Checking the ills of health-cost inflation

As far-sighted and comprehensive as it is, MediShield Life rests on fundamentals that must be constantly heeded for healthy outcomes, not just during its implementation but for decades to come.

These have been flagged by the Review Committee and aired in Parliament. For a scheme to remain always affordable and accessible to all, cost-effective options must rank paramount. And for a system to not crumble under its own weight, an accord on sharing costs equitably must be able to withstand the test of time.

If one fails to see the wood for the trees, there is the danger of expecting more and more from the promise of universal health coverage. MediShield Life offers basic protection to all from big hospital bills, by moving part of the high risk and cost from the individual to the community and the state. This is neither a sleight of hand nor the opening of a limitless lode of financing. Health-care costs are real, perennial and inflationary; these cannot be simply wished away or left entirely to an all-providing state.

Hence, the crucial need to work out sensibly the distribution of costs - in a manner that does not place an intolerable burden on cost-sharing users, premium-paying citizens, tax-paying individuals and budget-balancing governments alike.

Given the large scope of the exercise and the social and economic imperatives invoked, the responsibility of strengthening the underpinnings of the national insurance scheme lies with everyone - the Government, insurers, health-care providers, patients and their caregivers. A weak link could shift financial loads in ways that can strain the architecture and threaten what accord is now evident from the discussions held so far.

Private insurers, on their part, can do more to participate actively in the implementation process. The Review Committee and a host of MPs have called for a standardised Integrated Shield Plan (IP) targeted at B1-class wards. This would not only be cheaper than plans aimed at A-class wards or private hospitals but also do away with the confusing variations now offered by the market.

IP insurers should also take into account the actuarial benefit conferred to them by MediShield Life (as a result of compulsory risk-pooling to offer catastrophic coverage to all) and by the tendency of patients to go to public hospitals (four in five) even after buying costly plans for private hospital stays.

A robust accord on health-care financing should see industry professionals striving to keep health costs down, insurers offering value for money, and consumers viewing basic coverage as a necessity rather than a "benefit" to be consumed "buffet-style".