Commentary | Lian Jiade
At the start of 2019, the issue on the adequacy of Medshield Life in covering medical expenses received public attention. This was due to a case of an elderly who was asked to pay 4472.30 SGD out of a total fee of 4476.80 SGD for cataract surgery at the Singapore National Eye Centre (SNEC).
Some were surprised as to why Medishield life, our national health insurance scheme, paid a meagre $4.50 when it was supposed to provide coverage and cushion Singaporeans’ medical expense.
While an analysis of the calculation breakdown explained the rationality of the $4.50 payment, two critical issues, however, caught the eye of the public.
Claims limit*
One issue was why there was such a distinction between what was charged by a public hospital ($4476.80) for cataract surgery and the claims limit imposed by Medishield Life for the surgery ($2800).
The SNEC has explained that their fees are higher than other public healthcare institutions as they are a tertiary eye centre.
This then makes people wonder if the claims limit implemented by Medshield Life is out of touch with the fees charged by public hospitals.
Could claims data used during the formulation of Medishield Life become obsolete given rising medical expenses due to the advancement of medical technology?
Deductibles*
The second issue was the question on deductibles. It is common practice among insurers to impose deductibles to encourage responsible claiming among policyholders. This is to keep premiums affordable for the general population ultimately.
However, this incident has made some wonder if a national health insurance scheme should be imposing a 3000 SGD deductible for policyholders above the age of 80.
This is because most users of Medishield Life seek necessary – sometimes even vital – medical treatments at approved hospitals.
Hence, the issue of irresponsible claiming which warrants a higher deductible on policyholders may not be as relevant as in the case for private insurance.
Could there be more leeway in terms of deductibles especially on the elderly to reduce the already high medical expense on Singaporeans?
Overall, while it is heartening to see the Ministry of Health (MOH) and SNEC respond swiftly to the incident, with MOH pledging to review the claims limit set in Medishield Life more frequently and SNEC relooking their fees structure, this incident also brings to our attention other areas for improvements.
One such area is that the development of a more robust framework by the government to monitor the adequacy of not only our national health insurance but also other social policies to ensure that its sufficiency is not eroded by changing circumstances such as inflation and technology.
By doing so, policy reviews and adjustments would be carried out by the government more frequently and effectively to ensure problems could be nipped in the bud.
Singaporeans as a whole would surely hope that our social policies are being monitored actively to ensure they remain relevant to changing circumstances and in addressing the social and economic needs of the people.
*Claims limit: maximum amount of money an insurance company will pay you for a covered loss*Deductibles: The insurance deductible is the amount of money you will pay in an insurance claim before the insurance coverage kicks in
About the author: Jiade is a year 1 accountancy student with a keen interest in the national affairs of Singapore. He is an avid reader of domestic political news and keeps up to speed with ongoing developments. Jiade believes that all Singaporeans should see themselves as stakeholders of the country and actively participate in shaping the political discourse of Singapore.