Sunday, July 13, 2014

Medishield Life- Singapore's Obamacare... what's there not to like?

Medishield Life- Singapore’s Obamacare… What’s there not to like? 

Dear friends,

A long-time reader of my blog asked me to comment on Medishield Life (MSL) (MOH link here, here and here) from a doctor’s view-point.

LOL- the assumption was that doctors understand Medishield more than the lay-person.

Truth be told- many of us, docs, do not fully comprehend the soon to be defunct Medishield as it was irrelevant to us (esply in the private healthcare system). When asked by many patients how this 2nd of the 3M   ie (Medisave/Medishield/Medifund) was relevant to their impending surgery/hospitalization… I just truthfully say- “it is irrelevant to you ( in private hospital with elective ENT condition) as it does not affect you”.

The high “deductibles” plus the “co-insurance” portions means that when the final invoice is issued- little (if any) Medishield funds will be disbursed in most private hospital scenarios. Please do not be confused with the Private Integrated Plan ( enhanced private scheme that supplements Medishield).

Private hospital healthcare is very expensive and as Medishield is designed for the public hospitals’ B2/C wards in mind, the payout portion is miniscule compared to the total private hospital bill and even if disbursed, it will be such a negligible portion of the total bill as to be meaningless.

Friends- I hope that you do not think me as condescending … but if you think public healthcare is expensive, you have not seen anything yet.  That is why we must do something to ensure healthcare remains  affordable to Singaporeans … in both public and private healthcare sectors. Did you know that public hospitals often act as pricing signal for the private sector? Many procedures/investigations cost more in the public hospitals. Hard to believe?

Also- don’t confuse MSL with CPF Life or with the debate about CPF payouts or even with the court case about the PM and Roy.

Medishield Life (MSL): Universal coverage that will be affordable to most in B2/C Ward setting.

1.MSL is not free healthcare. Anything that is free attracts morale hazard ( also known as buffet syndrome). Co-payment ( even a little) makes one less generous with other people’s money. Hence I am a strong believer in need for deductible and co-insurance.

I have seen people who feel that since they paid insurance premiums- then their hospital stay should be like a holiday stay with consultations with multiple different specialists (even when not needed) and with many expensive tests thrown in for good measure.

2.Advantages of  MSL in a nutshell (click here). 
All -even those with pre-existing conditions and previously uninsurable ,are covered. No one is rejected ( although there is higher premiums for pre-existing conditions). IMHO- it is good that no opting out means that no one sacrifices his health due to pressure from domestic situations etc. All of us chipping in to ensure no one gets left behind is a good thing. 

Lower co-insurance: That means for each hospitalization- out of pocket cash portion is less.
Increase in limits  for annual claim/daily claim limit/each surgical procedure/ outpatient cancer treatment ( Chemo/radiotherapy).

Contrary to what I expected- the deductibles appear unchanged.

Rightly- higher wards such as B1/private wards and private hospitals, does not come under ambit of MSL. Government should take care of basic no-frills healthcare. If one wants the bells and whistles- then pay for it.

3. Cost of future healthcare should be consciously contained
Even in public hospitals- the cost should be contained or else the payouts from the MSL would soon be made redundant in a few years time. Eg the surgery cost for Table 7 ( most complex surgery) will easily be more than $2000 (MSL surgery claim limit now) if not controlled.

4. Perceptions of B2/C wards should be addressed
The general public perception that doctors/medications for B2/C class are inferior to higher class wards should be addressed and corrected. Does MOH keep track of every hospital department to ensure that doctors with appropriate competence treat each patient regardless of ward class? I am sure the majority of departments do- but are there black sheep department? If one needs robotic or minimally invasive surgery- one must get it (and not have to upgrade to higher class ward).  If Generic (unbranded) drugs are just as good they should be used for all class patients. Proprietary (branded) drugs still under patent- should be used in patients of all class- if needed. No discrimination!

Every public hospital is a teaching hospital- regardless of class ward- trainees (medical students/ post-graduate doctors) should have access to all patients – but they should of course be closely supervised. Doctors have been trained via apprenticeship from time in memorial!

I fully support the thinking behind MSL. No one should be left behind. We should tweak the top-ups to help those who have problems paying for the premiums and keep an eagle eye to ensure every public hospital department does not neglect B2/C ward patients.

Don’t anyhow protest.. or we risk throwing out the baby with the bath water.


Dr Huang Shoou Chyuan

1 comment:

mystery said...

I don't know why there are so many adverts on TV regarding MSL.
They are willing to spend so much money for the advert instead of increasing benefits of MSL.
What is the use of no lifetime limit when the you can claim so little? The surgical table limit is so miniscule. $2000 for surgical procedure 7 is a joke. (the range from table 1 to 7 is $200 to $2000). Really?? which hospital will charge you that rate even for subsidised patients? If they think the plan is for class c/b2 then remove the table limits and peg it to 'as charged' for c/b2 patients in govt hosp.
To me, the MSL is just an excuse to increase premiums to subsidise those who are not currently insured and which the state is likely to shoulder the burden.
The MSL- small bill, you can't claim because of deductible and co-payment. Big bill, very little to claim because of the surgical table limits. They are covered on all sides.
And they say it's good? Pleeease