MediShield Life Council report shows rising cancer prevalence among Singaporeans

CHEMOTHERAPY claims have risen significantly for MediShield Life, and what is worrying is that the cost of cancer drugs in Singapore is also markedly higher than some places in the region.

The MediShield Life Council will appoint a committee of oncologists to "review the coverage of cancer drugs, so that they can be covered in a more sustainable manner".

Prices in Singapore of some of the top spending cancer drugs may be 1.5 to two times higher than other jurisdictions in the region such as Taiwan and South Korea.

The Council yesterday released the MediShield Life Council Report 2020, which reflects the recommendations of the MediShield Life Review and incorporates feedback gathered from over 11,000 Singaporeans, including insurers and medical professionals.

The government yesterday said it accepted all the Council's recommendations. The changes will be implemented in March 2021. It also said that following public consultation, it will defer premium payments until end-December 2021 for those who do not have sufficient MediSave balances to pay the premiums in the coming year. It will also enhance the annual MediSave top-ups for Pioneer Generation seniors.

It has also come out with details of higher MediShield Life and MediSave daily ward and treatment limits for acute hospital stays. It will adjust the MediSave withdrawal limits for acute hospital stays in tandem. This is expected to provide better coverage for short stays and result in lower out-of-pocket costs.

On the worrying trend in cancer, the report said the number of chemotherapy claims has risen by almost 50 per cent from 116,000 in 2017 to 170,000 in 2019. Payouts for chemotherapy claims also rose by about 40 per cent from S$109 million to S$152 million, almost double the MediShield Life payout growth over the same period, which was about 22 per cent.

Chemotherapy accounted for about 15 per cent of total MediShield Life payouts in 2019.

Singapore's national spending on cancer drugs has grown faster than the global average, more than doubling between 2015 and 2019. At public healthcare institutions, spending on cancer drugs grew at a higher compound annual growth rate of 25 per cent, compared to 6 per cent for non-cancer drugs.

According to the Council's report, this trend reflects rising cancer prevalence among Singaporeans. The Singapore Cancer Registry had 71,265 cancer cases reported in 2013 to 2017, a growth of 25 per cent from 57,243 cases in the preceding five years.

Advances in treatments also come with higher costs, which seems unlikely to abate. The Council's report said one possible reason for high prices is the single MediShield Life claim limit - currently S$3,000 per month - that applies to all cancer drugs today, on top of the MediSave withdrawal limit, currently S$1,200 per month.

"As the cost of cancer drugs vary widely, a single claim limit that is set to cover the majority of subsidised chemotherapy bills would not be commensurate with the clinical benefits and patient outcomes realised for many of the cancer drugs.

"The Singapore Society of Oncology has given feedback during the public consultation that cancer drug prices are high in Singapore, and suggested to study ways of negotiating better prices with pharmaceutical companies."

One of the tasks of the committee of oncologists would be to look into the approaches taken by other developed countries, which include negotiating prices with pharmaceutical companies before funding is extended.

"We will look at what has worked for these countries and make recommendations to MOH (Ministry of Health) on how to re-design MediShield Life coverage to ensure that cancer therapies continue to be affordable and sustainable for Singaporeans," said the report.

The Council considered the public's concern over the timing of premium increases. But it decided to go ahead to recommend premium adjustments and asked the government for additional premium assistance.

It said premiums needed to rise to support higher claims. "Delaying the premium adjustment may affect the sustainability of the scheme, and will also result in an even bigger premium increase next year due to the need to catch up with rising claims and cost inflation."

It said the bulk of the MediShield Life Fund's reserves today are committed for future premium rebates, and cannot be used to delay the required premium increases. Between 2016 and 2019, a total of S$7.5 billion in premiums were collected. This comprised S$4.4 billion in premiums and S$3.1 billion from the government in premium subsidies and other support to keep premiums affordable.

In the same period, S$3.5 billion in claims were paid out and S$4.3 billion set aside as reserves for future commitments. These reserves comprise premium rebates that will be paid out in the future to make premiums affordable for older Singaporeans. It also includes future claims for those who have started on multi-year treatments such as dialysis and chemotherapy.

The Council said it was not in favour of the concept of "no claim discount" as a way to encourage Singaporeans to adopt healthy living habits, "as it would penalise Singaporeans, especially the elderly for illnesses and large bills they may inevitably face throughout their lives".

"A no-claims discount could also discourage Singaporeans from seeking early diagnosis and treatment for fear of losing their discount. This could lead to poorer health and higher healthcare cost down the road when the condition exacerbates and complications set in."