Lower medical co-payment could mean higher taxes

By Salma Khalik, The Straits Times, 11 May 2012 

REACTIONS to health-care changes have generally been positive, with many people welcoming the increased subsidies for longer-term care and outpatient chronic care, said Dr Amy Khor, Minister of State for Health.

The changes also increased the pool of patients who can get subsidies at private general practices to include middle-income earners aged 40 and above.

But Dr Khor, in her blog yesterday, referred to a particular issue in feedback received, especially via Reach, the Government's engagement channel, which she chairs. It is a suggestion to remove or significantly reduce co-payment for MediShield, the national health insurance scheme which covers people up to age 85.

She said that while many may welcome this, 'it would inevitably lead to over-consumption'. Furthermore, she said: 'If I pay less or not at all, someone else will need to pay. Who will that 'someone else' be?'

That person 'is inevitably you, me, or our children - often through higher taxes,' she added.

The extent of health insurance coverage has sparked debate in The Straits Times. For example, Fortis Healthcare Singapore chief executive Jeremy Lim said that national health insurance 'is not an economic decision' but is, at its core, 'a moral decision'. Associate Professor Lim Meng Kim of the Saw Swee Hock School of Public Health at the National University of Singapore also highlighted the plight facing Taiwan in a commentary in The Straits Times on May 9.

Referring to this, Dr Khor said: 'As expenditure outstripped the premiums collected, Taiwan's National Health Insurance ran into a sizeable deficit. The working population and their employers bear the bulk of health-care costs, but this may not be tenable in the long term as its population ages, just like ours.'

Feedback also reflected continued worry over rising medical costs and affordability. Dr Khor reminded people that aside from government subsidies, there is also MediShield insurance and Medisave savings. If all else fails, the government-funded Medifund will step in.

With this system, she said most Singaporeans 'fork out little or no cash payment for hospitalisation'. She gave the assurance that the Health Ministry will continue to 'refine the system' to meet changing needs and address gaps.

Elaborating further, Dr Khor told The Straits Times yesterday that a lot of people rationalise it this way: 'I've worked my whole life and helped to build up the nation. Now I'm old and sick, the Government should take care of me.'

And to a large extent, the Government agrees, which is why there are heavy subsidies in hospitals, she said. 'The bottom line is: spending by the Government on health care will go up.'.

The Government has pledged to double its health-care expenditure to $8 billion in five years, and promised that no one will go without medical care because they cannot afford it. But Dr Khor said that just spending more on health-care services is not a measure of success.

'Everyone also has a personal responsibility for his own health. Practising healthy eating habits and exercising regularly should be among every Singaporean's priorities,' she added.

Yesterday, she was at the Parliament House gym by 6am for an hour of workout before starting her work day. As she urged in her blog: 'Health care is too important to leave to 'someone else'. Join me and thousands of other Signaporeans to lead a more healthy lifestyle.'