Major review to keep health care affordable

Govt's share of patient bills likely to be larger to help S'poreans cope: Gan

THE Ministry of Health (MOH) is embarking on a major review next year to ensure that public health care remains accessible and affordable to Singaporeans.

A likely outcome of the review is that the Government will take on a larger share of patient bills, Health Minister Gan Kim Yong told The Straits Times.

Currently, these bills are paid for through a combination of government subsidies, risk pooling through insurance and individual savings.

The Government may need to re-examine the balance among the three because Singapore's demographic is changing, and the current system may not be robust enough to ensure that everyone has access to basic health care in the future, said Mr Gan.

The Government announced plans early this yearto double yearly health-care spending from $4 billion to $8 billion over the next five years.

They include increasing the number of beds in acute public hospitals by 30 per cent and more than doubling beds in community hospitals by 2020.

Public health care in Singapore is subsidised to various degrees depending on the class of stay and treatment in hospitals and polyclinics.

Patient bills are then paid for by what is known as "the 3Ms": compulsory Medisave savings, MediShield insurance and Medifund subsidies for the poor.

"The 3Ms plus subsidy has served us well, and maybe it is still able to cope with the financing system over the next few years," said Mr Gan.

But he added that there are three key factors that make it imperative to review how health-care costs are shared by the Government, insurance and the individual.

The first has to do with advances in medical drugs and treatment. "They may produce a better outcome, but they are most costly," noted Mr Gan.

A second factor is that people now have greater accessibility to complex treatments than, say, a decade ago.

For example, in 2000, surgeons here did 725 knee replacements. Last year, the number soared to 2,441 - a rate of rise that has far outpaced the growth in the elderly population.

The final factor is ageing, said Mr Gan. The number of people aged 65 and older is expected to treble from 30,000 today to more than 90,000 by 2030, and older people need more medical services.

The MOH has been making several changes in recent years to deal with rising health-care costs that have generally outrun general inflation.

It recently announced changes to MediShield, the national health insurance, to provide higher annual and lifetime limits. These will be implemented early next year.

It also increased subsidies for expensive drugs and step-down facilities like nursing homes.

But Mr Gan said making piecemeal changes will not be enough in the long term.

The review, which is expected to take more than a year to complete, will therefore "take an overall relook at the 3Ms and the overall system to see how we can reshape it to make sure it continues to be affordable", he said.

One possible solution is changing how individuals fund MediShield, so that they pay higher premiums when they are young and working, and pay less when they get older and have retired.

"The bottom line is that we want to make sure that when the total bill goes up, the people's portion will remain affordable," said Mr Gan.

Reacting to news of the review, housewife Lim Chween Yiing, 35, whose father has been diabetic for more than 30 years, said more help from the Government would aid both the poor and the middle-income group. "Prices today are okay given the quality of health care here," she said. "But it won't be good if it goes beyond what people can afford."

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