Carol Tan, For The Straits Times

MediShield Life reform: Three-legged stool for peace of mind

Parliament debates MediShield Life reform next week, with MPs expected to look at how to keep costs and premiums down. A geriatrician wants people to switch from thinking about what they can get out of MediShield Life, to thinking about what they can do to keep it affordable. Two researchers suggest setting up a standing committee to vet cost-effective treatments and drugs.

Policyholders, or patients, themselves are key to keeping costs down to maintain their peace of mind. People must learn to look after their health.
Policyholders, or patients, themselves are key to keeping costs down to maintain their peace of mind. People must learn to look after their health.ST FILE PHOTO

Covering people for life and including pre- existing conditions under the proposed Medi- Shield Life are welcome moves. So far, much of the controversy and debate has centred on affordability of premiums.

But should the focus be on this?

Premiums are a means to ensure that any insurance scheme does not go bankrupt. Insurers help make sure enough money is collected through premiums to pay out when policyholders get sick and claim.

Yes, expanding coverage for those already sick - and for the very old - means more claims are expected and therefore premiums have to go up. It is good that the Government will subsidise premium increases, to ensure they are affordable for the old and lower- income group.

But that should not be the main focus. Certainly the fear of premiums rising to become unaffordable is a real one. But premiums are a means to an end. What we want is peace of mind.

And peace of mind over health-care costs rests not just on premiums, but a three-legged stool. Insurance is only one leg of that stool. The second leg is propped up by health-care providers be they doctors, administrators or pharmaceutical firms. The third leg is policyholders or patients. Each of these groups needs to change the way it acts.


FOR insurance firms, it cannot be business as usual. Strategies such as excluding pre-existing conditions may no longer be possible. Local insurers need to look overseas for best practices to manage claims while keeping premiums affordable. One way is investing in the health of their policyholders by creating incentives for them to take part in active ageing programmes; these include appropriate screening and follow-up, health coaching, immunisation, exercise and lifestyle change.

The Government also plays a part in strengthening the regulatory framework for insurers, to safeguard policyholders' interests.

Health-care providers

HEALTH-CARE providers must change the way we provide care. We need to help our patients remain healthy, make the right choices and access the right care at the right cost.

Take one example: a total knee replacement operation costs about $25,000. But a more cost- effective health system might focus on enrolling a patient in an exercise, weight loss and pain management programme at a fraction of the cost, reducing the need for surgery.

As doctors, we need to guide our patients to make the right choices. But much of what goes into a hospital bill is often beyond the control of doctors. Drug costs, administrative and facility fees, rents, tests, equipment - they all add to health-care costs. Hospital administrators and pharmaceutical companies all play important roles in ensuring we all have peace of mind.


POLICYHOLDERS, or patients, themselves are key to keeping costs down to maintain their peace of mind. For chronic diseases, the most important intervention is taken by the patient himself.

I always tell my patients: "I cannot give you a magic pill to help you exercise and eat healthily. You must want it yourself. And don't just spend when you get sick. Invest in your health. Buy a blood pressure measuring set and check your blood pressure. Join a programme and learn how to manage your condition.

"Not all high blood pressure patients go on to get a heart attack. Not all diabetics end up with kidney failure. Learn how to reduce the risk of this happening. Not just for yourself but for your family, and all of us as a country, a people, a community."

In saying that "we" as a community and country want peace of mind offered by universal coverage, "we" must also realise that there is much we can all do as individuals, insurance providers, doctors, administrators, pharmaceutical companies to ensure that what "we" want remains sustainable.

We need to understand the key drivers to rising health-care costs and do our part to keep them down.

Policyholders need to keep healthy. Doctors and other health providers need to keep costs down. One way to drive down costs is to develop open and transparent pricing for common high cost conditions. This requires sharing of data on cost of facilities, treatment and medication.

With transparent pricing, insurance providers can calculate premiums better, and the Government can better assess affordability and adjust subsidies accordingly.

It isn't the premiums that will make or break MediShield Life.

What is vital is the paradigm shift in thinking required, for each of us to shift from thinking as an individual to a group, from thinking about how "I" will benefit, to thinking of our collective responsibility and collaboration.

MediShield Life is a common pool into which we put our premiums and from which we dip to take what we need. To paraphrase a common saying, ask not what MediShield Life can do for you, ask what you can do to help keep MediShield Life costs and premiums low for all.

The writer is a geriatrician in private practice and chairman of The Good Life Co-operative that aims to help members age well and manage heath-care costs.

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