There are many good elements in the proposed changes to MediShield Life (MediShield Life coverage set to widen next year, Sept 30).

Better coverage, higher limits, and ensuring continued viability by raising premiums, in principle, cannot be faulted.

However, any change to MediShield Life always has a ripple effect on private Integrated Shield Plans (IPs). About 70 per cent of Singaporeans have IPs. So we need to review the full picture.

If there is an increase in MediShield Life's coverage and increased premiums as a result, then by corollary there is less that needs to be covered by the IP and, hence, there should be lower IP premiums.

We currently cannot see what the net overall impact of MediShield Life changes will be on our pockets, until we see the concrete impact of any changes to both MediShield Life and IP coverage and premiums.

I recommend that the Government present the full picture of the proposed changes, both to IPs and MediShield Life, for citizen feedback, before implementing any change to just MediShield Life.

A much bigger policy question is about public hospital capacity. That public hospitals are full to capacity tells us that most middle- to lower-income citizens do want to use public hospitals and thereby also benefit from the lower premiums and subsidised charges.

However, many citizens opt for IPs because they don't want to be kept waiting for treatment in public hospitals.

If public hospital capacity were increased by 50 per cent, I think the number of people subscribing to IPs might drop to below half of the population.

This would be a much better way to benefit the middle- to lower-income groups in our society, assuring everyone of high quality treatment without delay, at low but viable MediShield Life premiums, and decent coverage for most illnesses.

The larger the public pool, the more economies of scale will drive premiums down further.

Instead, we seem to be growing private hospital capacity more quickly than public capacity, which is a sure way to rapidly increase the average cost per citizen of medical care in our society.

Rahul Keshav Patwardhan