to encourage preventive care - for instance, going for check-ups earlier or promoting healthy living and health improvement nationwide.

Instead of preparing for large hospital bills, we can attempt to minimise the chances of getting warded. By promoting a healthier lifestyle and creating a healthier nation, we lower the general hospitalisation rate and, eventually, premium rates as well.

Lance Tay
Chief Executive Officer
Tokio Marine Life Insurance Singapore

DEVELOPED countries like Singapore are faced with a common challenge - providing affordable healthcare and adequate coverage to an ageing population. While MediShield has been effective, the proposed MediShield Life is more nimble as it considers the needs of lower and middle-income families. Changes include raising the annual claim limits and lowering the co-payments for increasingly common procedures such as chemotherapy, so one can afford large medical bills.

Out-of-pocket expenses will also be minimised because of higher claim limits. With the various subsidies and increased funding support for the lower income group, MediShield Life will help cushion the impact of rising healthcare cost.

The recommended changes to MediShield means some parts of the bill originally covered by the integrated shield plans are now within the scope of MediShield Life. It will be interesting to see how this pre-funding model works out when affordability remains a key concern.

Healthcare cost has seen an inflation of 160 per cent in 30 years (1983-2013) - the highest among all categories measured, for example education, housing and transport. With the more comprehensive coverage of MediShield Life, over-consumption of healthcare services may happen and that could further raise healthcare costs.

This means healthcare affordability in the long term can be a concern, which may lead some people to downgrade their health insurance plans when they are older. This is obviously not advisable. At Tokio Marine Life Insurance Singapore, we understand that healthcare financing is also about ensuring you have adequate funds to cope with rising healthcare costs.

Hence, ensuring a lifetime retirement income stream by having suitable retirement insurance products can help ease the financial burden.

Lim Soon Hock
Managing Director
PLAN-B ICAG Pte Ltd

THE proposed new MediShield Life scheme certainly goes far enough on the supply side, to address concerns about rising healthcare costs in our ageing population. However, government, businesses and individuals will now have to focus more on the demand side, to ensure that all three key stakeholders will not be overly taxed in funding the scheme. It starts with individuals taking greater personal ownership of their health and wellbeing, especially those with chronic illnesses.

I would even advocate that those who cannot be insured and who will now be covered by MediShield Life, commit to taking steps to manage their chronic health conditions. The government can help by facilitating, for example, comprehensive nationwide telehealth services. Such services have proved to be effective in chronic disease management, wellness management, care for the aged and help for care-givers, in addition to triage management, in countries such as Australia and New Zealand.

Businesses must entrench work-life balance in the workplace more than ever, to ensure that employees do not fall ill as a result of excessive work stress. The government has been magnanimous as the single largest contributor to this new MediShield Life scheme.

The ball is now in the court of businesses and individuals to play their part. I contend that when businesses truly practise work-life harmony, that extra Medisave contribution can be kept within the proposed one percentage point, if not reduced.

When more individuals take personal ownership of their health, the demand on healthcare (and, hence, healthcare cost per capita) can be better managed and funded. What is clear is that government, businesses and individuals can and must play their respective parts responsibly and collaboratively, to balance demand and supply of the new MediShield Life scheme.

It is an imperative that must be achieved to avoid opening a Pandora's box in healthcare financing.

Chris Comer
CEO
Castlewood Group

THE newly enhanced MediShield Life scheme is a welcome and much needed change due to the evolving needs of our nation. As with any change in policy or government direction, we should anticipate that some critics will challenge the increase in premiums versus the increase in benefits.

The government must take these factors into consideration when educating Singaporeans on the wide scope of benefits and offer complete transparency into the running costs of the scheme. Educating people on why changes need to be made will also help the younger generation understand the importance of forward planning for retirement.

What we, as a nation, have to remember is that these socio-economic changes are unprecedented and this first step to tackling the ageing population issue will most certainly not be the last.

While the government has done right to take on a lot of the associated costs with the various subsidies, employers will also be responsible for increasing employee contributions. Companies operating here must support the growing needs of their employees.

At Castlewood Group, the health and economic wellbeing of our staff is paramount to us. However, recently employers seem to be bearing the brunt of various changes to regulations. As a company, it is our responsibility to support our employees but the government must take into account the ever-rising costs of operating a business in Singapore.

While it might be sustainable for some businesses to take on these costs right now, how long can this last?

By all means, the government has made the right decision to tackle an issue that is at the forefront of the minds of most Singaporeans. But I don't see this being a complete solution as there are a number of factors that need to be considered aside from medical bills alone.

Annie Yap
Managing Director
AYP Associates Pte Ltd

THE new MediShield Life is a welcome change, especially when it provides coverage to Singaporeans with pre-existing illnesses. It is almost near impossible for people with pre-existing illnesses to look for insurance coverage. However, with MediShield Life, it will help ease the burden for these people. Moreover, given the rise in the cost of medical services as Singapore faces an ageing population and the enhanced coverage under MediShield Life, the higher premiums are justified to ensure that bills can be fully subsidised.

As our lifespan increases, MediShield Life eases concerns about the lack of savings to cope with medical bills in our twilight years. Another issue that the government can consider is possibly hedging against inflation to ensure that the premiums paid remain sufficient against claims.

Thirumalai Chandroo
Chairman/CEO
Modern Montessori International Group

WE have one of the most stable healthcare systems around. The measures undertaken now are a rehaul towards making medical healthcare more affordable for Singaporeans. With a growing ageing population it is pertinent to prepare for increasing medical expenses now rather than later. As with any policy there will be areas of concerns that some may have such as affordability for the premiums. It also raises the issue of rising costs for employers; this may result in more Singaporeans getting lower salaries in some industries.

All societies have to make choices between how generally to provide access to fundamental and advanced healthcare, how much to pay for healthcare and how much and which innovations to make available to their people. These very likely have to be efficient and affordable. Better treatments simply mean higher costs; hence, I feel it is the balance between advanced medical treatment and affordable healthcare that Singaporeans are striving for. Larger withdrawal amounts from the Medisave will prove extremely useful only for the elderly who may live alone and require heightened medical care. As an employer, I believe it is important to also look at cost for patient-centric care in time to come, and educate Singaporeans on wellness and prevention of major illnesses to reduce the need for acute care later on.

Robin C Lee
Group COO
Bok Seng Group

WHILE Singaporeans are living longer, for many, it may not necessarily be more good years of healthy living. Indeed, as one lives longer, the cost of maintaining and sustaining one's life will inevitably escalate. Living in a country that has one of the highest cost of living in the world does not help either. Fortunately, the entire medical scheme put forth by the government thus far is a move in the right direction to ensure that Singaporeans receive the proper healthcare they need.

What we need to do now is to focus on mandating a healthy lifestyle and not merely encouraging it. By that, I mean we should abstain from habits such as over-consumption of unhealthy food, smoking and vices that may hurt our body.

As we live longer, we want to do so in a fulfilling way and not just clock the years. Health is thus of utmost importance to every one of us. In my view, I think the government should pick up the medical expense tab for any citizen above the average age of, say, 84 years for women and 82 years for men. I feel that due to the rising costs of healthcare at that age, the government could really lend a helping hand to those most in need.

But it is imperative to note that medical subsidies address only the problem, but not the root of the problem. Medicine alone is not enough to ensure a healthy and fulfilling life; it must also be accompanied by a healthy outlook in life, both in practice and mind.

David Leong
Managing Director
PeopleWorldwide Consulting Pte Ltd

THE new shift in healthcare financial framework is significant in that it allows for larger claim sums, has no limit on claims over one's lifetime and co-payment sums are substantially reduced. These were the bugbears of the old MediShield regime. As Singaporeans age, cost of medical care and medical consumption will tend to increase.

More allowable coverage for outpatient treatments should be included and Singaporeans should not have to worry about the rising costs of care and prescriptive medicine. So long as the medical care and prescriptions fall within the ambit of geriatric medicine, claims should be considered, and it will be helpful if the framework can highlight and make known the areas of coverage. With MediShield Life, healthcare coverage will be deeper and more inclusive. The increase in premiums will not hit hard as there will be top-ups and case-by-case reviews. An open assurance by the government will put hearts at ease.

Ronald Lee
Managing Director
PrimeStaff Management Services Pte Ltd

ONE of the biggest concerns among Singaporeans is the rising cost of healthcare and, in particular, the fear of being slapped with a hefty medical or hospital bill in one's later years as critical illnesses such as cancer become more common. The proposed new MediShield Life scheme will help to alleviate this concern, as the insurance will cover a higher claim limit while patient co-payments will also be reduced. Under this scheme, pre-existing illnesses will also be covered and all Singaporeans will enjoy lifetime coverage. These are great strides forward. But if the enhanced scheme - with higher premiums - is made compulsory, what will happen if a person's Medisave funds run out? Over the course of time, the compulsory payment of higher premiums means that the person's Medisave savings will diminish and perhaps run out, especially for a retiree. If the person is a housewife or only able to work part-time, there may not be much in the Medisave account to begin with. What if these people do not have family members who can help top up their Medisave accounts? Would their coverage cease entirely?

These are practical considerations that the public needs to be aware of but such details will only be released at a later stage. Besides hospital bills, another area of concern is the growing need for long-term care in the future. Today, couples are generally having fewer (if any) children and there is a higher percentage of singles who simply don't wish to get married. Decades from now, there will be greater demand for nursing homes and assisted living facilities, which will be costly.

As a nation, how are we preparing for that and will our citizens be financially prepared for such heavy expenses in their golden years?

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