MediShield Life should go beyond covering
patients for hospital treatment, to covering them for health screening. Early treatment,
after all, can help lower hospital bills.
The
launch of MediShield Life last year was a major milestone in healthcare for
Singapore.
With it,
for the first time, every Singaporean and permanent resident is assured
insurance coverage to protect them against large hospital bills, from the time
they are born till the day they die. This is especially crucial for people suffering
from chronic ailments that require lifetime care, such as heart or kidney
failure, and certain cancers.
The
Ministry of Health (MOH) must be applauded for taking this major step. But it
should not stop there. By underwriting the major healthcare cost of everyone,
it is certainly in MediShield Life's interest to keep people as healthy as
possible for as long as possible, as this is the only way to ensure that
healthcare bills remain manageable.
It is
time for MOH to consider making health screening compulsory within the
MediShield Life framework. This is one good way to control rising hospital
bills.
Already,
the Life Insurance Association says that in recent years, claims for B1 and A
class wards have increased by 12 per cent a year while those for private
hospitals have risen by 17 per cent a year. Higher claims inevitably lead to
higher premiums that everyone will have to pay.
Many
studies have shown how proven health screening can catch diseases early, and as
a result, reduce treatment costs as well as suffering by the patient.
This is
where MediShield Life can come in - since it is the one that will bear a large
part of the cost of treatment. It should make it compulsory for people to
screen for certain diseases at certain ages.
Screening,
for example, can dramatically reduce the incidence of some cancers. This not
just results in better lives for the patients, but also significantly reduces
the cost of healthcare treatment to the nation.
THE CASE
FOR MANDATORY SCREENING
This is
why, in the United States, most health plans must offer preventive services
such as vaccinations and screening tests, at no additional cost to the insured.
Insurers
there know that it is to their benefit to pay for such screening as it will
reduce the amount they would need to pay out if the disease is caught late.
The US
National Cancer Institute says 59 per cent of adults aged 50 to 75 have
screened for colorectal cancer according to its guidelines. Cases of colon
cancer there have fallen from 51 to 37 per 100,000 people from 2003 to 2013.
If polyps
in the colon and rectum are discovered and removed, they do not become
cancerous.
While
treatment for this cancer has improved tremendously, preventing it is always
better. Today, this is the most common cancer in Singapore, with close to 2,000
people diagnosed a year.
Other
cancers with high screening rates in the US include cervical and breast, and
deaths from these cancers have also gone down.
While the
actual cost effectiveness of national screening varies because such costs will
take into account not just the cost of treatment, but also loss of working
years, there is no doubt about the benefits in terms of human suffering.
This is
why countries push for certain diseases to be screened. Not all diseases can be
screened for. But where such screening is effective and available - such as for
diabetes - they can go a long way in curbing rising incidence and healthcare
costs.
Why make
screening mandatory, when there are already heavily subsidised ones, you may
ask.
It is
true that Singapore already has national screening programmes that are heavily
subsided or even free. For some, Medisave can be used. Yet the take-up rate
remains low.
As a
result, Health Minister Gan Kim Yong told Parliamentearlier this month that a
third of diabetics here do not even know they have the disease.
Diabetes
is a terrible disease, largely because it is silent till things go wrong - and
when that happens, it can affect many parts of the body.
In
Singapore, diabetes is the top cause of kidney failure - the number of people
on dialysis more than doubled from 2,764 in 2000 to 5,912 in 2014, and the
number continues to rise every year. It is also one of the top causes of
blindness and results in at least two amputations a day.
To make
things worse, Singapore has one of the highest rates of diabetes among
developed countries, second only to the US.
And
that's just diabetes.
Based on
national healthcare surveys by the MOH, one in four people here with
hypertension and almost half of those with high cholesterol levels don't know
they have these conditions. Both are major risk factors in heart disease and
stroke.
Being
unaware, they do not take steps to prevent their conditions from becoming
severe.
The
bottom line is that screening tools exist that can alert people in the early
stages of a disease, be it diabetes, cancer or cardiovascular disease. Whatever
the reason - fear, ignorance, apathy - the fact is that people aren't making
use of them, even when screening programmes are free or heavily subsidised.
But, of
course, people can find out they have a disease and still not do anything about
it. Mr Gan shared that of the people who know that they have diabetes, one in
three have poor control over their blood sugar levels. But the first step is to
make sure that people know that they have, or are heading towards, a serious
medical condition.
And the
only way to do that here, it appears, is to make such screening tests
compulsory.
It would
be best if these tests are provided free of charge. There are many studies that
show it is far cheaper to screen and to catch a disease early, rather than not
screen and to pay for treatment later.
US
insurers - hard-headed businesses - obviously believe this to be true as they
provide selected free vaccinations and health screening to their policyholders.
But
offering free screening tests alone will not be enough, as there will always be
people who would rather not know, or find it too much of a hassle since they
are not feeling sick.
So
MediShield Life should impose a penalty on people who refuse to screen - such
as adding a loading to their annual premiums which will remain in place until
they get screened.
There
will, of course, be exceptions, such as people who have already been diagnosed
with the disease. It no longer makes sense for them to screen, and it would be
unfair to penalise them for having the disease. Those who screen under private
schemes can simply get their doctor to let MediShield Life know that the test
has been done.
To
prevent concern that people would be disadvantaged if their insurance company
or employer finds out they have serious medical conditions, the results of the
tests should remain confidential between doctor and patient.
MediShield
Life only needs to know that the test has been done and the patient informed.
WHAT TO
SCREEN FOR
Exactly
what diseases MediShield Life should screen for and when they should be done,
can be determined by a panel of medical experts, drawing from the ample pool of
studies available.
It will
be tedious work but not rocket science to suss out which screening might be
cost-effective.
For
example, cancer, cardiovascular disease and diabetes together account for
almost half the years of illness suffered by people here. Today, Singaporean
men live about nine years with poor health, and women, almost 11 years.
The idea
is to ensure that people discover such conditions early, so that they are able
to nip them in the bud, or get their condition treated so it does not become a
major problem that will result in high hospital bills. Early treatment can also
spare them suffering for weeks, months or years.
It would
be a massive boon - to individuals and potentially to the Budget - if the
number of unhealthy years can be reduced through health screening and early
care.
No comments:
Post a Comment