Compulsory health screening could raise costs

I disagree with senior health correspondent Salma Khalik's suggestion to make health screening compulsory within the MediShield Life framework ("Make health screening compulsory and free under MediShield Life"; yesterday).

Ms Khalik has hypothesised that mandatory health screening can lead to diseases being caught early, and consequently reduce treatment costs.

However, this hypothesis is not conclusive.

For example, according to a Cochrane review that was published in the British Medical Journal in 2012, general health screening "did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes" in the adult populations studied.

In addition, the review showed that general health screenings were associated with more diagnoses and more drug treatment - implying increased overall cost to the entire healthcare system, rather than any cost benefit.

Ms Khalik also argued that it would be best if these tests were provided free.

However, nothing comes free. Making health screening compulsory could lead to substantial increases in healthcare expenditure that ultimately have to be borne by the general population, indirectly as tax or directly as increased MediShield Life premiums.

Ms Khalik also suggested that a penalty be imposed on people who refuse to undergo health screening.

But, forcing mandatory health screening on the public would be a very unpopular measure that could lead to calls for the abolishment of mandatory MediShield Life coverage.

People may have valid reasons for not presenting themselves for mandatory health screening.

For example, some people may have been stationed overseas for years; others, due to age, may be immobile or in institutional care.

To take extraordinary measures to ensure that such individuals are similarly screened periodically could significantly increase the administrative costs of running MediShield Life.

I am also concerned that compulsory health screening could lead to a rise in the number of cases of overdiagnosis - picking up "diseases" that were never going to cause any problem - and unnecessary treatment of false positives that, again, could translate into higher MediShield Life premiums for the public.

Overall, it is doubtful whether compulsory health screening can reduce overall healthcare expenditure. Forcing the public to submit to compulsory health screening would also prove to be very unpopular.

Chan Yeow Chuan

A version of this article appeared in the print edition of The Straits Times on April 29, 2016, with the headline 'Compulsory health screening could raise costs'. Print Edition | Subscribe