MediShield Life: Extend it to less common diseases

By Jeremy Lim, Published The Straits Times, 24 Dec 2014

BY THIS time next year, the risk of financial catastrophe from large health-care bills will be much reduced for cancer patients.

Why? Simple: MediShield Life, which would have come into effect by then, will greatly increase coverage for cancer care. For outpatient chemotherapy, coverage would jump from $1,240 to $3,000 a month. Radiation therapy will also enjoy an increase, from $160 a treatment to $500.

Why did the Ministry of Health (MOH) decide to focus on cancer? Why not other diseases too?

The decision to expand coverage for cancer is unsurprising.

Cancer accounts for almost a third of deaths in Singapore and 5.9 per cent of all hospitalisations. Furthermore, cancer care and especially its costs are frequently raised as concerns.

The late senior minister of state for health Balaji Sadasivan, while undergoing treatment for cancer, remarked: "Cancer treatment can be very, very expensive. This is something our health system will have to deal with. It is not surprising if some patients have to sell their house."

Cancer care has also been revolutionised by the advent of targeted therapies, biologics that target cancer cells at the molecular level. These medicines have three important implications for the way we finance health care.

First, in certain diseases such as breast and colon cancers, the results have been transformative, even for advanced disease. We are not talking about weeks or months of added survival but, in many instances, years of life, years of quality life.

This brings us to the second point, on toxicity. Because of the specific targeting, side effects are much reduced compared with conventional chemotherapy, which affects normal cells as well. Hence, many of the targeted therapies can and are prescribed on an outpatient basis. While some outpatient chemotherapy treatment can be covered, our health financing remains heavily inpatient-biased.

Third, the minimal side effects and continued "suppression" of cancer activity means the treatment regime continues for extended periods. Treatment cycles are no longer confined to 21- or 28-day periods - typical for conventional chemotherapies which have to be of short duration because of their toxic effect on the body. Instead, treatment can last for years. Increasingly, some cancer therapies are becoming more like drugs for chronic ailments such as heart disease and diabetes which need to be taken for life.

For example, trastuzumab (also called herceptin) is a treatment for some types of advanced breast cancer. It is recommended to be given "for as long as it keeps the cancer under control".

In the United States, almost 90 per cent of women diagnosed with breast cancer survive at least five years. Of those whose cancers have spread to other parts of the body, 25 per cent survive at least five years.

That amounts to many doses of trastuzumab, which, at about $4,000 a month, translates to very heavy costs for Singaporeans in the local context if insurance such as MediShield/ MediShield Life did not provide some cover for extended periods.

From next year, MediShield Life will step in. The rationale for increasing coverage for cancer is well-founded and the MOH deserves credit for expanding coverage in this area.

But what about Singaporeans with other diseases who may find themselves in similar predicaments? These diseases may not be as common as cancer but the advances in medicine can be just as transformative. Perhaps immune conditions such as lupus or rheumatoid arthritis? I know of at least one Singaporean who is living away from Singapore because her insurance overseas covers outpatient-targeted therapies for lupus.

What about multiple sclerosis, which is estimated to affect some 100 Singaporeans? It tends to hit women between the ages of 20 and 40, when many would be mothers and economically active.

MediShield Life cannot cover every disease comprehensively - there simply isn't enough money - but we don't need to stop at just cancer. Over time, transformative treatments even for less common diseases should be considered for specific inclusion in MediShield Life.

MediShield Life promises "Better Protection. For All. For Life". As we move into 2015, Singapore's 50th anniversary, let's make this more and more a reality for every Singaporean.

The writer is head of the health and life sciences practice, Asia-Pacific, for global consultancy firm Oliver Wyman.