Tackling Healthcare Inequality – Leon Perera
Mr Speaker sir, from a recent reply to my Parliamentary question, we now know that residents aged 25 years old with below secondary education have a life expectancy 5.8 years lower than that of those with post-secondary education. I thank the Minister for Health for that detailed reply. We also learnt that people with below secondary education have a greater likelihood of chronic diseases like diabetes, and high cholesterol.
Sir, for many of my lower-income constituents, convenient and cheap food options are unhealthy ones like instant noodles. Research shows poverty often overwhelms one’s cognitive ability to make good decisions about health. I thus speak on the urgent need to tackle health inequality.
It would seem that the prevalence of conditions like obesity, diabetes, hypertension and high cholesterol has risen over the years. Sir, I would suggest that there is an urgent need to revamp our preventive healthcare efforts, particularly for poorer Singaporeans. While many efforts have been undertaken, the outcomes seem to be moving in the opposite direction. To achieve better outcomes, we need better measurement.
Firstly, could we make public more timely and comprehensive data of chronic diseases by socio-economic group? Other than the response to my recent PQ, from what I understand, the most recent publicly available data on health risk behaviours and outcomes by socio-economic class was the 2010 National Health Survey. The National Registry of Diseases already collects data on the incidence of cancer and chronic kidney failure. It is an easy next step to include SES indicators like income and education. We must also study the entire life cycle of chronic diseases: are low-income groups contracting more diseases, more severe diseases or even earlier diseases?
Secondly, can we make more data public on healthcare outcomes for low-income groups? Are they receiving a later diagnosis with poorer outcomes compared to wealthy Singaporeans who can choose top-tier private care, for example? I am not suggesting this is the case, but it would be useful to have the data. Some doctors have observed Covid-19 related backlogs, and patients transferring from private to public to save money, pressuring the public system and lengthening waiting times for subsidised patients.
Thirdly, could we develop a national health equity index? This could be created by an independent group of academics, and include social determinants of health as well as healthcare accessibility, affordability and outcomes. This will pinpoint areas for targeted action.
Once we have more data, we must act decisively. I note that HPB piloted the Healthy Living Passport Scheme in mid-2020 and aims to reach 15,000 lower-income residents over 3 years. How effective have the incentives been among lower-income groups? Other than number of participants, can we set targets in terms of better health outcomes?
The national health screening programme “Screen for Life” heavily subsidises screening for some conditions. What is the take-up rate and outcomes thus far, particularly for those who are less advantaged socio-economically?
Mr Speaker, sir, we must improve outcomes at the intersection of health inequality and preventive healthcare, not only because we have a responsibility to the less fortunate, but also because this problem creates spillover effects that cost society more if left untreated.
Medisave Use for Outpatient Treatments – Gerald Giam Yean Song
Many seniors suffer from chronic conditions which require extended care that can be very expensive. Most outpatient treatment is not covered by Medishield Life, and access to Medifund is only available to the very low income. The use of Medisave is subject to annual withdrawal caps. This can have the undesirable effect of discouraging seniors from seeking early treatment.
Can MOH allow MediSave withdrawals for the treatment of all chronic conditions, not just those on the Chronic Disease Management Programme list, to ensure that no one is excluded just because they suffer from a less common chronic condition.
Can MOH remove annual withdrawal limits on the use of MediSave for patients over 60 who have a balance of at least $5,000 in their MediSave accounts?
This can be rolled out at polyclinics, restructured hospitals and CHAS clinics, where tight procedures are already in place to ensure that only medically-necessary treatment is prescribed.
MediShield Life Premiums – Gerald Giam Yean Song
Between 2016 to 2019, $7.5 billion in premiums for MediShield Life were collected and $3.5 billion in claims were paid out, while a further $3 billion was set aside for future premium rebates.
Many Singaporeans are concerned about the premium hikes of up to 35% to MediShield Life. More transparency on the data and assumptions used will help better explain these premiums hikes.
Last November, in response to my request for the release of the full MediShield Life actuarial report, SMS Koh Poh Koon said that MOH may engage different consultants to challenge the assumptions and do another calculation, and publish some of this data “in an academic way”.
Will the full MediShield Life actuarial report be provided to these consultants and academics for further analysis and, if so, when will this be done?
Lastly, I note that the new MediShield Life premiums have kicked in on 1 March. Can MOH consider postponing the increased premiums until our economy recovers?