Watch out for rising health-care costs, say MPs

SINGAPORE - Many places with promising health-care systems have found themselves struggling with high costs and Singapore should not go down that road with MediShield Life, several Members of Parliament cautioned yesterday.

From Taiwan to Britain, the MPs noted, health-care costs are rising and the schemes are "surviving on borrowed time".

Dr Chia Shi-Lu (Tanjong Pagar GRC), chairman of the Government Parliamentary Committee for Health, said that social public health systems such as those adopted in Hong Kong or Britain appear attractive as most medical services are practically free.

But such systems are very expensive to maintain, he said, and can also be very inefficient.

Non-emergency services and highly specialised care can be quite severely rationed and of uneven quality, he said.

This has created "dual track systems" where private medical services are increasingly in demand and command higher fees, and also a problem of over-coverage.

Several MPs also pointed to Taiwan's National Health Insurance (NHI) scheme as a warning against overconsumption and how costs can spiral out of control.

Started with much fanfare in 1995, the NHI scheme sank into deficit four years later, "and has been sinking ever since", said Dr Chia.

Unlike MediShield Life, the NHI also covers outpatient care. This has encouraged patients with minor ailments to visit doctors often instead of self-medicating, and many were prescribed antibiotics even when they did not need any.

This has led to Taiwan having one of the highest numbers of clinic visits in the world per capita, and also high antibiotic resistance due to the overuse of these drugs.

Ms Tin Pei Ling (Marine Parade GRC) noted that these problems have led to the Taiwanese government having to borrow from banks to fund the NHI scheme.

The financing gap is widening in Japan too, she added.

In the United States, the national insurance programme known as Medicare is also fast becoming "unsustainable" because enrolment is growing faster than the economy.

Given these concerns, Non-Constituency MP Yee Jenn Jong and Dr Chia urged the Government to set up an independent panel to evaluate the cost-effectiveness of treatments before reimbursing them.

Britain's National Institute for Health and Care Excellence also evaluates the cost-effectiveness of treatments, Dr Chia said.

Health Minister Gan Kim Yong gave the assurance that financing would be kept sustainable through co-payments, where citizens foot part of the medical cost.

kashc@sph.com.sg

This article was first published on July 9, 2014.
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