Thursday 15 August 2013

GPC makes recommendations for affordable healthcare

Allow wider use of Medisave: Panel
Parliamentary committee report urges tweaks to heath-care financing
By Salma Khalik, The Straits Times, 14 Aug 2013

MEDISAVE should be used to cover more services and MediShield should pay for a larger share of treatment bills, according to the Government Parliamentary Committee (GPC) for Health.

These were among a slew of changes to health-care financing that it recommended in a report to Health Minister Gan Kim Yong yesterday. Led by GPC head Dr Lam Pin Min, the team of eight MPs gathered feedback from the public, health-care professionals and social workers.

Its suggestions include widening subsidies to cover more medicines, reviewing Medisave limits regularly, and removing age limits for health insurance and the portable primary care subsidy.

GPCs are groups of People's Action Party backbenchers who take a special interest in the workings of a ministry. They are regularly briefed by the ministry and consulted on issues of public interest. But it is unusual for them to issue a public report like this.

This committee's suggestions aim to help the many Singaporeans "worried and apprehensive about their current and future medical needs".

It said restrictions on the use of Medisave encourage unnecessary hospitalisation. Dr Lam pointed out an example to The Straits Times: Medisave pays up to $250 a day to patients in a nursing home but $450 to those in hospital. The committee wants the same limit for both.

The report added: "Social workers indicate that they see regular cases of clients who choose to voluntarily admit themselves or extend their stays in the hospitals so that they can utilise their Medisave for treatment."

It also suggested a tiered withdrawal limit, with older people allowed to take out more. Dr Chia Shi-Lu, another GPC member, said: "The current level of Medisave monies is probably a bit high and can be put to better use."

The Ministry of Health says people aged 65 to 70 have an average of $19,000 in Medisave. The GPC suggested freeing up Medi-save cash for health screening, dental procedures, physiotherapy and occupational therapy.

But it wants to cap the amount that can be used on treatment for relatives, so a person's savings are not depleted prematurely.

The GPC also highlighted failings in the national health insurance scheme. Some Singaporeans let their MediShield lapse because they can no longer afford the high premiums. Government top-ups do not help as these are often used to pay medical bills.

"Doctors shared that they would deliberately advise elderly patients to allow their MediShield coverage to lapse as the premiums were too high," said the report. The GPC added that it means their years spent paying into MediShield are wiped out.

It suggested letting people pay higher premiums when they are young to offset higher ones as they age, adding that it is best to use government top-ups only for paying premiums.

Mr Gan announced early this year that the ministry was undertaking a review of health-care financing. In his reply to the Health GPC yesterday, he said: "I agree with the key thrusts proposed by the committee. They reflect the same spirit of review that my ministry is undertaking for our health-care financing framework."

He added: "Several of our current policy reviews are aligned to your recommendations."

Suggestions at a glance

- Set same limits for care in and outside of hospital.
- Introduce tiered withdrawal limits, allowing older people to withdraw more.
- Let Medisave cover more treatments, such as health screening and dental work.
- Review limits regularly to ensure they are relevant.

- Get people to pay more in premiums when young.
- Cover social and community care costs.
- Make insurance kick in earlier and cover more of the bill.
- Remove age limit of 90, when MediShield drops cover.
- Ensure Medisave top-ups from the Government are used only to pay premiums.

- Remove lower age limit of 40 for Community Health Assist Scheme.
- Allow patients referred to a hospital by a GP to enjoy subsidies so they don't need to be referred by a polyclinic.
- Subsidise more essential medicines.
- Means-test patients only once and apply results to all schemes that enjoy subsidy.

Publish private sector fees online, including what GPs charge.


Gan gives nod to extending Medisave use

By Salma Khalik, The Straits Times, 15 Aug 2013

HEALTH Minister Gan Kim Yong is agreeable to extending the use of Medisave, but says this must be thought through carefully to ensure that people do not end up depleting their savings.

In a report submitted to the Minister on Tuesday, the Government Parliamentary Committee (GPC) for Health urged that the use of Medisave should cover health screening, essential dental procedures and physiotherapy.

Still, expanding the use of Medisave, a national savings scheme in which a part of the salary is set aside for medical bills, has to be done very carefully, said Mr Gan last night.

"As we open up Medisave for more applications, will there be enough savings for old age and MediShield premiums?" he asked, refusing to be drawn into identifying what else Medisave might be used for.

He said that even if the annual $400 cap on outpatient use for chronic diseases is kept, expanding the scheme will result in more money being withdrawn. This is because most people today do not use up the full $400, but might do so if the list of allowed services goes up significantly.

"It's not just the balance you have today when you're young, but for future consumption and to pay for future MediShield premiums," he said.

Current annual premiums for the national medical insurance scheme are as much as $1,190 for basic coverage.

Speaking on the sidelines of an appreciation dinner for participants of the Our Singapore Conversation on health, Mr Gan said what came through is that health care is important to most people and its rising high cost is a worry - not just for the poor and the elderly.

"Middle- and high-income groups are also concerned that they may be hit by a very big bill. It's rare, but if it happens to you, it can be a big burden," he said.

This is why the ministry will enhance MediShield to take care of very big bills, so Singaporeans can have greater assurance that they will be able to afford large medical bills.

At the same time, premiums cannot go up by too much, said Mr Gan, adding that the Government will have to help the poor pay the higher premiums.

He revealed that key improvements on how health care is financed will be released in the coming months, but the details will take longer to work out.

At a separate event yesterday, Minister of State for Health Amy Khor said: "We agree broadly with the key focus areas that have been highlighted in the GPC for Health report."


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