Monday, September 14, 2009

Offer window period for uninsured to join Medishield

Printed in Straits Times Forum Page, 14 September 2009

Editor
Forum Page
Straits Times

When Medishield was introduced more than two decades ago, the Government decided to cover CPF contributors only and give the right for members to opt-out of the scheme. Some members opted out as they were already covered by their employer or for other reasons. Many other people were not covered under Medishield as they do not have a CPF account at that time, for example, they were not working or self-employed.

Today, there are many people who are not covered by Medishield. They are allowed to join Medishield but are subject to underwriting. If they are not in good health, they may be rejected or have exclusions imposed on them.

As many years have passed since Medishield was first launched, it is time to review the need for underwriting requirement for Medishield. I suggest the following measures:

a) Have a window period to allow those not insured to join Medishield on special terms. They are not subject to underwriting but will have existing illnesses excluded or partially covered for a period of two years. These illnesses will be fully covered after the two year period. The excluded illnesses will be of a serious nature and will be defined clearly.

b) Identify the non-insured people, approach them and have an easy way for them to join Medishield. The people to be approached are those with a Medisave account, who is not covered under a Medishield plan.

c) Make it compulsory and automatic for all new-born babies to be covered under Medishield.

It is important to have every resident covered under Medishield, so that they will not be bankrupted by the high cost of major medical expenses. As Medishield is a national scheme, it can be made easily available to all eligible people, without the need for the meticulous underwriting measures that are adopted by commercial insurers. The risk of adverse selection and moral hazard is already reduced by the imposition of a deductible that has to be paid first by the insured.

We have read about the debate in USA about reforming their health care system and the need to offer coverage to more than 30 million uninsured people.

We have a similar problem in Singapore, although on a smaller scale. We have to act early and offer coverage to our own uninsured people.

Tan Kin Lian

2 comments:

Anonymous said...

"It is important to have every resident covered under Medishield, so that they will not be bankrupted by the high cost of major medical expenses."

Is it true? How many people in Singapore have been bankrupted by high cost of major medical expenses? I think it is less than 1 in 100,000.

I don't think Medishield can help at all to save these people from being bankrupted.

If you stay in higher class wards, then bills will be high - Medishield is inadequate.

If you stay in lower class wards, then bills will be low - you cannot be bankrupted by low cost bills.

Why should we pay our hard earn money that is earning 4% to our elite government?

Anonymous said...

I think a lot of people underestimate healthcare bills even in lower class wards, especially with means testing now. Medishield is a good scheme but it covers only 84 percent of the population and does not cover congenital conditions. Some people are lucky enough not to have even a single friend or relative who has pre-existing condition and is not covered by Medishield. They are correct that extending a window period now to cover those with pre-existing conditions who had missed out on Medishield is going to drive up costs and raise premiums. The selfish ones among these people are of course not willing to see any such change to the scheme that will increase their premiums but only benefit others. They of course do not consider that if the govt had done a proper job, Medishield would already have covered everyone and premiums would not have been as cheap as it is now. A strong govt should make the case for extending the window period to the uninsured with pre-existing conditions and go ahead to execute in spite of the selfish voices of dissent. Alternatively it can use govt budget to pay for this medishield change by subsidising the premium. This will quell the selfish voices but at the expense of govt coffers. In the same vein, Medishield should also be extended to cover congenital conditions as well.

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