Labour Movement Offers Workers’ Feedback on MediShield Life to MediShield Life Review Committee

To better protect against large medical bills, and assure Singaporeans that they are covered for life, the Singapore Government will implement MediShield Life scheme in 2015. The MediShield Life Review Committee (MLRC) has been reviewing the scheme, and gathering feedback and suggestions from the public and key stakeholders, and will submit its recommendations to the Ministry of Health.

To better reflect the concerns of the workers, the Labour Movement held eight focus group discussions with over 300 participants from our various communities such as union leaders, youths, families, active agers, women, the self-employed, freelancers and pensioners.

The Labour Movement is glad that the Government is enhancing the MediShield to help Singaporeans cope with their healthcare and medical costs which will increase with an aging population.  

Based on the participants’ feedback, the Labour Movement would like to put forward several suggestions that fall into three broad areas:

            i)           Making Healthcare Affordable and Accessible

– Review current deductibles, co-insurance, chronic outpatient treatments included in MediShield to contain out-of-pocket expenses.

            ii)          Ensuring Relevance in MediShield Life

– Making sure benefits stay relevant to the changing profile of Singapore’s population, and reviewing duplication in insurance coverage to reduce premium wastage.

           iii)           Ensuring Inclusiveness

– Through collective efforts of service buyers and customers and freelancers/self-employed, to ensure they have enough Medisave savings for healthcare needs.

Making Healthcare Affordable and Accessible

Review current deductibles, co-insurance, and chronic outpatient treatments included in MediShield to contain out-of-pocket expenses:

·             Standardise deductibles across age bands

Currently, patients who are covered under MediShield have to pay a deductible, which is the initial amount to be paid for claim(s) made in a policy year, before there is MediShield payout. Patients aged 81 to 92 have to pay a higher deductible as compared to those 80 and below. Patients above 81 years old are likely not to be working and do not have monthly Medisave contributions. In addition, they are likely to incur relatively higher hospital bills compared to those that are younger.

Thus, to ensure that they have a peace of mind, the Labour Movement proposes to the MLRC that the deductible be standardised across all ages and reduced for those aged 81 to 92, as MediShield Life move towards universal coverage.

The current and proposed changes in deductibles are shown in Table 1 and 2 respectively.

Table 1: Current Deductible Amounts

Table 2: NTUC Proposed Changes to Deductible Amounts

·              Further Expand Co-Insurance Tiers

The Labour Movement welcomes the MLRC’s recommendations on 1 March 2014 to reduce the co-insurance rates borne by patients to 5-10% for inpatient and 10% for outpatient bills.

On this, the Labour Movement recommends to the MLRC to expand the tiers further to contain out-of-pocket expenses, especially in the event of a large medical bill.  For exceptionally larger bills, the MLRC could consider further tiering to help the patients cope with the cash outlay.

NTUC’s proposal for further tiering is highlighted in Table 3.

Table 3: NTUC Proposal for Further Tiering of Co-Insurance (as highlighted in pink)

·             More Assistance for Chronic Outpatient Illnesses

Currently, MediShield covers only hospitalisation, inpatient surgery, day surgery and approved outpatient treatments for cancer, kidney dialysis and organ transplants.

The Labour Movement hopes to see a review that will include more chronic outpatient treatments being covered under MediShield Life

·             Expand Standard Drug List (SDL)

Currently only a dozen new drugs are introduced into the list annually as reviewed by a panel of experts. However there are more than 1,000 new drugs registered in Singapore.

The Labour Movement suggests including more drugs into the SDL after they have been used regularly and effectively for a certain period of time. This would benefit the general public as total hospital bills would then be lowered and out-of-pocket cost reduced as drugs under the SDL would be cheaper than non-standard drugs.

Ensuring Relevance in MediShield Life

·             Review breadth and depth of parameters and claim limits

Since its introduction in 1990, MediShield has largely remained unchanged till the MediShield reform in 2005.  Enhancements to some of its parameters and claim limits were later made between 2008 and 2013.  However, healthcare costs have risen 15% during 2008 to 2013, based on Consumer Price Index of healthcare from the Department of Statistics.

We are pleased that the Review Committee’s preliminary recommendations include increasing the daily claim limits by between 33 and 55% for normal wards and Intensive Care Unit wards, to adequately cover most large Class B2 and C bills.

The Labour Movement urges for a structured periodic review of MediShield Life by MOH every three to five years to ensure the parameters and claim limits stay relevant and are responsive to meet the medical needs of Singaporeans and rapid advancements in the healthcare industry.

·             Review duplication of insurance coverage to reduce premium wastage since MediShield Life will provide universal coverage

The Labour Movement calls upon the tripartite partners to review the duplication of coverage – insurance and premiums – in the current system. This arises when an employee has both self-paid and employer-paid insurance. The outcome is to reduce the wastage of resources for companies and employees.

Ensuring Inclusiveness

·            Freelancers and self-employed

For this group of workers, the concerns are their savings for their healthcare needs.

The Labour Movement would like to encourage through the collective efforts of service buyers and customers and freelancers/self-employed themselves, to ensure contributions are made towards their Medisave accounts so as to build up sufficient Medisave savings for healthcare needs. We also urge the Government to consider providing some incentives to service buyers and customers to spur this effort.

·              Pensioners

There are an estimated 35,000 pensioners in Singapore. They are on two medical schemes: CPW (co-payment of ward) and CCS (comprehensive co-pay). Pensioners on the CPW scheme only need to co-pay 20% of ward charges while those on CCS co-pay 15% of the total bill.

For the pensioner group with their existing healthcare provisions, we need to ensure that with MediShield Life, they do not become worse off in the future.

Conclusion

The Labour Movement acknowledges that with these proposals calling for more benefits and coverage for MediShield Life, a higher premium can be expected.  

For MediShield members, they can play their part through pre-funding which ensures a better spread of premium payments over one’s lifetime so as to help with premium affordability in old age.

On the part of Government, it can provide support through MediSave top ups for the needy and low-income households to ensure they can have enough savings for their healthcare needs. This is in addition to the support that will be given to the Pioneer Generation.