There is a wide range of treatment options with very different price tags. The cost of implants or stents can range from a few hundred to thousands of dollars. Often the marginal effectiveness of the more expensive devices is not even proven. For many treatment options, there is also no clear consensus among specialists on what constitutes 'standard' care.

For the Government to take full charge of all large bills, increasing the effective subsidy beyond current levels, and extending coverage beyond standard care, will be most unwise.

Hence, we limit full subsidy to only treatments that doctors say patients need to ensure that costs do not spiral out of control. Because of such limits, large Class C bills exceeding, say $10,000, are rare here - they would be considered small in the United States.

For a common surgical procedure such as knee-joint replacement, it would cost about $15,000 (or $3,000-$4,000 after heavy subsidies) here but $59,000 to $84,000 in the US.

More health-care spending does not necessarily lead to better health outcome. The correct approach is to spend within our means, to go for lower-cost solutions wherever appropriate and fully subsidise only treatments that are genuinely essential.

For some patients who may require prolonged, costly ICU stays because of medical complications, the rational way to fund these 'catastrophic' events is via MediShield. Such occurrences are uncommon but the financial burden to the individuals is huge. A few dollars per month of additional premiums can buy financial protection against such an event.

When MediShield was reformed in 2005, we wanted to reduce co-payment of such large bills from 60 per cent (pre-2005) to about 20 per cent. However the public feedback then suggested that premium hikes should ideally not exceed, say, $10 per month. That is why the reform was implemented in phases: reducing co-payment to 40 per cent in the first instance and to 20 per cent this year.

The more we can share the burden fairly among those who are in a position to shoulder it, the better we can target government funding to help the needy or the uninsurable. The alternative approach of spreading limited resources among all will just draw in patients who may not need such assistance, at the expense of the poor.

Karen Tan (Ms)
Director, Corporate Communications
Ministry of Health