Sunday, May 1, 2016
Singapore - Make health screening compulsory and free under MediShield Life
MediShield Life should go beyond covering patients for hospital treatment, to covering them for health screening. Early treatment, after all, can help lower hospital bills.
The launch of MediShield Life last year was a major milestone in healthcare for Singapore.
With it, for the first time, every Singaporean and permanent resident is assured insurance coverage to protect them against large hospital bills, from the time they are born till the day they die. This is especially crucial for people suffering from chronic ailments that require lifetime care, such as heart or kidney failure, and certain cancers.
The Ministry of Health (MOH) must be applauded for taking this major step. But it should not stop there. By underwriting the major healthcare cost of everyone, it is certainly in MediShield Life's interest to keep people as healthy as possible for as long as possible, as this is the only way to ensure that healthcare bills remain manageable.
It is time for MOH to consider making health screening compulsory within the MediShield Life framework. This is one good way to control rising hospital bills.
Already, the Life Insurance Association says that in recent years, claims for B1 and A class wards have increased by 12 per cent a year while those for private hospitals have risen by 17 per cent a year. Higher claims inevitably lead to higher premiums that everyone will have to pay.
Many studies have shown how proven health screening can catch diseases early, and as a result, reduce treatment costs as well as suffering by the patient.
This is where MediShield Life can come in - since it is the one that will bear a large part of the cost of treatment. It should make it compulsory for people to screen for certain diseases at certain ages.
Screening, for example, can dramatically reduce the incidence of some cancers. This not just results in better lives for the patients, but also significantly reduces the cost of healthcare treatment to the nation.
THE CASE FOR MANDATORY SCREENING
This is why, in the United States, most health plans must offer preventive services such as vaccinations and screening tests, at no additional cost to the insured.
Insurers there know that it is to their benefit to pay for such screening as it will reduce the amount they would need to pay out if the disease is caught late.
The US National Cancer Institute says 59 per cent of adults aged 50 to 75 have screened for colorectal cancer according to its guidelines. Cases of colon cancer there have fallen from 51 to 37 per 100,000 people from 2003 to 2013.
If polyps in the colon and rectum are discovered and removed, they do not become cancerous.
While treatment for this cancer has improved tremendously, preventing it is always better. Today, this is the most common cancer in Singapore, with close to 2,000 people diagnosed a year.
Other cancers with high screening rates in the US include cervical and breast, and deaths from these cancers have also gone down.
While the actual cost effectiveness of national screening varies because such costs will take into account not just the cost of treatment, but also loss of working years, there is no doubt about the benefits in terms of human suffering.
This is why countries push for certain diseases to be screened. Not all diseases can be screened for. But where such screening is effective and available - such as for diabetes - they can go a long way in curbing rising incidence and healthcare costs.
Why make screening mandatory, when there are already heavily subsidised ones, you may ask.
It is true that Singapore already has national screening programmes that are heavily subsided or even free. For some, Medisave can be used. Yet the take-up rate remains low.
As a result, Health Minister Gan Kim Yong told Parliamentearlier this month that a third of diabetics here do not even know they have the disease.
Diabetes is a terrible disease, largely because it is silent till things go wrong - and when that happens, it can affect many parts of the body.
In Singapore, diabetes is the top cause of kidney failure - the number of people on dialysis more than doubled from 2,764 in 2000 to 5,912 in 2014, and the number continues to rise every year. It is also one of the top causes of blindness and results in at least two amputations a day.
To make things worse, Singapore has one of the highest rates of diabetes among developed countries, second only to the US.
And that's just diabetes.
Based on national healthcare surveys by the MOH, one in four people here with hypertension and almost half of those with high cholesterol levels don't know they have these conditions. Both are major risk factors in heart disease and stroke.
Being unaware, they do not take steps to prevent their conditions from becoming severe.
The bottom line is that screening tools exist that can alert people in the early stages of a disease, be it diabetes, cancer or cardiovascular disease. Whatever the reason - fear, ignorance, apathy - the fact is that people aren't making use of them, even when screening programmes are free or heavily subsidised.
But, of course, people can find out they have a disease and still not do anything about it. Mr Gan shared that of the people who know that they have diabetes, one in three have poor control over their blood sugar levels. But the first step is to make sure that people know that they have, or are heading towards, a serious medical condition.
And the only way to do that here, it appears, is to make such screening tests compulsory.
It would be best if these tests are provided free of charge. There are many studies that show it is far cheaper to screen and to catch a disease early, rather than not screen and to pay for treatment later.
US insurers - hard-headed businesses - obviously believe this to be true as they provide selected free vaccinations and health screening to their policyholders.
But offering free screening tests alone will not be enough, as there will always be people who would rather not know, or find it too much of a hassle since they are not feeling sick.
So MediShield Life should impose a penalty on people who refuse to screen - such as adding a loading to their annual premiums which will remain in place until they get screened.
There will, of course, be exceptions, such as people who have already been diagnosed with the disease. It no longer makes sense for them to screen, and it would be unfair to penalise them for having the disease. Those who screen under private schemes can simply get their doctor to let MediShield Life know that the test has been done.
To prevent concern that people would be disadvantaged if their insurance company or employer finds out they have serious medical conditions, the results of the tests should remain confidential between doctor and patient.
MediShield Life only needs to know that the test has been done and the patient informed.
WHAT TO SCREEN FOR
Exactly what diseases MediShield Life should screen for and when they should be done, can be determined by a panel of medical experts, drawing from the ample pool of studies available.
It will be tedious work but not rocket science to suss out which screening might be cost-effective.
For example, cancer, cardiovascular disease and diabetes together account for almost half the years of illness suffered by people here. Today, Singaporean men live about nine years with poor health, and women, almost 11 years.
The idea is to ensure that people discover such conditions early, so that they are able to nip them in the bud, or get their condition treated so it does not become a major problem that will result in high hospital bills. Early treatment can also spare them suffering for weeks, months or years.
It would be a massive boon - to individuals and potentially to the Budget - if the number of unhealthy years can be reduced through health screening and early care.