Dr Lam Pin Min: “Front-load healthcare premiums, but...”

Dr Lam Pin Min, the chairman of the Government Parliamentary Committee (GPC) for Health, talks about the new measures to make healthcare affordable to all that were announced at the National Day Rally, and the challenges of implementing the new national medical insurance scheme, MediShield Life.

Q: People have commented on the timing of your GPC report.

We did not want to clash with the release of the OSC (Our Singapore Conversation) report, which was going to receive major publicity. After it was released, we realised there was a window period till the rally. I reckoned that was the ideal time to submit our report to the Health Ministry.

Q: How convinced are you that it's a big shift, as the PM said, for healthcare?

It is a fundamental philosophical shift in healthcare financing by the Government. The current philosophy is that of pragmatism, eclecticism and personal responsibility. The fundamental shift entails the Government taking on a bigger role in providing that social safety net and extending a bigger helping hand to Singaporeans' healthcare needs.

Q: Is this shift enough to put to rest the sentiment that Singaporeans can afford to die, but can't afford to fall ill in this society?

This is always work in progress. The Government needs to carefully titrate the policy tweaks to meet the healthcare needs of Singaporeans and to ensure that our healthcare financing policies remain relevant. However, we should not go down the slippery road of excessive and extravagant spending so much so that it becomes financially unsustainable in the long run.

Q: There's going to be public consultation for MediShield Life. What are the challenges?

One is that of the affordability of the premium. How much increase is fair and manageable for the majority of Singaporeans?

Secondly, how much coverage is necessary and sufficient? You can strengthen MediShield to cover very expensive bills, but that will result in significantly higher premiums. Like what PM mentioned in the Rally, Ministry of Health has combed through all the cases, and those cases where patients incurred really big bills and are unable to afford them, are far and few between.

If the increase is too excessive, low-income and elderly Singaporeans will definitely find it difficult to manage. One way is to seriously consider Dr Amy Khor's (Minister of State for Health & Manpower) proposal to front-load the premium.

However, we need to explain to Singaporeans the concept and rationale of front-loading. Younger working Singaporeans can pay higher premiums so that when they grow old and are retired, the premium quantum can be lowered to a more manageable level. It's like front-loading for your own policy in the future.

At the end of the day, insurance is about risk-pooling. Everybody pays into a big pool and you subsidise one another. About 8 per cent of Singaporeans aren't covered by MediShield due to pre-existing illnesses or for other reasons. MediShield Life will include them, many of whom are in the higher-risk group.

I hope the Government will step in to assist, so that the premium will remain manageable for this group. This leads us to the Pioneer Generation Package which PM announced. I'm looking forward to the details.

Q: How will you sell the higher premiums to young people?

When Dr Khor suggested front-loading, she did receive positive feedback from the public, in particular younger Singaporeans.

Q: But how representative is this group? How confident are you that the Government can persuade them?

I don't think I want to jump to this conclusion prematurely. We should await the ministry's consultation process to gather more suggestions and feedback on the acceptabililty and feasibility of this proposal.

Q: Risk pooling and front-loading only works if MediShield Life has enough young and healthy people. With an ageing society and declining fertility, fewer young people will support a fast growing number of elderly. Will premiums have to go up by a lot later? Will the scheme be sustainable?

I see front-loading as a way of funding one's healthcare needs for the future. By paying higher premium when we are young, it allows the premium to be lowered when we reach retirement age. The challenge lies in the current pioneer generation whose Medisave savings may be inadequate to pay for their current MediShield premium. The Pioneer Generation Package comes in handy.

Q: A General Election is due in two to three years. How will it affect the timing and quantum of the premium increase?

I personally feel that the introduction of MediShield Life is a positive step in the right direction. It offers universal coverage and better peace of mind for all Singaporeans. However, I do understand the concerns of Singaporeans and I believe the Government will do its best to address these.

Q: What's your personal experience with patients struggling with paying bills?

One reason residents approached me is that they are not aware of existing schemes to help them.

They will often tell me: "I'm not going to see the doctor because I cannot afford to pay the bills." I feel extremely disturbed whenever I hear that.

My response to them is always: "Just go and see the doctor. After that, ask the doctor to refer you to the medical social worker. They will be able to help you pay for the medical bills through Medifund."

The fact that they are in financial difficulties and genuinely cannot afford the medical bills would mean that they can qualify for some form of assistance.

Communication with regards to various assistance schemes has to be strengthened so that Singaporeans are aware of the schemes out there to help them. It will allay their fears about falling ill and not being able to pay for their own medical bills.

Q: Given that prevention is better than cure, how do you keep healthy?

Whenever possible, I will go to the gym to exercise, hopefully two, three times a week. I will do some weights training and brisk walking on the treadmill. I don't run very much because I don't like running. It's tiring and I don't really like to sweat a lot. I prefer swimming to running because it is less traumatic to the knees and ankles.