MediShield Life

Mr Deputy Speaker, thank you for allowing me to speak on the Motion to seek Parliament's endorsement of the MediShield Life Review Committee (MLRC) report.

The idea of MediShield Life was first conceived at the National Day Rally in August 2013 when Prime Minister Lee announced that the Government would be looking into providing universal lifetime medical insurance coverage for all Singaporeans. From August last year till the submission of the MLRC report in June this year is almost nine and a half months – exactly the same duration needed to bear a baby till full-term. From the reception of many Singaporeans, this seems like a smooth normal delivery. However, I do believe the MLRC must have gone through the perils of this "pregnancy", such as morning sickness and abdominal cramps, before reaching the final report.

For that, let me congratulate and thank Mr Bobby Chin and his Committee for doing an excellent job in reviewing a complex health insurance plan, such as the MediShield Life, and putting forth the recommendations that will eventually better the lives of all Singaporeans.

So, why did the Government take on a mammoth undertaking, such as the MediShield Life? We have often received feedback from friends, relatives, constituents and fellow Singaporeans that the cost of healthcare has increased significantly over the years and many Singaporeans are worried about the affordability of healthcare as they grow old.

Whilst the current MediShield does cover a significant portion of the hospitalisation bills, Singaporeans are concerned about the high co-payments and deductibles, albeit they can be paid for through the Medisave accounts. However, for those with limited Medisave savings, this would translate to more out-of-pocket expenditure in the form of cash.

I had raised this concern countless times in Parliament and I believe many like-minded colleagues in this house had done so, too. The Government Parliamentary Committee (GPC) for Health had also submitted our paper on enhancing healthcare affordability to the Government last year, and one of our recommendations specifically called for enhancing the 3M framework, which included better protection and continual coverage of MediShield for

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all Singaporeans without any age limit.

It is good and heartening to know that the Government has accepted the recommendations of the MLRC and will work towards operationalising and communicating this scheme to the general public.

I am especially pleased that we have decided to adopt the approach of "Better Protection, For All, For Life" towards MediShield Life. This is a universal lifetime health insurance that aims to give all Singaporeans better protection and peace of mind. Let us also acknowledge from the start that these are the result of a government that listens; one that listens to the people and addresses the evolving needs of Singaporeans, and is ever-ready to change our existing policies to meet the changing needs of the people.

The MLRC recommends that the lifetime claim limit be removed and this is, indeed, good news for those patients with chronic diseases that require lifelong treatment. The daily claim limits for hospitalisation will also be increased by 55% from $450 to $700 and the cancer treatment claim limits increased by 140% from $1,240 to $3,000. The co-insurance rates will also be decreased from the current 10%-20% to 3%-10%. This would eventually mean that MediShield Life will pick up a higher proportion of the medical bills, and the patient pays less, offering Singaporeans with better protection.

The MLRC has also recommended that MediShield Life be all-inclusive by providing coverage to all Singaporeans, including the uninsured, previously excluded due to pre-existing medical conditions and, most importantly, for life, that is, for as long as one lives. The removal of the current MediShield age limit of 90 is thoughtful as Singaporeans are living longer and the likelihood of the elderly falling sick is much higher, thus making medical insurance coverage for them even more critical. With this universal lifetime coverage, all Singaporeans will have greater peace of mind, for life.

Of particular interest to many Singaporeans is the affordability of the MediShield Life premium. Many Singaporeans have given feedback to me that they are pleasantly surprised by the lower-than-expected increase in quantum for the new MediShield Life plan. Many are also happy with the permanent subsidies provided for Pioneer Generation and low- and middle income Singaporeans, as well as the four-year transitional subsidies for everyone. Of course, the additional subsidies and assistance for those who may be facing financial difficulties in paying the premium, whatever the reasons may be, are exceptionally reassuring to many.

While we immerse ourselves in the euphoria of the birth of a universal lifetime medical insurance scheme, we need to be cognisant that MediShield Life alone is not a panacea for

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ensuring the affordability of healthcare in Singapore. It is the combination of all efforts, from enhancing the 3M framework to reining in medical inflation and, most importantly, keeping Singaporeans healthy for as long as possible. Besides addressing affordability, MOH will also need to work towards maintaining quality and improving accessibility of healthcare to all Singaporeans.

Having worked in the healthcare industry for the past 20 years and having interacted with many healthcare professionals from all over the world, I am confident to state that our healthcare system is undoubtedly one of the best in the world. In fact, it is an envy of many other countries. I believe many of my medical colleagues, both inside and outside the House will agree with me wholeheartedly. This did not happen by chance but through the foresight and hard work of the Government, policy makers, as well as dedicated healthcare workers.

In all honesty, ask yourself, do you trust that you will receive appropriate and sound professional treatment with a good outcome when you visit a doctor for your medical problem? In the course of my work, I have often seen patients from outside Singapore who shared with me that they do not trust their healthcare system and doctors in their own countries.

So, is our current healthcare system rotten to its core, requiring a major facelift, as some advocates make it to be? Are we really a First World country with Third World healthcare problems? Obviously, I personally do not think so.

The Singapore healthcare system and its financial framework are generally sound and cost-effective: our National Healthcare Expenditure (NHE) is at 4% of GDP. In comparison, OECD's average is 9.6%. Even then, Singapore achieves good health outcomes. With an ageing population, our national healthcare expenditure and the Government's share of our overall healthcare expenditure are expected to increase.

It is not just my personal belief or opinion that our healthcare system is one of the best in the world. Singapore's healthcare system has been rated by the World Health Organization as the best in Asia, and the sixth best in the world in year 2000. In 2004, Political & Economic Risk Consultancy (PERC) ranked Singapore's healthcare system as the third best in the world. In 2008, the Global Competitiveness report ranked Singapore second for infant mortality rate and twelfth for life expectancy at birth.

The Singapore healthcare financing framework is anchored on the twin philosophies of individual responsibility and affordable healthcare for all. This system has evolved over the years, with the current multi-tiered protection to ensure that no Singaporean is denied

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access to basic healthcare because of affordability issues.

The first tier of protection is provided by heavy Government subsidies in acute public hospitals and polyclinics, which all Singaporeans can access. The quantum of subsidy will increase, especially for the Pioneer Generation and low-income Singaporeans. The second tier of protection is provided by Medisave, a compulsory individual medical savings account scheme which allows Singaporeans to pay for their share of medical treatment. The third tier of protection is provided by MediShield, a low-cost catastrophic medical insurance scheme, which will soon be replaced by MediShield Life, an enhanced universal lifetime medical insurance plan for all Singaporeans.

Individual responsibility for one's healthcare needs is also promoted through features of deductibles and co-payment in the new MediShield Life – our universal health insurance scheme. As for Singaporeans who really cannot afford to pay for their medical bills despite heavy subsidies by the Government, there is Medifund – a medical endowment fund set up by the Government to act as the ultimate safety net to help needy Singaporeans.

It may sound like a broken record but I must emphasise that our 3M framework is something that has worked well for us and we should not just throw the baby out together with the bathwater. What we need to do is to groom and nurture the baby and eventually transform it to a fine gentleman.

While the Government has done much to address affordability through increased subsidies, MediShield Life and the Pioneer Generation Package, much work needs to be done to address the accessibility issue – such as the crowdedness in polyclinics, long waiting times at Specialist Outpatient Clinics and the emergency departments, and the near 100% occupancy of inpatient beds in many restructured hospitals.

The MLRC has also brought up issues relating to Employer Medical Benefits. Many employees today have some form of medical insurance provided by their employers. Even Public Service employees today are also offered additional payment under the MSO scheme to purchase additional insurance on their own. It is important for MOH to rethink how this would work synergistically together with the new MediShield Life scheme.

I noticed, for instance, that MOM has recommendations for portable medical benefits which allow employers implementing any of the recommended portable medical benefit options higher tax deductions.

How can we streamline Government policies such that they would complement the new MediShield Life scheme? One way, perhaps, is to enable employees in the Civil Service or

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private sector to make the right choices of insurance plans that complement MediShield Life. Singaporeans need to be educated about what MediShield Life covers or not cover so that all employees can make informed decisions on what additional plans to purchase to complement their existing MediShield Life plan.

I also fully agree with the MLRC's recommendation that the Government should consider strengthening financial support to companies willing to provide portable medical benefits that ride on the MediShield Life scheme. Should we also consider going one step further to legislate health insurance portability, such as the Health Insurance Portability and Accountability Act in the United States?

In many ways, this draws us in to the standardised B1 Integrated Shield Plan that the Committee has recommended. A standardised Shield plan for B1 class wards would provide those Singaporeans who are keen for an upgraded plan better clarity and less confusion. There are, currently, many different Integrated Shield Plans out there in the market and, more often than not, patients may not fully understand the financial implications for each and every one of the Integrated Shield Plans available. Many Singaporeans do want to have better coverage and the option to choose the doctors of their choice, without having to pay an arm or leg or being excessively insured. The standardised B1 Integrated Shield Plan can provide such a choice with standardised coverage across-the-board. It should ideally also complement MediShield Life, and also Employee Medical Benefits at the same time. The last thing we want to do is to encourage the market to come up with products that duplicate and waste resources.

It is, therefore, important to note that the insurance market is essentially a private-sector venture. Companies that underwrite insurance are for-profit organisations, and it is essential that medical insurance, a vital component of the financing framework for healthcare in Singapore, be regulated properly. This would mean that we should be looking at ways to ensure that different products can be compared across-the-board, and information is readily available for Singaporeans to make the right choices.

On this note, perhaps we should also consider how different Singaporeans have different types of needs. Pensioners, for instance, are a group of people who have different needs – they have medical coverage under existing public service medical benefits for pensioners. Many pensioners are concerned about the MediShield Life plan and how they will be affected with its implementation. Many have questioned what will happen to their existing medical benefits. Will they be better or worse off? Besides pensioners, are there other groups of Singaporeans who will be affected? While we have the guiding principles right, it is also necessary to go down to the nitty-gritty and look at MediShield Life in terms of the impact it will have on the lives of ordinary people.

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Now, while we have moved forward on our plans for universal lifetime medical coverage, let us remember that the artificial boundaries that we draw between health and social care are gradually blurring. We need to see social care as an important part of health care and a part of the continuum of care. I have spoken about how Singaporeans choose to remain in the acute hospital settings because they are unable to utilise Medisave/MediShield funds for community hospitals and other social care settings.

It is important for MOH to look at these social care aspects and see how they can influence health outcomes. After the rollout of MediShield Life, we need to ensure that social care is sufficiently funded for Singaporeans. Perhaps, we can take a leaf from the UK, where the government is undertaking the Care Act 2014, which promises to integrate health and social care services.

Mr Deputy Speaker, Members in the House had spoken about Obamacare previously and how Singapore can learn from this initiative. MediShield Life offers Singaporeans many similar promises that Obamacare does. But at the same time, Obamacare has been criticised for the "broken promises" by its critics, and the Republicans are talking about repealing and changing Obamacare.

One of the main things that I will be particularly concerned about is the implementation of MediShield Life. Like what many married couples and new parents will tell you – having a child is a lifelong journey. The story does not just end with the delivery of the child. We need to ensure that the benefits and the promises of the new plan filter down to all Singaporeans.

Several things we need to be aware of:

(a) we need to ensure its delivery is what it promises;

(b) the scheme needs to be adaptable to changes according to the needs of Singaporeans; and, lastly,

(c) we need to ensure that all Singaporeans know and understand what benefits MediShield Life brings.

For this, I am particularly pleased by the communication materials that have been published, and I hope, in the subsequent roll-outs, it can be simple and easy to understand by all.

In conclusion, the 3M framework has served Singapore well and, moving forward, we need to continuously review and tweak the system to make it more relevant to

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commensurate with the needs and expectations of Singaporeans. The universal coverage provided by Medishield Life is an important move to provide peace of mind and ensure that all Singaporeans are protected. I am sure the Government will continue to provide strong support to achieve universal coverage and enhance benefits, while ensuring affordable premiums for Singaporeans. With that, I pledge my support and endorse the recommendations of the MLRC.

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