SINGAPORE: Medisave could be used more freely, especially for outpatient treatments, and visits to family doctors could be exempted from GST, Dr Chia Shi-Lu has suggested.
Speaking in Parliament on Wednesday (May 16) in response to the President’s address, Dr Chia, who is the chairman of the government parliamentary committee for health, proposed these changes to “smoothen some bumps and ripples in our healthcare landscape, to remove some friction where it is not needed, and to promote more equal access to medical services”.
“I propose that we think about liberalising the use of Medisave in a bolder and more decisive manner,” said Dr Chia, who is MP for Tanjong Pagar GRC.
While Dr Chia acknowledged that the introduction and expansion of schemes by the Ministry of Health like the Chronic Disease Management Programme (CDMP) and Flexi-Medisave are effective, and allow greater use of Medisave for medical scans, he said they can be complex and at times too restrictive.
“The concern, of course, is that too loose a policy on Medisave withdrawals could lead to earlier depletion of our accounts, leaving nothing for us to rely on in later years when medical needs and expenses could be greater,” he said.
He added that this concern is not necessarily well-founded, as the mean Medisave account balances have been increasing over the years, and a significant number die with remaining balances in the account. He also proposed changes that he said would help those above retirement age.
MORE HELP FOR ELDERLY PAYING BIG AMOUNTS OUT-OF-POCKET
Dr Chia suggested that Singaporeans above the retirement age be allowed to pay for up to 80 per cent of their subsidised outpatient treatment costs at Government clinics through Medisave, regardless of how much the amount comes to, subject to a doctor’s certification.
This is because for some Singaporeans with multiple chronic diseases, or whose illnesses cannot be adequately controlled by medicines on the Standard Medication list, the out of pocket cash outlay for medical treatment, even at a polyclinic and with Pioneer Generation benefits, can be quite high due to the current utilisation limits for Medisave, he said.
This move would not change matters for the majority of elderly patients, for whom the current chronic disease withdrawal limit would adequately cover 80 per cent of their annual outpatient treatment costs, he added.
“But it could make a meaningful difference to the elderly with multiple or less common conditions requiring more specialised and expensive medications, or who require more medical investigations to better manage their conditions,” he said.
Presently, a patient who has exceeded his Medisave claims limit and who finds it challenging to pay the remainder in cash, can appeal to the Ministry to withdraw more from his Medisave, apply to welfare schemes, or simply choose to forego treatment in excess of what he is willing to pay for in cash.
Allowing for greater Medisave withdrawal in these cases can help a patient avoid trying the welfare route, which ultimately adds to public expenditure, and encourage compliance with treatment, Dr Chia said.
“I am of the opinion that such further loosening of the Medisave purse strings would not lead to over-servicing or over-consumption,” he added, pointing to how the introduction of a Pioneer Generation package with generous benefits in 2015 has not led to worrying levels of over-consumption or over-servicing within the public healthcare system thus far.
When it came to GST exemption for primary medical services, Dr Chia said that while philosophically this is a slippery slope, in practical terms it would be “in keeping with the intent of current policy that already absorbs GST from subsidised healthcare services”.
“Removing this consumption tax from all primary healthcare services could nudge more patients back to their family doctors for care and encourage compliance with treatment and follow-up, by reducing costs,” he said.
Dr Chia, who is a senior consultant in Singapore General Hospital's department of orthopaedic surgery, stressed that his suggestion referred only to primary care services, which can be defined and licensed, and not for hospital or other types of medical care.
INSURANCE COVERAGE FOR CONDITIONS RELATED TO PREGNANCY AND MENTAL HEALTH
Dr Chia also suggested that gaps in MediShield Life, introduced to provide universal health insurance, should be plugged.
Presently, pregnancy-related complications, and conditions related to mental health, are not covered under the scheme when hospitalisation is required.
“I believe that we should consider expanding coverage to these conditions as well. We have been strongly encouraging parenthood, and it would serve as greater assurance to would-be parents that the mother’s medical care can be covered in the uncommon instances of complications related to the pregnancy,” he said.