Cost emerged as a key issue at the MediShield Life committee's first feedback session with the public on Wednesday. This is predictable for a number of reasons. First, people worry about ever-rising medical bills as salaries, facilities, procedures, equipment and drugs exert a constant upward pressure on costs. Then, there is the perception that premiums are also influenced by insurers' expectations of certain margins of profit; and terms are framed to reduce their risk. How will policyholders be affected?
Worryingly, concerns over cost might sideline all other matters because of an insufficient grasp of what universal health coverage entails. Hence, it will be useful if committee chairman Bobby Chin can galvanise insurers to be more transparent about the calculations that determine premiums. The industry should also seize this opportunity to help educate the public about the economics of health care, as a broad spectrum of Singaporeans worry not just about premium costs but also the portion of the bill not covered by insurance, as a result of various exclusions.
Queries about pre-funding and cross-subsidies have been raised by people in the media. But there's much more, of course, to health-care financing. Educational efforts to separate myths from facts and to clarify the operation of co-payments, deductibles, co-insurance and such will help to make the forthcoming forums more focused and constructive. When the common aspiration is to extend health care to all Singaporeans without exception, it will be helpful if the sessions can bring to the surface the core principles of universal health coverage that matter to most people.
Such thinking would be in line with public sensibilities that health care should not be denied to anyone, including the least well-off members of society, even if legitimate differences might arise over the best means to secure that end. If the state picks up the tab for everyone equally, the cost burden on taxpayers would be intolerable. Thus, it is sound practice for state support to be devoted largely to those who cannot afford to pay. For others, it makes sense to pool risks and share costs equitably across the population.
Healthy lifestyles, always a matter of necessity, will gain urgency under any scheme that reflects a collective responsibility for health-care costs. Suggestions have touched on the possibility of using carrots such as no-claim discounts and tax reliefs to incentivise good health habits and encourage healthy lifestyles. These are worth considering.
If principles are aired thoroughly, the public will be in a better position to evaluate the specific proposals of insurers on how integrated medical insurance plans are to be affected by the new scheme.
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