Speech by Health Minister Gan Kim Yong, in the Debate on the President’s Address 2014, 27 May 2014

INTRODUCTION

1.            Madam Speaker, the President’s Address highlighted several programmes to strengthen our social safety net.  One of the key focus is keeping healthcare affordable for Singaporeans.

2.            In the last few years, we have re-shaped our health and aged care services - adding capacity, bringing services closer to citizens, and we have taken steps to make healthcare services more affordable for Singaporeans.  

3.            We have increased subsidies in our hospitals, and intermediate and long-term care facilities.  We have expanded Medisave uses in the outpatient setting, for chronic disease treatment, selected vaccinations and screenings.  To make primary care at GP clinics more affordable, we introduced the Primary Care Partnership Scheme which later became the Community Health Assist Scheme (CHAS). CHAS was recently enhanced this year with the removal of age criteria and the addition of more chronic diseases.  We are going one step further to extend CHAS to all pioneers regardless of their income and assets, and with even better benefits.     

4.            In the next few years, we will put in place a new social compact, so that all Singaporeans know that they are looked after, in good times and especially in bad times.

MediShield Life: Better Coverage, For Life, For All

A New Social Compact

5.            One major initiative is the proposed Medishield Life.  Medishield has played an important role in helping Singaporeans with large medical bills.  Over the years, we have improved MediShield to keep up with the changing needs of Singaporeans. We extended the maximum age of coverage because Singaporeans are living longer. We increased the claim limits, to keep pace with medical inflation and improvements in healthcare technology. And here I must disagree with Mr Giam, that healthcare cost are easy to estimate. There are many factors that could affect estimation like medical inflation and technology improvements.  Last year, we expanded MediShield to also cover congenital and neonatal conditions. With each improvement, Singaporeans are better protected.

6.            Moving from MediShield to MediShield Life next year is a much more significant shift.  It will provide stronger protection for all of us today, and our children in future. It will also reflect a stronger sense of community, because it involves Singaporeans coming together collectively, to look after one another.   This is what an inclusive and caring society is about.

7.            Medshield Life will provide all of us with better protection against large bills, for life.  It works on the concept of risk-pooling.  All of us each contribute our share into the pool, and the few among us who face large hospital bills can draw on this pool to help pay for their bills. This way, all of us can be protected and assured.    

8.            However, for MediShield Life to protect all Singaporeans, all of us need to do our part.  We must contribute our share of the premiums, and we must do all we can to keep healthy.  I want to encourage you to take up the eight steps by Dr Janil, to keep us all healthy. Healthcare providers need to deliver cost-effective services, and avoid driving up demand and pushing up claims, which will result in higher premiums in future years.

9.            The Government has committed to ensuring that premiums for MediShield Life are affordable for everyone, not just the high income, but also for the middle and lower income. This is a long-term commitment, so that everyone will always be protected and have peace of mind.

MediShield Life Review Committee

10.         The MediShield Life Review Committee has been working hard since last November to review and recommend the key benefits and parameters for MediShield Life.

11.         Led by Mr Bobby Chin, the Committee has intensively engaged people of all ages and backgrounds. They have also spoken to key stakeholders and experts such as the unions, grassroots, employers, academics, insurers, actuaries and healthcare professionals. I would like to express my sincere appreciation for the Committee’s hard work and for those who have contributed their views, including the Government Parliamentary Committee (GPC) of Health which has put up a comprehensive list of views.  

12.         It is encouraging to hear that MediShield Life has received broad-based support from Singaporeans.  Those with friends or family members who could not be covered by insurance due to their pre-existing conditions, such as those with cancer, stroke or heart conditions, were especially appreciative that MediShield Life would cover them and give them peace-of-mind about healthcare costs.

13.         I visited an NKF dialysis centre in Ang Mo Kio last week, and some of the patients there could not get insurance protection because of their kidney conditions.   But with MediShield Life, they will be able to get the protection and peace of mind they have longed for, not just for dialysis treatments but for hospital bills that they may face from time to time.

14.         Many Singaporeans understand that premiums will have to go up when benefits are improved.  Some are concerned that improvements to benefits would lead to over-consumption of healthcare services, resulting in higher costs and higher premiums in the long run.  

15.         The Committee has to calibrate carefully and strike a balance between providing better protection for Singaporeans, and keeping premiums affordable. 

More Protection Under MediShield Life

16.         The Committee shared in March this year its preliminary thinking on MediShield Life. They suggested three key shifts: removing the lifetime claim limit of $300,000; increasing claim limits significantly for hospital stays and outpatient cancer treatments; and cutting patients’ co-insurance rates by half. 

17.         The Government is supportive of these recommendations. If implemented, MediShield Life will pay out more and cover a larger portion of the bills, reducing significantly what patients have to pay.   

18.         Let me give you some examples of how these will work:  

a.         48 years old Mr Yee Kwek Chin, was hospitalized for 14 days for stroke.  His MediShield currently covered about $5,000 of his subsidized bill, and he paid the remaining $4,800 using his Medisave.  With the higher daily ward limits and lower co-insurance the Committee has recommended for MediShield Life, patients like Mr Yee would need to pay only $2,500 of his bill, about half of what he has to pay today.

b.         Currently, MediShield coverage stops when one reaches 91. For those Singaporeans who are older, like Mr Yasmuddin Rasul (aged 92), they would not be covered under MediShield. With MediShield Life, there will be no age limits, older Singaporeans will be brought into the scheme, and be covered for life. 

c.         The removal of the claims limit will benefit long term dialysis patients like Mr Hashim Abdul Rahim whom I met last week at NKF Dialysis Centre, who is likely to reach the current claims limit in a few years’ time. MediShield Life will also benefit patients like Mdm Wong Kui Lan, who is 65 and has no insurance coverage. She has been undergoing dialysis for about a year, and suffers from high blood pressure, heart conditions and cataract. In the past year, the total subsidized bill for her hospital stays came close to $8,000. MediShield Life will protect Singaporeans like Mr Hashim and Madam Wong in the future, reducing the amount they have to pay for their healthcare bills, and relieving them of a heavy burden.

Government to Ensure Premium Affordability

19.         The Committee has shared with me that most Singaporeans hope that the MediShield Life premiums will remain affordable and can be fully paid for with Medisave, so that they do not have to fork out cash for their premiums.  Some shared that they are providing for a large family, for their children as well as elderly parents, and are worried about whether they can continue to pay for their premiums in future.  They hope that the Government will provide those in financial need with more support to pay for their premiums.

20.         The Government understands their concerns, and will provide help to in three ways. First, we will provide permanent premium subsidies for the less well-off and our pioneers. These are permanent subsidies, and not one-off help. To help everyone transit from MediShield to MediShield Life, the Government will also be providing transitional support for the first few years for all Singaporeans, so that the premium increases will be phased in. Second, we will provide Medisave top-ups for the elderly and the low-income to help them pay for the premiums. Third, for those who still cannot afford the premiums, we will provide financial assistance such as through Medifund, over and above the premium subsidies.

21.         The Committee is currently finalising its proposed recommendations on MediShield Life, and I understand that they will be ready to share some of these details next month.

22.         My Ministry will review and finalise the design of MediShield Life after the Committee submits its final report, and aim to implement it by end-2015.

Action PLan for Successful Ageing

23.         Madam, we have announced the Pioneer Generation Package to recognise and honour our pioneers and address their concerns on healthcare.  Together with Medishield Life and enhancements to subsidies for outpatient care, we reassure our seniors that we will take care of their healthcare needs, and we will do more for them.

24.         Beyond lessening their worry, we want our seniors to live life to the fullest, to always have something to look forward to, and continue to achieve their aspirations in their silver years.

25.         While we speak of the challenges of an ageing population, we should not forget that ageing and longevity is a blessing after all. We are all living longer and that is a good thing.  But we must plan ahead to help Singaporeans age successfully and meaningfully.

26.         The Ministerial Committee on Ageing has spent the last few years building up aged care services to support an ageing population.  By 2020, we will add about 5,000 nursing home beds as well as expand the capacity of our center based services.  We will also give home care a big push to support seniors to age in place.  We have rolled out a set of quality standards for nursing homes and we are in the midst of developing guidelines for home care. Aged care services are made more affordable with higher and more targeted government subsidies for the middle- and lower income families.    

27.         Moving beyond developing aged care services, the Committee will coordinate a whole-of-nation effort to put together a coherent national agenda to prepare our population for successful ageing.  This is an action plan that will holistically chart strategies and initiatives to support and enable Singaporeans to achieve meaningful and successful ageing. It will cover 7 diverse areas – lifelong learning for seniors, employment, volunteerism, urban infrastructure, healthcare, retirement adequacy and research into ageing.

28.         Ageing is a conversation that involves all of us – our aspirations for our silver years, how we hope to live our lives to the fullest, how we wish to relate to peers and younger persons, and the kind of society we wish to live in when we grow old.  It is a conversation not just among the old, but also with the young.

29.         From the middle of this year, the MCA will hold a series of public consultations to hear the aspirations and suggestions from Singaporeans on what we should do to collectively plan for successful ageing for our seniors and for ourselves in time to come.  We will also engage voluntary welfare groups, businesses, unions and academia in this whole-of-nation conversation on ageing.

30.         Let us now change the conversation about ageing – from worrying about the challenges that come from ageing to celebrating longevity.

31.         We want to hear ideas from educational institutions, voluntary welfare organizations and senior learners themselves, on what can be done to help seniors continue to learn new things so that they can remain active, and their days filled with excitement.    For example, the Council for Third Age (C3A) has initiated Kopi and Toast, where active seniors mentor and encourage less active seniors to adopt an active lifestyle. Through this programme, the more reserved seniors have become more active and participated in activities which they had not done previously, such as ukulele classes and even signing up as a volunteer for the 2015 SEA Games. The pilot run, which was conducted in 2013 with 68 seniors, received very good feedback through various success stories shared by participants.

32.         We also want to hear suggestions from unions, employers and HR practitioners on how we can tap the talents and growth opportunities from a workforce that will enjoy longer years of productive lives and how the workplace can be made more welcoming and empowering for our seniors to put their experience and talents to good use.   

33.         St Luke’s ElderCare is a good example. Its comprehensive age friendly HR strategy has empowered seniors and developed a culture of lifelong learning and this allows seniors to be more competent, confident and appreciative of their work while at the same time keeping them engaged.  St Luke’s has shown that given opportunities, seniors can continue to contribute meaningfully.

34.         We also welcome ideas from community leaders, healthcare professionals and active agers, on what we can do collectively to encourage and support our seniors to age actively and preserve good health for as long as possible.  It is also important to explore how we can encourage and provide better support for multi-generation families, in terms of housing and amenities in the heartlands, how we can support them in strengthening family value, and intergenerational bonding. For example, we are rolling out larger 3Gen flats for multigenerational families to stay together and injecting aged care services in our estates so that seniors can age at home close to their loved ones.

35.         Professionals like architects, IT experts and urban and transport planners can also share their ideas on how we can build an intelligent city for all ages, leveraging on technology to make living easier for seniors and allowing them to participate as an active member of our society.

36.         The formulation of the action plan will involve various government ministries and agencies, private and people sectors.  We will consult widely and we hope the plan will be ready by next year.  The ideas and suggestions we gather will then be incorporated in our national action plan for successful ageing.  We hope that, through the collective efforts of Singaporeans – of all ages and from all walks of life – we can build a Nation for All Ages.

Conclusion

37.         Singapore celebrates 50 years as a nation next year.  The last 50 years of the Singapore Story is an amazing one of rapid development and growth, fuelled by youthful idealism and strive for success.  

38.         For the next 50 years and beyond, the Singapore Story will surely continue.  But it will not be identical to the last 50 years.  Because we are now more mature and also wiser, economically stronger and more confident about our future.  But we are still young as a nation.  We must remain youthful in our ideals and aspirations, even as each of us grow old.

39.         We will turn longevity into our advantage.  We will work together to forge an action plan to make Singapore a Nation for All Ages.  This will be the best tribute to our pioneers and the best gift to the next generation of Singaporeans.