Monday, August 6, 2012

Iron out flaws in MediShield first

Aug 03, 2012
By Salma Khalik Health Correspondent

THE birth of a child should be a joyous event. Unfortunately, this is not the case for all.

Between 2 per cent and 3 per cent of babies born each year in Singapore suffer from some congenital problems. Some conditions, such as a cleft palate or a club foot, merely need some initial treatment for the child to lead a completely normal life. Some others, like some congenital heart diseases, might require lifelong care.

The cost, even for a highly subsidised C class patient, can vary from a few hundred dollars to more than $100,000, which most people would find a heavy burden.

Everyone appears to agree that parents of such babies, and the people with such problems, should get help. What they disagree on is who should pay.

Is this something that society as a whole can help out with, should we all share the burden?

Since the subject was raised a few years ago, there have been discussions on whether MediShield, the national health insurance scheme that covers 93 per cent of the population, should cover congenital problems.

Those with a strong social conscience, or with personal or family experience of such problems, are vocal in its support.

Others, worried about the additional cost to them, argue that asking policy-holders to pay for the treatment of a known problem is unfair to the healthy. Instead, they view insurance as essentially pooling risks for potential problems that all are at equal risk of getting.

They argue that it should be the Government's job to look after such unfortunate people.

Given the polarisation of views, the idea of extending insurance coverage for neonatal and congenital diseases is clearly not one that the Health Ministry can push through without strong public support.

There are at least a few other reasons why some are wary.

As is obvious, the need for neonatal care is immediate and congenital problems are usually diagnosed within the first year of birth.

As MediShield is an opt-out scheme, there is nothing to stop parents of healthy babies from signing up at birth, and then opting out after the first year when they realise their baby does not need the coverage.

The Ministry has calculated that if the parents of children aged up to 20 years are fully behind it, then all each has to pay is an additional $12 a year. This means everyone needs to pay a total of $240 more - over a period of 20 years - to help out.

To some, this is part and parcel of being a caring society, to share the burden of paying for treatment for the stricken.

Others may view this as a forced subsidy they are unwilling to bear. Such people might decide to drop out of the scheme after a year or so, once they are confident that their child is not suffering from any congenital diseases.

If the group that drops out is large, it would push up premiums for those remaining on the scheme, which could lead to a domino effect of even fewer people wanting to be on it. Folk who are willing to pay $240 for coverage their family does not need, might baulk at $480, or more.

There is, however, a way out of this dilemma, and that is to load the premiums upfront in the baby's first year, or even better, from before the birth of the child.

That is when parents are still uncertain if their child has such diseases, and when they are likely to be willing to fork out the premiums for peace of mind.

At that point in time, most parents would be willing to pay high premiums of $200 or even more - especially as it can be taken from their Medisave accounts.

This means very little of the cost needs to be spread out among policy-holders up to the age of 20, making it less likely that they would drop out.

But the suggestion to cover neonatal and congenital problems with MediShield has another flaw.

This basic scheme is pegged at subsidised treatment at a public hospital. But more than half the babies born here are delivered in private hospitals.

If the baby is born premature, treatment will have to be at the place where the infant was born. If they are transferred to a public hospital, the child has to be a private patient.

A KK Women's and Children's Hospital spokesman said to downgrade to a subsidised ward, the parents have to be means tested. Is the payout from MediShield enough to pay for private treatment?

If not, it might defeat the purpose - unless the MOH is willing to change the current rule and allow any infant transferred from a private hospital to enjoy subsidised rates.

After several years of discussion, it would be a pity if Singapore is still unable to insure people born with congenital medical problems, or the several thousand born premature each year.

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