Two letters to the Straits Times forum in the past week shed light on a little known fact that our national health insurance scheme, MediShield, does not provide the universal coverage that many Singaporeans would have expected it to.
On September 2nd, a parent wrote in to express dismay that his newborn daughter was refused MediShield coverage because she was born with a suspected cyst in her lungs, a condition diagnosed during pregnancy. He said the CPF Board, which manages MediShield, denied her coverage, citing “the higher insurance risk posed by her pre-existing health condition”.
The parent stated that he was prepared to pay a higher premium, but did not expect his daughter to be refused Basic MediShield coverage altogether.
In their joint reply on September 11th, the Ministry of Health (MOH) and CPF Board reiterated that they are “unable to insure her under MediShield at this point” because the girl is still undergoing treatment. They then went on to say: “We encourage all parents to secure early MediShield coverage for their children before the onset of illness.”
This was quite incredible: How could this parent have secured MediShield coverage for his daughter “before the onset of illness” if she was born like that? Are parents expected to insure unborn babies?
MOH and CPF ended by saying: “Children with pre-existing health conditions can still join MediShield, but like other medical insurance schemes, MediShield could impose exclusion of certain pre-existing medical conditions from claim while still offering coverage. This is to ensure viability of the insurance scheme and to keep premiums affordable for existing members who generally enter the scheme in good health.”
Therein lies the crux of the problem, which I think requires a mindset change in this government.
Firstly, MediShield is Singapore’s national health insurance scheme, set up by the government and run by a government agency. It is not simply “like other medical insurance schemes”.
Secondly, why are MOH and CPF talking about ensuring the “viability of the insurance scheme” by excluding certain categories of Singaporeans from coverage? Since this is a state-run insurance scheme, it should be underwritten by the government as part of their social contract with Singaporeans.
Furthermore, with 75% of Singaporeans paying MediShield premiums, this should provide a huge financial base which private insurers do not enjoy.
Indeed, to get a picture of how “viable” MediShield currently is, readers can check out CPF Board’s 2008 Annual Report, which shows that last year, $303 million in premiums were collected and only $161 million was disbursed as claims. After factoring in all the administrative costs and interest earned, the MediShield fund stands at a healthy $205 million in the black.
Will it really become “unviable” if they start covering those few unfortunate newborns with congenital illnesses? (It should be noted that MediShield also excludes those over 85 years old from coverage, and it recently increased the premiums for all members, particularly the elderly.)
More importantly, what is wrong with MediShield going a little into the red? Can’t that be easily covered by the $5.6 billion that CPF gained as income from its investments of Singaporeans’ retirement savings last year?
MediShield is supposed to be one of the “3Ms” of the government’s much vaunted health care “safety net”. But if CPF Board can cherry pick who to insure and who to reject, then what makes it different from any profit-oriented private insurance company?
This revelation from MOH and CPF comes just as the debate about national insurance schemes is raging in the US. President Barack Obama in fact recognized this problem of insurers refusing coverage just when people needed it the most. In his health care speech to Congress this past week, he said of his new health care plan:
“What this plan will do is make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a preexisting condition.”
Singaporeans have been led to believe that we already have a fantastic “public option” (i.e., a state-run health insurance scheme) in form of MediShield.
Well it seems MediShield is public alright, but with a lot of options for our bottom line driven government.