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Source:
www.gov.sg |
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MOH Budget Speech (Part 1) -
Gearing Up for 2020 |
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By Mr Khaw Boon Wan, Minister
for Health |
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This is my 4th Health Budget. Having dealt
with the more immediate issues for 3 years, I will from now on focus on
gearing up Singapore for its 2020 healthcare needs. |
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Introduction |
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I will be 68 by then, with my wife
equally silver-haired. |
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My daughters should be married and
hopefully we will have a hall full of grandchildren. |
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My family and I will need much more
healthcare than we do now. |
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Hence, I am most mindful that 2020 is
only 13 years away. We must not let it slip by casually. |
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The questions posed by Mdm Halimah and
Dr Lily Neo are pertinent. We must have answers to those questions
over the next few months and continue to refine them over the next
few years. |
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The socio-demographic changes to come
are well-known. Still it is worth highlighting the key factors
that will significantly impact our future healthcare demand. |
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Most Singaporeans will be better
educated, have higher expectations, want high-quality care and, I
hope, be able and willing to pay for it. |
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For the bottom 20%, striving to cope
with global competition, money will be tight and healthcare cost
will be their key concern. |
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The number of people above 65 will
increase; fortunately most will be healthy and well. Many will
however be health-conscious and will seek medical attention
without hesitation, to address any discomfort or just to be
assured. |
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The number of "old-old", exceeding 80
years of age, will increase many-fold. By this age, many will have
some medical problem. Many will be financially comfortable, but
there will be a sizeable number who will be tight financially. |
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Scientific discoveries, medical
technologies will accelerate and make available diagnostic and
treatment modalities that we can only dream of today. |
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But many of these will be costly and
the companies that invent and produce them are not going to give
them away for free. |
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Clearly, one size will not fit all. As
Health Minister, my duty is to put the big pieces in place so that
by 2020, we have a healthcare system that offers the full spectrum
of care that meets the needs of the young and the old, the rich
and the poor and the large numbers in between, and we have the
financial resources to pay for them. |
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So let me start with funding. |
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(a) Financial Resources |
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In the musical cabaret, Lisa Minelli
sang "money makes the world go round", and Jack Neo made "money no
enough" part of our psyche. Well, money does not make the world go
round, people do. And we will have enough money for healthcare if
we save for it, have the right expectations and do not waste. |
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What are the realities of healthcare? |
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Everyone will need it, most towards
the latter part of life when we are not at our peak in earnings. |
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Social welfare and comprehensive
insurance are seductive ideas - no need for co-payment and nobody
needs to worry about healthcare cost. |
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But they both lead to the "buffet
syndrome" of abuses and over-servicing and financial disaster.
When the healthcare system is overwhelmed, the poor suffer as
unlike the rich they cannot afford other alternatives. |
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The truth is that healthcare demand is
unlimited but supply is, because not many people will willingly
pay more tax or insurance premiums which are needed to expand
supply. |
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The rational approach is to require
some co-payment by patients. A meaningful co-payment makes a
dramatic difference to patient behaviour and even doctors'
behaviour. |
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So that everyone can afford the
co-payment, we get everyone to save through Medisave for a rainy
day. |
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On top of that, we pool the risks
through a basic insurance plan, MediShield, as the backup. |
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Finally, we provide sensible social
welfare through Medifund as the ultimate safety net. |
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This is how we tackle the financing
challenge, with 3Ms providing multiple layers of safety nets. |
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Each layer does not cover all cases,
but together we cover everyone. Dr Muhammad Faishal asked that we
explain our healthcare financing schemes more thoroughly to
Singaporeans. I fully agree. |
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We must keep the schemes easy to
understand, because healthcare can sometimes be complex. We will
improve our public communication efforts. Let me use this
opportunity to reiterate our model. |
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For minor treatment and healthcare
needs at GPs and polyclinics: use cash. Our GP services are very
competitive, inexpensive and affordable for most people. |
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For larger medical expenses that
require hospitalisation, our Medisave scheme is working as
designed, especially after we have fine-tuned it in recent years.
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I have now extended Medisave to cover
outpatient treatment of 4 common chronic diseases. |
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Its full impact will be felt over the
years when the scheme matures. I am optimistic that, if
participating chronic patients co-operate with their Family
Physicians and actively change their lifestyle and comply with
medication, their health will improve. This will avoid future
complications and save patients money and suffering. |
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Mr Low Thia Khiang asked that we
remove or lower the cash co-payment; I think that will be unwise.
Remember that Medisave was not designed for outpatient care. We
must not unwittingly deplete it for purposes not originally
planned as then the contribution rate will not be enough and we
would have to raise it. |
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Collectively, there are $36 billion in
our Medisave Accounts today and this is still growing at more than
$1 billion a year. This is healthy but only because we are still a
very young society. Medisave is our savings for the future when we
will all grow old. |
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The only structural problem now is
that some Singaporeans, a minority, are not saving. They are
naturally worried about healthcare cost. The solution is not to
make healthcare free but to get them to save. Workfare and
Government top-ups will help them build up their Medisave for the
future rainy day. But they must themselves make some effort. |
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For larger medical expenses requiring
intensive and prolonged hospitalisation, we have MediShield. |
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After the reform in 2005, it is now
working better. We will continue to refine it to reduce the
co-payment by patients but we must not make it a comprehensive
medical insurance scheme without any need for co-payment. |
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Some insurers sell MediShield riders
to eliminate co-payment. This is not wise and we do not encourage
this. That is why we do not allow Medisave to pay for the premiums
of such riders, as proposed by NMP Cham Hui Fong. But if
Singaporeans want to buy such riders out of their cash savings, I
cannot stop them. |
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I have a couple of ideas to enhance
MediShield further. MediShield coverage among active workers is
not bad, at 90%. |
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But 390,000 Singaporeans below 20
years of age are not insured. The premium at their age is
inexpensive, only $30 per year. |
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And young parents can use their Baby
Bonus to pay the premium. So cost is not the issue. Many parents
already do so; in fact about half of our youths are covered by the
enhanced MediShield promoted by private insurers. Some parents who
did not do so told me that they know MediShield is good but
inertia is the reason for their lack of participation. |
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MediShield Auto-Cover for Children |
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I will make it easier for these
parents to sign on their children for basic MediShield coverage. |
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We will introduce an opt-out scheme
for infants to be automatically covered under MediShield from the
time their births are registered. |
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Premiums can be deducted from their
fathers' Medisave or alternatively their mothers'. Parents who do
not want such coverage can opt out any time by informing the CPF
Board. We will get this done later this year. |
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For those who are already born but
below 7, we will work with MOE to provide this opt-out service at
the time of Primary One registration. |
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For older students, we will work with
MOE to see how we can get them in as a one-off exercise. I thank
Mr Yeo Guat Kwang for his support of the measure and I hope
parents will support it too. It will be good for their children. |
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To keep basic premiums affordable for
the majority, MediShield will continue to exclude coverage of
congenital illnesses. |
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But for the vast majority, MediShield
coverage from young will give parents the peace of mind that,
should their children develop any illnesses as they grow up, they
will have insurance coverage for such illnesses and the subsequent
treatment. |
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After I have brought the children into
MediShield, I will see how best to bring in the 100,000 or so
housewives who are still outside MediShield. I will study Mr Yeo
Guat Kwang's suggestion of an opt-out scheme for husbands to sign
on their wives. |
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More..... |
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Source:
www.gov.sg Media Release 6 Mar
2007 |
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FrontPage Edition: Tue 6 March 2007
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