MediShield Life: How the Shield was forged

PHOTO: MediShield Life: How the Shield was forged

SINGAPORE - It took seven months, 36 focus-group discussions, considerable burning of the proverbial midnight oil and some fireworks to produce the 116-page final report on MediShield Life.

And the only things the MediShield Life Review Committee chairman Bobby Chin is sure of, he says, are that "the journey has been very tough" and that the final report "does not deliver everything people want" - but is what he and his committee felt was best for all Singaporeans.

Delivering everything people wanted would have been impossible, says Mr Chin, former managing partner of international accounting firm KPMG Singapore and a member of the Council of Presidential Advisers.

The 1,700 people who attended discussions or sent in their views had asked for everything under the sun - reducing or removing deductibles (the portion people have to pay before insurance kicks in), better benefits, no-claims bonus for those who keep healthy, lower co-payment (the patient's share of the bill on top of the deductible) and even death benefits.

"Every single benefit affects premiums," says Mr Chin, and a prime directive was to ensure that premiums remained "affordable".

The 11-member committee comes from a mixed background, with only four with financial experience. The others include heads of hospitals, the labour movement and big business as well as grassroots leaders and welfare practitioners.

So most had a steep learning curve to educate themselves before they could contribute meaningfully to discussions."There was a lot of personal reading up. But within a month, everybody was up to speed," says Mr Chin.

Ms Janet Ang, managing director of computing giant IBM Singapore, recalls: "We needed to read up, but the (Ministry of Health) secretariat was very effective in getting experts to brief us." This included getting academics to talk about how other countries do it.

"All in all, I probably spent close to 100 hours working with this committee," she says, adding that she had put this work as "high priority" and tried to attend as many sub-committee meetings and public forums as possible.

Lawyer Abdul Rohim Sarip, who also spent close to 100 hours on this, says: "There was nothing easy about this job. One has to do lots of reading, firstly to understand the complex health-care system, to make sense out of all the policy decisions, and then to make recommendations."

He adds wryly: "I can say that I spent more time in this one committee in seven months than in all other committees I sit on in a whole year! And I sit on many committees."

The review committee was supported by a 23-member Ministry of Health (MOH) secretariat that provided information, did the number-crunching, typed up reports - and provided breakfasts, snacks and drinks at the 30 meetings held over weekends and evenings. This was on top of the 36 focus-group discussions. Says Ms Sinni Lim, assistant director of finance policy at MOH: "After seven months, we know the coffee preferences of the members."

Friction is inevitable with such intense work, but everyone involved is being diplomatic about it, now that it's a wrap.

Dr Tan See Leng, group chief executive officer of private hospital group Parkway Pantai, reveals: "There were many heated debates and constructive proposals which warranted long hours of consideration and discussions. There were also varying viewpoints but the bonding and camaraderie were exceptionally strong."

Mr Rohim recalls: "Some issues, we agreed on immediately, unanimously. But for some, there were strong debates, even arguments."

Mrs Oon Kum Loon, who is on the boards of shipping conglomerate Keppel Corporation and Singapore Power, describes the sessions as "robust", while Mr Patrick Lee, chairman of apparel manufacturer Sing Lun Holdings and Kwong Wai Shiu Hospital, says: "We had several healthy disagreements and debates."

From the secretariat, MOH's principal finance policy specialist Lee Shiao Wei says: "They did not take anything at face value, (and) were rigorous in scrutinising data, policy rationale and arguments for each proposal."

The CEO-level nature of the committee members' backgrounds proved a factor, with Ms Lee noting that individually and as a group, "this committee brings together a formidable combination of expertise and competencies. They would not simply 'accede'". But she adds that they were not "unreasonable".

Says Mr Chin: "We challenged them. We considered alternatives. We are people of standing. While they (secretariat) offered their views, ultimately, the decision rested with the committee. We must feel comfortable."

Mr Chin says the committee took a "building block" approach, as though building a house. It started by looking at the benefits it wanted, then at the other areas.

"After finishing the design of the house, we asked ourselves, 'Can we afford to build it?'" he says. The answer was "No", as having everything means premiums would go through the roof.

One of the first things dropped was the suggestion of removing or reducing the deductible, which committee member Diana Chia, president of the labour movement, had fought hard for.

The committee had not accepted the secretariat's word that it would be too expensive, and insisted on seeing the numbers. It was a subject of major debate, until the numbers were produced to show how even the slightest change has a huge impact on premiums.

"Then the decision was not difficult," says Ms Ang.

Reducing or removing the deductible - which currently starts at $1,500 a year (the deductible is cumulative, so once it is exceeded, insurance covers 90-97 per cent of the rest of the bill) - will mean that insurance would cover even small bills. Says Mr Chin: "We always reverted to the fundamentals of the scheme, which is peace of mind for large bills. Most people can afford the small bills."

The argument that convinced the committee was that deductibles are paid only by people who are sick, but premiums are paid by everyone, every year.

In fact, one member of the committee actually suggested raising the deductible to make premiums more affordable.

Another thing that was discussed and dropped was giving a "no-claims bonus" to people who stayed healthy and out of hospitals - the same way car insurance does. It sounded good, until the committee found that the vast majority of people would qualify, as only a fraction of the four million people eligible for MediShield Life would make claims.

Mr Chin says that in the end, everyone agreed that it didn't make sense as "you will have to pay higher premiums to pay for your own no-claims bonus".

But they did not just accept the secretariat's assurance that it would be too expensive. The intensity of the discussions meant some tense situations. When asked if it was true that he actually did not turn up for a meeting with MOH because he was upset, Mr Chin smiles, pauses and would only say: "In a way, it shows the independence of the committee."

He would not elaborate on what exactly happened or what had upset him. Indeed, now that the report is out, the committee is all praise for the support it received from the secretariat.

Parkway's Dr Tan says: "The secretariat was the most productive team I have worked with and they often worked into the wee hours of the morning turning around our suggestions and incorporating our feedback, including providing answers to some of the committee's difficult questions."

But as anyone on the committee will also admit, there is the next tough hurdle: The Government's job of getting buy-in and explaining the new scheme and all its fine print is only just beginning.