By MP for Hougang SMC, Png Eng Huat
[Delivered in Parliament on 29 Jan 2015]
Madam, the proposed MediShield Life will address the fundamental issue of providing basic universal health insurance for all Singaporeans.
The transit from Medishield to Medishield Life may be a non-event for many Singaporeans due to transitional subsidies but for 2 groups of Singaporeans, those with pre-existing conditions and those with pre-existing medical benefits, the impact of the new health insurance scheme could be significant.
For Singaporeans with pre-existing conditions, it means a lot to be able to buy health insurance for their pre-existing conditions finally albeit at a higher premium. Medishield Life is taking a step in the right direction. I urge private insurers to ride on this and provide better coverage for those who need more benefits and to keep the additional premiums affordable since the underlying risk of covering someone with pre-existing conditions is already underwritten by Medishield Life.
As for Singaporeans with pre-existing medical benefits, the transition to Medishield Life may not be so straightforward. This group includes people with private medical insurance plans and pensioners.
For those people with private medical insurance plans other than the integrated shield plans, it does not make financial sense for them to over-insure themselves with Medishield Life. These Singaporeans should be exempted from the scheme. They can opt to join the scheme anytime or when their private insurance coverage ends since premium is calculated based on age, annual value of their home, per capita household monthly income and there is a 30 per cent loading on premiums for those with pre-existing conditions.
I can understand the Government does not want Singaporeans to be saddled with large medical bills if they are underinsured but this can be easily resolved by drawing up a list of approved private healthcare insurance plans in lieu of Medishield Life that would qualify Singaporeans for exemption.
Next, the impact of Medishield Life on the 32,000 pensioners needs to be spelt out clearly. The last time I spoke on this issue, I asked that these pensioners be given an option to opt out of Medishield Life as well. Although the Health Minister has assured this House that pensioners will not be worse off, I will repeat my call for pensioners to be given this option for good reasons.
In a news report last July, the Public Service Division has announced that 40 per cent of these pensioners who are currently receiving 1 per cent additional Medisave contribution will get another 1 per cent when Medishield Life starts. This will certainly help pensioners who are on the Comprehensive Co-payment scheme (CCS) cope with the transition to Medishield Life.
In the same report, it was mentioned that ‘the other 60 per cent of the pensioners who are on older medical benefits schemes, which already provide better coverage than what Medishield Life will be providing,’ will have their premiums for Medishield Life paid by the Government. The reports said PSD will be writing to pensioners with more details on Medishield Life by October 2014.
Madam, I wish to ask the Minister to share with this House the impact of Medishield Life on this group of pensioners whom PSD had said are currently receiving better coverage than what Medishield Life will be providing.
Apart from paying the premiums for these pensioners and their spouses, what about the deductible under Medishield Life that they have to bear now?
For pensioners under the Fixed Amount of Ward charges scheme (FAW), their public hospital bills are capped at $8 per day. Would these pensioners and their dependents be paying the same rate under Medishield Life?
For pensioners and their dependents under the Co-Payment on Ward charges scheme (CPW), their co-payments for ward charges are capped at 20 per cent and 50 per cent respectively. So for a hospital bill of $2,000 for example, these pensioners only need to pay $400 for themselves. How much would these pensioners being paying under Medishield Life since the deductible for Class C ward is already $1,500 for policyholders aged 80 and below?
How would Medishield Life be better for these pensioners when PSD has acknowledged that it is not? And why would the Government want to go to great lengths to match the benefits of Medishield Life with what the pensioners are currently receiving when a simple solution is to let them remain status quo.
The Medishield Life Review Committee report has made reference to the Swiss experience on health insurance. The Swiss has mandatory health insurance but there are exemptions allowed for good reasons. Likewise, our Medishield Life Scheme should also allow exemptions especially for pensioners and for very good reasons.
One, pensioners have an existing ecosystem in the government catering to their needs including a comprehensive Medical Billing System for participating medical practitioners to file medical claims so that pensioners and their dependents do not need to pay the full fee up-front.
Two, this group of pensioners will never grow in numbers. Their percentage share of the insured pool is negligible and shrinking at the same time. Would it be so difficult to let this group of pensioners remain status quo and run its course?
I urge the Ministry to consider implementing exemptions for Medishield Life for these selected groups of Singaporeans as highlighted.