Bracing for limits on cancer outpatient claims under MediShield Life
ADVANCES IN medical therapies are surely a blessing. Not only have they enhanced longevity, but diseases that decades ago seemed stubbornly impervious to treatment may well come under control. Deaths by heart disease in the United States, for example, have fallen by 40 per cent since 1998, thanks to a combination of sophisticated surgical techniques, faster response times and medications like statins that slow the build-up of plaque in arteries.
There is also progress in cancer survival rates. The American Cancer Society reports that the risk of dying from cancer in the US has fallen by 32 per cent between 1991 and 2019 due partly to early detection; chemotherapy after surgery and combination therapies. Singapore proffers good news as well. The Singapore Cancer Registry, which tracks cancer trends, found that survival rates have risen to 60 per cent, compared to just 18 per cent in 1968.
There is, however, renewed concern over the funding of cancer treatments here via insurance. Last year the Health Ministry began to compile a list of clinically proven and cost-effective drugs that would be claimable under MediShield Life from September this year. Private Integrated Shield plans are to comply with this list from April 2023. The changes are driven by concern over the escalating cost of cancer therapies. National spending on cancer drugs has grown at an annual compounded rate of 20 per cent compared to 6 per cent for non-cancer drugs. The number of claimants and payouts for cancer drug treatments have also risen under Medishield Life.
To be sure, Singapore is not alone in its efforts to rein in the cost of cancer therapies. A report by HSBC Asset Management cites healthcare costs at “nosebleed’’ levels, rising from about 10 per cent of GDP a decade ago, to 18 per cent in the USA and 14 per cent in Europe. “Payers and governments are accordingly querying and rejecting costly therapies resulting from recent R&D, or setting limits to how much they’ll pay for them, no matter how technologically advanced they might be.’’
Cancer sufferers, particularly those whose cancers are relatively rare, are caught between a rock and a hard place. They purchased insurance to cover catastrophic illnesses, but now find the proverbial rug pulled out from under them. The Health Ministry has said that under the new framework 9 out of 10 subsidised patients would be fully covered, compared to 70 per cent today. But that is cold comfort for those that fall out of the net.
Efforts to ensure the long-term sustainability of insurance plans are par for the course for the government and private insurers. Insurance, after all, is an indispensable pillar of healthcare financing and goes a long way to reduce consumers’ out-of-pocket expenses. Premium increases can shore up underwriting losses in the short term, but unbridled increases threaten affordability.
Price negotiations for medical therapies – and not just for cancer – should be part of insurers’ sustainability efforts. Already such negotiations by the government have reduced the cost of cancer therapies by 30 per cent on average. In the meantime, for cancer sufferers, there are other avenues such as Medifund and the Medication Assistance Fund Plus, where the eligible income criteria is being raised. Another avenue to consider is the establishment of a panel to consider off-label drugs on a case-by-case basis. Cancer may well be the biggest culprit of rising healthcare costs, but it is by no means the only one as society ages.
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