The PAP.SG Medishield Life Dialogue

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Overview

Since the release of the recommendations of the MediShield Life Review Committee earlier this month on the 5 June 2014, members of PAP Seniors Group (PAP.SG) chapters have been receiving increasing queries from the ground about issues surrounding the policy. There have also been calls by members for better clarity and understanding on how MediShield Life will actually work, its impact on the CPF (Medisave) Savings for various groups of Singaporeans and how it can reduce cash outlay to cope with healthcare costs.

Discussion Framework

On the 24 June 2014, PAP.SG organised a dialogue session at the PAP HQ from 7.00-9.30pm. The key objective of the session was to provide members with greater understanding on how the policy will actually work to help Singaporeans cope with healthcare costs and to receive feedback and suggestions on how the policy can be effectively communicated, delivered and remain sustainable for all Singaporeans.

The session was open to all PAP.SG chapter members from across all branches and was attended by 81 members from 38 PAP.SG chapters, from diverse backgrounds predominantly in the 55-65 age groups. The session was hosted by Chair of PAP.SG, Madam Halimah Yacob and Mr David Ong.

Participants were split into 4 different breakout groups for the discussions, each facilitated by members from the Young PAP. The open discussions gave participants opportunities to post questions, discuss their opinions and comment around the MediShield Life general framework and recommendations from the MediShield Life Review Committee.

The dialogue fostered a robust exchange of views and ideas, focusing from a range of narrow issues on technical issues such as who to cover, duplication with existing private and company insurance schemes and what happens to 'unutilized premiums'; to broader topics such as communication effectiveness.

Compilation of Feedback

Employment Status

When MediShield Life (ML) scheme comes into effect, Singaporeans who are employed will be able to afford the premiums through their own and employer's contribution to Medisave. However, there is concern that as employment status change over the course of their lives, affordability of premiums may become an issue. Hence, it is important the premiums are affordable not only in the short and medium term but in the long term as well since ML provides coverage from cradle to grave.

'Underutilisation' of Premiums

Some Private Insurance Schemes currently make periodic 'cash backs' paid to policy-holders. Similarly, MediShield Life premiums if not utilised over the lifetime of a policy-holder, can perhaps be channelled towards a pool that will help defray premium payments for the lower income groups. Alternatively, there could be a no claims bonus policy to incentivise those who keep themselves healthy.

National Budget Top Ups for Premiums

In terms of sustainability and to foster continued 'Government-Community' shared effort for the policy, a feature of yearly Budget can perhaps be used to annually offset premiums of Singaporeans, such as through a small percentage of interest earned on national reserves.

Duplication and Co-existence with other Private Insurance Schemes

Many Singaporeans are currently policy-holders with a plethora of insurance schemes retailed by private institutions. The extent to which MediShield Life covers may overlap with existing policies should be made clear so that choices can be made if PI schemes should be retained or cancelled in order to avoid a drain of resources on premiums to support both policies.

Impact of ML on Certain Groups

Some groups for example Pensioners on 'Co-Payment on Ward' Scheme (CPW) scheme do not presently need to pay premiums and deductibles as their Medical costs are already covered. However, with the introduction of ML, they would be required to do so. The ML scheme should allow an 'opt out' for those affected or should be designed in a way so as not to burden certain groups that already have their medical costs covered throughout their lives.

Mass Media Channels and Accessible Platforms of Communication

The ML Policy can have better outreach if explained on mass media platforms such as on Television or other platforms that are easily accessible by all Singaporeans, both young and old. Currently all the information is found only on Government websites and printed collaterals that may not be as accessible compared to traditional media platforms.

More Clarity between MediShield Life and other Government Schemes

The timing of announcements of Pioneer Generation Package and MediShield Life were made fairly close, resulting in some becoming confused between the two, not being able to differentiate between MediShield Life being an insurance policy and Pioneer Generation Package being a financing package.

Perhaps, MediShield Life can be better explained in the communication materials through the use of charts that show side-by-side ML 'benefits and function' versus other schemes or 'Before-ML' versus 'After-ML' type of visuals.

The fact that MediShield Life is an health insurance policy for all is not clear in the name "MediShield Life". An introduction of the operative word 'insurance' or a renaming of MediShield Life to bear some semblance to a "National Health Insurance Plan" is preferred. The logic of insurance is will understood and thus will make much easier in explaining to the masses the rational for payment of premiums and collective risk pooling.

Cut out Jargon in Communicating MediShield Life Policy to Seniors

The ability to communicate well to everyone, especially Seniors in the community, is important in order for MediShield Life to be properly embraced and supported by all. Complicated and technical jargon in all communication material must be reduced and simpler words be used in place.

Explaining Benefits of MediShield Life Policy on Hospital Bills

The impact of MediShield Life on one's hospital bills should be properly explained by a person on site at the hospital before patients commit to treatment or hospital stay. This could be facilitated by the Medical Social Worker or otherwise. The importance is to enable patients to have better peace of mind through understanding how ML will help lower out of pocket payments for the treatment they are undergoing. Having clarity will relieve the mental stress of patients significantly.

Increased Regulation of Private Insurers

With the kick-in of MediShield Life, premiums will be an additional drain on income. Private Insurers should be regulated to such extent their cash premiums do not cause over burden.

Duplication with Company Insurance Schemes

There is currently a great deal of overlap between those who are covered under Medishield and the medical benefits provided by their employers. Now that Medishield Life is compulsory, there is a need to study how to rationalise the two schemes to reduce wastage and over insurance of individuals.

Revise Amount of 'Deductible' for Lower Income

When MediShield was first launched, the deductible was a lot lower in order to obtain claim payouts. Today however, the amount of deductibles has gone higher to $2000, regardless of ward class (b2, b1 or c). There should be a revision of this as $2,000 for deductible required upfront is still high for some, especially the lower income.

Establish a Fund to assist those who fall through the cracks

The subsidies that the government provides for ML premiums mean that Singaporeans are now enjoying two bites of the cherry - they get the hospital subsidies as well as premium subsidies. Also, the fact that the premiums can now be paid out of the Medisave, will reduce the burden on many Singaporeans. Nevertheless, there will be some who will continue to fall through the cracks, for example if they experience bouts of unemployment or are housewives. Moreover, requiring those with pre-existing illnesses to pay 30 per cent more premiums compared to the rest, will be burdensome for some of them who cannot work because of their illness or handicaps. Hence, for such Singaporeans, the government could consider setting up a Fund which could be used to pay for the premiums of needy Singaporeans so that they will have greater peace of mind.

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