Feb 9, 2011
COMMENTARY
Dedicated plan to cover birth risks, congenital problems lacking here
By Salma Khalik
EVERY year, about 860 babies - or more than two a day - are born with some serious birth defect.
Among them, more than half have a heart problem, almost a quarter have musculoskeletal problems such as scoliosis and about one in 10 has defects involving the urinary tract, chromosomes or central nervous system.
On top of that, thousands of babies are born prematurely every year, some of whom require special treatment in the first days of their life.
In 2009, 13.5 per cent of babies born at KK Women's and Children's Hospital (KKH) were premature. Of these, some needed no special care. But 8.5 per cent of all babies born at KKH - or more than 1,000 babies - needed either intensive or special care following their delivery.
For parents with such babies, the cost of hospital care is not cheap. According to Ministry of Health (MOH) figures, the median bill for neonatal care for babies below the age of one year was $450 for a subsidised patient in 2009. For a private patient, the median was $900. Even among subsidised patients, 5 per cent had bills that totalled more than $5,000.
For some, especially those with babies with serious congenital defects, the financial woes do not end there, as the child may need continuing medical care for some years, or even for the rest of his life.
There is currently little parents can do to protect themselves against such heavy financial liability, unlike in Malaysia, where parents are able to insure against treatment for congenital problems and other medical conditions following birth.
Despite the emphasis the MOH places on medical insurance, with Health Minister Khaw Boon Wan frequently urging everyone to have such insurance, Singapore does not have one that covers babies at birth, with one exception.
Babies conceived through in-vitro fertilisation (IVF) are insured. Parents trying to conceive through IVF methods must buy insurance for their babies.
Under the existing coverage, the cheapest premium is a one-time payment of $60, when only one embryo is involved. The baby is protected for the first six months of life, with payouts of $100 or $300 a day, depending on the level of hospital care needed. Payment ceases 180 days from birth.
It is compulsory because of the higher risks of complications from such assisted conceptions. At the upper limit, parents who are using four embryos in one attempt have to pay an insurance premium of $2,330.
The irony is that babies conceived naturally, who might also encounter medical problems, do not have that protection.
Commercial insurers have been chary of offering such coverage here for two main reasons.
First, they argue that it is difficult to assess the potential health risks an unborn child might face. The only insurance that provides some cover - PRUfirstgift from Prudential - covers a child for onlyup to $2,500 for hospital fees and $5,000 for congenital defects. This is far less coverage than its Malaysian equivalent, which pays up to RM50,000 (S$21,000).
This brings up the insurance companies' other reason for not offering good coverage for unborn babies - the lack of a 'critical mass', given Singapore's falling birth rate coupled with its small population. In other words, they do not think there will be enough people insuring to make it a profitable operation.
To be sure, private insurers have no social obligations, but are responsible to their shareholders for their bottom line.
As a result, normally conceived babies are the only group in Singapore who cannot get comprehensive health insurance. This is something that should be rectified.
Mr Khaw recently suggested that babies born with congenital problems could be covered under MediShield when it is next reviewed.
This would bring babies under the national health insurance plan, and is an improvement on the current situation.
But bringing these babies within the mainstream MediShield fold is unfair to others who are healthy, and whose premiums will have to go up to cover those with known medical problems, who will draw on the insurance from day one.
It would be more equitable to have a dedicated national pre-birth insurance plan. This BabyShield plan would cover all babies before birth, before it is known if a child is healthy or is born with a congenital problem. Premiums should be payable with Medisave.
Babies insured under this plan to cover the risks of birth should be allowed to move to the normal MediShield insurance once they are born - regardless of whether they suffer from any congenital problem or not.
In order not to overburden other subscribers, BabyShield should deposit a lump sum into MediShield should the infant have congenital problems that will require years of treatments.
Despite being a national health insurance plan, MediShield turns down applicants. In 2009, 500 applicants for MediShield coverage were rejected. It is not known how many were babies.
Sometimes, it extends coverage with exclusions. Exclusions means no coverage for any hospitalisation that is linked to the disease excluded. But that is the very disease the person needs help for.
Once BabyShield is introduced, all expectant parents should be persuaded to sign their babies up before birth. Ideally, they should do so within the first trimester of pregnancy, not wait till a possible problem has been diagnosed. With about 40,000 babies born a year here, there is some critical mass to help keep premiums affordable and payouts meaningful.
Today, many parents already start their children on MediShield when they register their births. They would probably require little persuasion to insure their babies a few months earlier.
Having a dedicated BabyShield insurance plan will bring the insurance umbrella to cover all, especially babies with difficult births, or those born with congenital medical problems, who are now left out in the cold.
salma@sph.com.sg
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