Govt considers covering congenital illnesses under MediShield

MediShield should be run on social principles, to ensure that no child, no adult, no elderly person is left behind because of their inability to pay.

I am glad to read that, in response to the calls from several Singaporeans, including Tan Kin Lian and myself, the government is now considering covering under MediShield, the national health insurance scheme, children with congenital illnesses.

In a letter to the Straits Times (21 Sept 2009), the Ministry of Health (MOH) said that:

…for those with congenital illnesses, we are sympathetic to their plight. We would like to get them insured but precisely because they are in the minority, the premiums will be high for such a risk group. One way to lower the premium significantly is for the majority of Singaporeans without congenital illnesses to cross-subsidise them through higher premiums across the board. This is done in some countries and we are studying their experience. But such an approach will require the support of Singaporeans.

While I am glad to hear of this long overdue move by the government, I disagree with its proposed approach, which is (1) to make the parents of the insured children pay much higher premiums; and (2) to increase the premiums of all Singaporeans to cross subsidize them.

Let me state from the outset that I personally have no objections to paying higher premiums if it is the only way to provide insurance coverage for children with congenital illnesses, especially those from low income families.

But I don’t think that is the only way.

From what I know about how this government operates, they want MediShield to be a self-funding scheme — and preferably profit-making. The government’s rationale, I would assume, is that MediShield needs to be sustainable for future generations of Singaporeans and they cannot have it depend on constant government injections of funds to prop it up.

As I’ve said before, this is not the way a state-run health insurance scheme should work.

There is a distinct difference between a national health insurance scheme and private insurance schemes. Private insurance exists for the purpose of enriching the shareholders of the insurance companies, and minimizing the payouts.

MediShield should be run on social principles, to ensure that no child, no adult, no elderly person is left behind because of their inability to pay. It should be run on a cost recovery basis — but only as far as possible. For certain categories of people like sick babies, the elderly and the poor, we cannot expect them to bear the same burden as the wealthy. It should definitely not be run for profit, as it appears to be now.

My proposal is for the government to cover the higher premiums for these babies with congenital illnesses. Since such babies are in a minority, as even MOH has admitted, the cost cannot possibly be prohibitively high, especially in contrast to the $5.6 billion that CPF Board (which administers MediShield) gained from its investments of Singaporeans’ retirement savings last year.

Raising a child is difficult enough. I cannot imagine the financial and emotional burden that parents with sick children have to bear. If we aspire to be a compassionate country, the government should lead by example and help relieve the financial burden of these parents.

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6 thoughts on “Govt considers covering congenital illnesses under MediShield”

  1. I’ve written about the need to cover children at birth with congenital problems because of the high cost of treatment. Heart defect cases requiring long stays in ICU or babies born prematurely will incur very high bills – six figures bills are not uncommon. These children require extra care and very often the mother has to quit her job to care for the child.

    What good is a system that leaves out the most severe cases? We have about 33,000 children born every year and about 1.5-2% of them will be born with congenital problems. We are talking about 400 babies every year. Assuming the cost is $100K we are talking about $40M that is roughly $1K per child born. $40M…it is not that the govt cannot afford to solve this – it is what priority the govt gives to this problem. We spend billions every year on guns and planes that we probably won’t use to fight but cannot do this for the parents of Singaporean babies who need our help the most…it is unconscionable.

  2. I don’t think it’ll even cost that much, Lucky. Not all babies born with congenital illnesses will be so sick to have medical fees that high. As you’ve said, the purpose of national insurance is to help those who need it, not to enrich the insurer.

  3. Yes agree. Even the absolute worst case is pocket change for this govt so what is this govt waiting for?

    I was at a Club Rainbow function once and spent considerable amount of time talking to the parents. It is so tough for them to cope with a child with medical needs in terms of man effort and all of them spoke of the high cost just adds to their burden.

    We have a low tax near zero welfare system so the govt passes the responsibility of taking care of the old to the children, passes the cost of medical care to the sick, paases the responsibility of caring for the elderly back to the elderly …and so on. The unfortunate carry their own burdens…superimpose this on top of the big income gap. So where is the risk pooling mechansim in our society…..ITS EVERY MAN FOR HIMSELF…you make money you keep, you get a misfortune take care of it yourself, …after a while you will get a lot of people who don’t care, they will just leave when they can.

  4. My daughter has a congenital condition and we can’t find a private insurance company to cover her. Initially i thought Medishield could be of help, but seems that i’m mistaken. It does appear that Medishield operates just like any other private insurers. Just that they charge lesser premium and in turn gives lower coverage. It doesn’t seem to be playing much of a social role.

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