Debate on MediShield Life Scheme Bill

During the debate during the second reading of the MediShield Life Scheme Bill, I raised several concerns and questions regarding the disclosure of confidential information and the approach to the recovery of outstanding premiums. I pointed out that some people may have genuine privacy concerns and they should not be automatically penalised for it in the form of higher premiums. Instead they should be allowed to make statutory declarations about their health status.

During the debate during the second reading of the MediShield Life Scheme Bill, I raised several concerns and questions regarding the disclosure of confidential information and the approach to the recovery of outstanding premiums. I pointed out that some people may have genuine privacy concerns and they should not be automatically penalised for it in the form of higher premiums. Instead they should be allowed to make statutory declarations about their health status.

Speech delivered in Parliament on 29 January 2015

Mdm Speaker,

This Bill gives effect to the MediShield Life Scheme, which was debated in this House in July 2014. It spells out the framework for the disclosure of an individual’s confidential health and financial information, recovering outstanding premiums, and the offences and penalties for false declarations and claims.

I have several concerns to raise regarding the disclosure of information and the recovery of outstanding premiums.

DISCLOSURE OF INFORMATION

First, on the disclosure of information described in Part 5 of the Bill.

The Bill authorises certain “authorised persons”, including public servants from the Central Provident Fund Board (CPF), the Ministry of Health (MOH) and public hospitals, to tap into various government databases to extract an individual’s confidential health information for two purposes: One, to assess whether a person has pre-existing medical conditions for which premium loading may apply; and two, to assess the person’s benefit claims under MediShield Life.

The Bill also permits these authorised persons to request for, access, use or disclose to other authorised persons the “means information” of an individual, which could include monthly income, income tax data, information on assets, residential address and household composition.

My queries and concerns on this Part of the Bill fall into four categories:

1. The means testing process;
2. The extent of access, disclosure and use of confidential data;
3. The process and consequences of opting out; and
4. Safeguards to prevent illegal disclosure.

Means testing process

First on means testing. I understand the rationale for authorising this disclosure of health and means information is to facilitate a smoother and more seamless execution of the MediShield Life Scheme.

I raised the matter of means-tested premium subsidies in both my adjournment motion on healthcare affordability in November 2013 and during the MediShield Life White Paper debate in July 2014. I had asked for premium subsidies to be provided automatically to households that have already undergone means-testing for other government assistance schemes like CHAS (Community Health Assist Scheme). I also asked for the appropriate level of premium subsidies to be automatically extended to all vulnerable groups of Singaporeans, without requiring them to apply separately. This is so that all individuals who are eligible for premium subsidies will receive them with minimal paperwork.

Can the Minister confirm if the provisions in this Bill will enable means testing to be automated, such that individuals do not have to submit additional forms to receive the premium subsidies?

If not, what would be the procedure for individuals to apply for premium subsidies, and how will MOH ensure that the process is simple and convenient, especially for the elderly, people with disabilities or those with lower levels of literacy?

Given the very tough premium recovery measures in Part 3 of this Bill, it is ever more important no one misses out on their premium subsidies, if they are eligible to receive them.

Extent of use of confidential information

Next, the use of confidential information.

Will the Government and its functionaries be allowed to use any of the confidential information authorised under this Bill for purposes other than means testing, premium calculations and benefit claims assessments? I note there are provisions under the Bill, including in Clause 30, for the Minister to approve the access or disclosure of such information as he “considers appropriate”. This is gives very broad powers to the Minister and could potentially negate the protections spelled out in other parts of the Bill.

Can the Minister give some examples of what he may “consider appropriate” for access or disclosure of confidential information that is not already provided for in this Bill? Can these not be spelled out in the Bill instead of giving the Minister so much discretion?

Opting out

Next, on opting out.

For those who do not consent to access to their confidential information, how will they opt out? Will the process be made simple and explained clearly to all persons, including those who have not yet expressed a desire to opt out? The Bill does not explain the procedure for opting out, but simply that it should be in “the manner determined by the Minister”.

If individuals opt out, will they automatically have a 30% premium load for 10 years imposed on them?

It is easy to assume that people all fall into one of only two groups: First, those who are willing to allow the Government to access their health and means information; and second, those who have some medical conditions that they are trying to hide so as not to attract higher premiums.

But there is a third group of individuals: Those who have no medical conditions that warrant higher premiums but still do not wish to give the State such wide ranging access to their personal information. People in this group should not be penalised for wishing to maintain their privacy, neither should they be forced to make a Hobson’s choice: Either permit access to your data, or pay higher premiums.

For individuals who are concerned about privacy, can the Government allow them to opt out from the provision of health information, and instead make a statutory declaration about their health status? If they declare that they have no relevant medical conditions, they would not be required to pay higher premiums. If they are untruthful in their declarations, then there are already penalties in this Bill and other laws that can be used to punish them and deter such behaviour.

I believe this would strike a fair balance between individuals’ desire for privacy and the need to ascertain their health status for premium calculations.

Safeguards to prevent illegal disclosure

Next, on safeguards.

This Bill greatly increases the potential number of people who will be authorised to access confidential information of individuals. We have seen examples in other countries where public officers who were given wide-ranging access to confidential information misused that information and even disclosed it publicly. We have also seen large organisations have their computer systems breached by hackers and suffer massive losses of confidential information, including health information of their employees or credit card numbers of their customers.

I note that there are penalties in the Bill for unauthorised disclosure. But it is not always easy to track down the source of a leak, and in any case, once confidential information is leaked, the damage would have already been done.

With the introduction in this Bill of such extensive authorisation to access confidential data, do the relevant agencies plan to significantly beef up the security of their computer systems to prevent unauthorised data access, either by external hackers or by disgruntled insiders?

Can the Minister assure us that authorised persons will be given access only on a strictly “need-to-know” basis, regardless of their seniority, and that the data in their possession is removed as soon as it is no longer needed?

I note that a new Cyber Security Agency (CSA) has been set up under the PMO. Will the security of confidential information covered in this Bill come under the purview of the CSA?

RECOVERY OF OUTSTANDING PREMIUMS

I now move on to Part 3 of the Bill: The recovery of outstanding premiums.

Under the Bill, those who do not pay their premiums could also be slapped with penalties of up to 17% of outstanding premiums and interest on late payments. Can the Minister elaborate on how the penalties will be computed and how soon after a default will they take effect?

The Bill empowers a “recovery body” to use methods of recovery of outstanding premiums similar to that used by the Inland Revenue Authority of Singapore (IRAS) to recover outstanding taxes. These include declaring any person or entity to be a “defaulter’s agent”, who could be one’s employer, bank or tenant. The defaulter’s agent will then be obliged to pay the premiums due from any salary, pensions or rent that he owes to the defaulter. Defaulters could also be sued.

I agree that those who have the means to pay their premiums but fail to should be firmly compelled to do so. This is only fair to other policyholders who are contributing their fair share to ensure that the Scheme is sustainable and viable in the long term. However, can the Minister assure the House that the Government will not aggressively pursue individuals who default due to their genuine inability to pay?

I am not referring to the destitute, who can be helped by premium subsidies, but those who may not qualify for premium subsidies but still cannot pay. For example, individuals who have lost their jobs or cannot work due to illness. Can the Government allow for premium deferment for such individuals who may have temporarily run into hard times financially?

And lastly, if an individual continues to default on premium payments, will he ever lose his MediShield Life cover? I hope this will not be the case, because it will call into question the universality of MediShield Life.

CONCLUSION

In conclusion, Madam, I support this Bill but have expressed a number of concerns about the disclosure of health and financial information, and the enforcement of the measures to recover outstanding premiums. I hope the Minister will address my queries in round up speech.

Author: Gerald Giam

Gerald Giam is the Member of Parliament for Aljunied GRC. He is a member of the Workers' Party of Singapore. The opinions expressed on this page are his alone.