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From Medishield to Integrated Shield Plan

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When Medishield was first implemented in 1990, it was administered by the government.

Four years later, the government introduced Medishield Plus, which was intended for people who preferred staying in better wards or in private hospitals.

Instead of administering the scheme itself, the government invited NTUC Income, a private insurance company, to run it, with the view of getting other companies to join if successful.

The move looked reasonable since Medishield Plus was a “luxury” good, while the basic insurance scheme, Medishield, was still run by the government on a non-profit basis. If richer folks want to pay more for better service, it is their prerogative and private businesses can cater to that.

But whatever the case, it opened the door for private insurance companies to enter the huge and lucrative government sanctioned medical insurance business, which was at that time, untapped.

Today, Medishield has become Medishield Life and Medishield Plus has become Integrated Shield Plan. The list of companies participating in the Integrated Shield Plan include GE Life, AIA, AXA, Prudential, Aviva, Raffles Health Insurance, and NTUC Income.

More and more people have taken up Integrated Shield Plans, not because they have become richer, but because the basic scheme, Medishield Life, is inadequate if one suffers a major illness.

For example, the basic scheme does not cover pre and post-hospitalization bills which can be costly if one is unfortunate to require, say, treatment for cancer. Also, the co-payment is hefty if the overall bill is big, and coverage for surgery is only up to $2,600 and one needs to top up if the bill exceeds the limit.

So, for peace of mind, more people have purchased the Integrated Shield Plans. In fact, the more inadequate the basic scheme, the better it will be for the private insurance companies because if a person is already compelled to buy a hospitalization insurance, he might as well buy one that covers him adequately, especially if the premium can be paid by Medisave.

No one can say that the government is working hand in glove with the insurance companies to pass business to them, but no one can dismiss the notion either, after all, Temasek is invested in the insurance companies and the banks, and has a few alumni in the highest echelon of the government.

When Medishield Plus was first started, the premium payable was $90 per annum for a 35-year-old, for the most expensive plan. Today, it is $626 per annum. (Both from NTUC Income). Although it is not an accurate comparison as the coverage are different, but it does give an Indication how much premium has increased.

But would it be any surprise? Instead of just paying the government the cost of administrating the scheme, we now have to pay 7 insurers for doing the same thing, on top of their profits. And how did they value add? Nothing much except being another cost centre. In fact, they may be destroying value, since we are not enjoying economy of scale.

Medical care is an essential service that should not have profit as the ultimate goal, but when we have a medical insurance scheme run by profit-maximization entities, what would the long run outcome be, especially since the customer doesn’t have much of a choice?

In fact, the current brouhaha between the Life Insurance Association which represents the 7 insurers and the Singapore Medical Association is ultimately about profits, or the lack of it.

If the government is sincere about keeping medical cost affordable, it should just cut off the insurance companies and let the CPF Board run it on a non-profit basis.

To be fair, the administrative cost and profits of the 7 insurance companies are not the only pertinent reason for the high cost of medical care today. The others are doctor’s fees and the cost of medicine.

The fees that doctors charge are at least subject to competitive market forces, so that is fair. But the cost of medicine is a different thing. It is one of the highest in the region, especially medicine to cure cancer and heart failure. The reason is that Singaporeans have to pay for patented, rather than generic drugs, no thanks to the intellectual property clause in the many Free Trade Agreements our government has signed, which compel them to enforce patents, which may be good for attracting foreign investments and GDP, but the people has to pay the price.

The recent coverage in the mainstream media of the row between the Life Insurance Association and the Singapore Medical Association may give the impression that we are serious about keeping medical cost affordable, but they detract from the root cause of the high cost of medical care, which the government is not addressing.

 

Foong Swee Fong

 

 

 

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18 Responses to “From Medishield to Integrated Shield Plan”

  • MEDISHAVED for Life!:

    Looks like the Sheeples are completely medishaved for life just to produce cotton!, not wool. Easily woolly-bullied by false assurers, they endup in a ward with a view to the other world, in the Plink of Hellth.

    Come to think of it, the medicare sector providers are somewhat profiteering on public good. Else, what Shield can it be called? Magicshield? All in the sleight of hands of the manipulators; the policymakers?

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  • Pinky has long lost it.....:

    Since the Pappies converted MOH into “MOH Holdings” under Temasek several years ago, ordinary sheeples have been subverted by their corporate ambitions and greed. The Emperor in his swivelling chair runs the various ministries like a Megastore CEO pressing for profits from one department to another.
    And what’s wrong with that haha?
    In the whole world it only happens in LKY Incorporated lah…..

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  • KT:

    I wonder how many of our MPs are on Medishield Life and Integrated Shield Plans? Bet the numbers will be very telling.

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  • Xia Suay:

    Of all the developed countries, Singapore spends the least on healthcare in terms of GDP percentage. New hospitals have become like football stadiums with naming rights — donate money and have a whole hospital, lab or research centre named after you.

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  • I beg to differ:

    Quote
    For example, the basic scheme does not cover pre and post-hospitalization bills which can be costly if one is unfortunate to require, say, treatment for cancer. Also, the co-payment is hefty if the overall bill is big, and coverage for surgery is only up to $2,600 and one needs to top up if the bill exceeds the limit.
    Unquote
    Come on, be realistic, if the basic medishield is to cover everything, then medical fees and insurance premium will shoot up to the sky.
    You might as well advocate medishield to cover unemployment benefits … for life!
    Medical service and insurance are utilities.
    Private doctors and hospitals are profit driven, so are the insurers.
    Doctors will maximise their profit when a patient comes in, the patients are paying.
    If the insurer is paying fully for the patient, the patient will not care, he or she will go for the best/most expensive service.
    I tell you a case where a patient rejects a 30% discount on the bill voluntarily offered by the doctor, the reason is she has a comprehensive policy that pays every cent.
    In another case, a healthy man went to a specialist requesting a procedure, because his brother recently was diagnosed to have cancer. The doctor did the procedure, billed him close to ten thousand dollars. It is not a medical treatment, the insurance policy does not cover. But the doctor wrote the medical report in such a way that the insurer pays!
    You hear of people asking to be hospitalized to receive treatments because their personal or company insurance policies cover fully hospitalization.
    I went to see a government specialist, the doctor did not recommend MRI but I requested, he agreed and referred me to the radiologist department, and suggested that I go for the MRI if my problem persists.
    I did not go for the MRI (not because it was estimated at $1,400) because the next specialist I saw said similarly as the first doctor (who was not available then due to an emergency that morning)
    If I had a comprehensive plan, I might request full investigation, MRI, CT scan, hospitalization, etc, because I do not have to pay a single cent. After all I (or my company) have already paid the premium.
    Every PR/citizen is sharing my cost because I am also claiming from medishield through my insurer indirectly.
    When private doctors and hospitals increase their fees, the government hospitals will do so too, to “benchmark”.
    Otherwise, the cliche is the government cannot retain talents! I think specialists in the public sector may get a cut of the fees.
    When claims increase, insurers naturally increase the premium.
    I take with a pinch of salt when insurers claim they lose money. They will increase their premium to recover the prior losses.
    And a substantial amount of the premium goes to the commission and pay of their agents/staff.
    The agents cross sell other products to their existing and new customers.
    The end result is ordinary folks pay higher medical fees and insurance premium.
    Who benefits the most?

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  • Thinking aloud:

    Quote
    Medical care is an essential service that should not have profit as the ultimate goal, but when we have a medical insurance scheme run by profit-maximization entities, what would the long run outcome be, especially since the customer doesn’t have much of a choice?
    Unquote

    I think you put the cart before the horse.

    In Singapore medical care is for profit. PAP is promoting medical tourism, Indonesians are coming here for treatment.

    Remember the case where a doctor charged millions of dollar on a patient who unfortunately died and more unfortunate to the doctor, the patient was very politically connected.

    Even medical care in the public sector is to cover cost. Some medical services are even more expensive than the private sector.

    It is the medical fees that have gone up and then the insurance premium.

    Of course, even if medical fees maintain the same or drop (in most unlikely case), insurers will still increase premium, in collusion or not, even they are subject to competitive market forces or not.

    By the way I do not work in the insurance industry.

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  • xoxo:

    Money,money,money.
    Its a PAPpy world?
    Aha! Whats wrong with collecting money.
    With easy money,we can live like princes.

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  • Lee Hsiao Laang:

    It’s a well known fact that they only way to save sg and singaporeans is a change of govt.

    The greed of the pap govt is causing so much grief and suffering to the ordinary people but the stupidity of the majority singaporeans are helping the heartless papies to feed their greed to the max! Haiz!

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  • Soccerbetting2:

    Quote an old post from Chua Chin Leng aka redbean part 1:Quote – “Source : TR Emeritus 28th Dec2013 .
    Title : The compulsory Medishield Life is the best thing to happen .

    Before you read further, let me clarify that this view is only applicable to those who have all the money to pay for the premium and living an extremely good life and want to live forever. I came to this view after watching a short 2 mins of the SG+ on the Medishield Life and the views expressed by a super talent who was obviously very rich and paying was not an issue. This super talent was so excited and exuberant, and was all praises for the Medishield Life Scheme and I can understand why.
    The Medishield Life has to be compulsory so that the cost of premium can be shared by everyone to be affordable. If you allow those losers, those that cannot afford to pay for the premium, those whose life is better dead than alive to opt out then the premium would have to be much higher. So it is crucial that no one be allowed to stay out of this wonderful scheme.
    Did I get the feeling that the rich and those who have a wonderful life to live on is roping in all the poor who rather die to help to finance their good life? The TV crew did an on the spot interview with some of the heartlanders and one interviewee pointedly insisted that he wanted to opt out of the scheme. He was a pensioner, no income, how to pay for the premium? Without an income even $10 is too much for him. Unfortunately he cannot get away. It is compulsory and he would have to find a way to pay.
    As for the rich, they would all love to pay. And it would be so nice if they can get the poor to help out to defray the cost. The reluctant poor, the unwilling poor, the poor that wanted to die than to live, must not get away from paying. It does not matter whether they want it or not, it does not matter whether they need it or not, just make them pay.
    No one bothers about lowering medical cost which is the main cause of fear of not being able to pay. And if there is such a great Medishield Life Scheme, the medical cost can continue to go up and away since there is this scheme to pay for it. Did anyone mention that they want to prevent a buffet syndrome? Didn’t they know that with this scheme, they are actually encouraging the buffet syndrome directly as everyone would feel more comfortable to seek medical services? Those that would have little reason to want to live would also choose to seek medical treatment since they have been compulsorily made to pay for it.
    Shouldn’t those that have a good life to live and to live forever and so happy to have such a medical insurance scheme be paying for themselves and not imposing or compulsorily forced those that cannot afford to pay to be robbed into paying? I am so happy too, I think I can afford to pay with the help of those that cannot afford to pay but forced by compulsion to pay and reduce what I have to pay….”Unquote.
    End Part 1.To be continue.

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  • Harder Truths:

    Why Guinea Pigs have to pay insurance?

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  • Don't trust PAP:

    Insurers are capping maximum payment to $3,000 is for show only.
    What is #3,000 to those people who can afford comprehensive plans?
    What is $3,000 to Khaw Boon Wan who paid only $8 for his bypass that cost tens of thousands of dollars? Just $2,908, less than his half day pay as MOH Minister then.
    It is the ordinary people who bear the cost – including sharing the cost of Khaw and the ilk.
    PAP will say we can use CPF to pay the premium, and they top up CPF for the poor, and we can use CPF to pay for the co-payment. We will subsidize your premium too!
    It is the same storyline as HDB flats, the government subsidizes you, you can use CPF, no need to use cash, if you are poor, we give you grants and if necessary more grants.
    CPF is still our money, hard earned money!
    PAP Ministers including DPM attend REDAS functions and annual dinners, telling the rich and influential folks about being responsible. It is a show for ordinary people to see!
    It happens year after year, home prices, not just private properties are going up.
    Obviously the countless cooling measures implemented since 2013 are not working.
    The rich are using their children names to buy properties. The ultra rich are buying in bulk to hold, and sell back or to other interested parties, to help the developers avoid the QC and duties.
    And the government is giving these companies Covid 19 money when they are still making tonnes of money out of Singapore.
    As if not enough, PM wife’s Temasek in billions of dollars to bail out listed GLC. Capitaland proposed restructuring to unlock value for shareholders and the share price rose sharply.
    It is not magic where money comes from the air.
    It is money Temasek pumps in, and value loss to Temasek when value is added to Capitaland shareholders!
    Same for SembCorp, Sembcorp Marine, SIA, etc.
    Something must give.

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  • Another PAP'S money mind:

    I had an emergency surgery in KL 2 yrs ago and I could not make an Medishield insurance claim because it is outside Singapore. Out of sympathy, CPF allowed me to withdraw same charges from my own account. For this I furnished with all the invoices from the KL hospital. All in all, it took about 3 months to approve.
    What a shit! Money sucked and stucked for stock market speculation. This government must go!!!

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  • Another PAP'S money mind:

    I made a complaint to KTP hospital against the orthopedic surgeon who refused to do metal wire removal surgery on my elbow citing high risk. I was told by KL surgeon to have it removed 6 months after otherwise it would be difficult because flesh would grow over the wire.
    She cause me alot of anxiety, worries and smart enough, TKS hospital surgeon did the surgery.
    I made the complaint to NHG which passed to KTPH and reply came 2 weeks after. KTPH said the surgeon did nothing wrong. I told them I had it removed 2 weeks ago. The surgeon was irresponsible and hospital did a cover up for her.
    Recently made the same complaint to Minister KOh after reading what happened to KTPH cancer patients. Since 3 mths I am still waiting for the outcome despite 1 mth ago sent a reminder to MOH. MOH said still working on it!
    The KTPH surgeon yelled at me when I requested for a bottle of procodine for my bad cough. She cooled down and asked me to go to polyclinic. What a shit and hell is going on here!

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  • Expensive Singapore:

    Harder Truths:
    Why Guinea Pigs have to pay insurance?

    Because nothing is free or cheap in Singapore not even dying.

    BTW the last payment you make when you die is to the government for your cremation. Nothing is free in Singapore.

    BTW, not all the ashes of those cremated are given back. Only some bone fragments are returned. The rest of the ashes are sold by the owner of the crematorium to make into organic fertilizer, after crematorium workers pick out the gold filling in the ashes to take home. “What’s wrong with making some money?”

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  • Soccerbetting2:

    Part 2 Continued-Quote an old post from Chua Chin Leng aka redbean :Quote-”……….. I would say a big thank you to them too. Needless to say, I too would be very happy with this Medishield Life. The only problem is that I do not know when misfortune will strike and I would find that I would not have the money to pay for the premium. Then I don’t think I would be happy like the happy rich anymore.
    Mind you, don’t ever think that you would always have the money to pay even if you can afford it today. If you don’t care a damn about those who cannot afford to pay and still wanting them to cough out blood to defray your cost, you are likely to end up like them one day. What goes around will come around. Getting the poor to subsidise the rich is simply wi****.

    Chua Chin Leng aka redbean
    * The writer blogs at http://mysingaporenew.blogspot.com“Unquote.

    End of Part 2.

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  • Will PAP care?:

    PAP paid themselves millions of dollars – to come up with this policy, housing policies, JSS, etc – to enrich themselves and cronies.

    When they retire, they become chairmen and directors of GLCs and companies.

    Mah is amongst the richest.
    Wonder what Khaw BW, former Minister of MND and MOH, former PAP Chairman, is doing now.

    Not surprise PAP solution is to increase insurance premium and coverage limits to cater to the rising medical cost.

    Mr Foong need not worry about the $2,600 surgery coverage, it will be increased soon.

    Soccerbetting2:
    Part 2 Continued-Quote an old post from Chua Chin Leng aka redbean :Quote-”……….. I would say a big thank you to them too. Needless to say, I too would be very happy with this Medishield Life. The only problem is that I do not know when misfortune will strike and I would find that I would not have the money to pay for the premium. Then I don’t think I would be happy like the happy rich anymore.
    Mind you, don’t ever think that you would always have the money to pay even if you can afford it today. If you don’t care a damn about those who cannot afford to pay and still wanting them to cough out blood to defray your cost, you are likely to end up like them one day. What goes around will come around. Getting the poor to subsidise the rich is simply wi****.

    Chua Chin Leng aka redbean
    * The writer blogs at http://mysingaporenew.blogspot.com“Unquote.

    End of Part 2.

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  • Dear Mr Foong:

    “For example, the basic scheme does not cover pre and post-hospitalization bills which can be costly if one is unfortunate to require, say, treatment for cancer. Also, the co-payment is hefty if the overall bill is big, and coverage for surgery is only up to $2,600 and one needs to top up if the bill exceeds the limit.”

    What is the surgery cost now? $3,500?
    PAP controlled committee has already proposed increasing the limit.
    Is $5,000 enough?
    Let’s make it $7,800. Happy?
    Be careful what you wish for.
    Before the next PAP/committee’s review in 3 years time, the cost of that surgery would be $10,000.
    Why?
    Because if the insurance is covering the full cost of that surgery (all below $7,800), how can the doctors and insurance companies justify increasing fees and premium the next time?
    How can the committee, senior civil servants and PAP Ministers justify their high pay and demanding higher pay if there are no problems, or not complicated enough problems to solve.
    PAP is notorious for creating problems to solve, and a sense of crisis to solidify power.
    PAP created this problem, and did the simple job of creating a review committee and now played the good guy for SMA and LIA to resolve the issue as if the problem lies with the doctors and insurers only.
    PAP literally gets away with murders – 61% supported them for another term of mass murders.

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  • I would like to add something:

    If the government is sincere about keeping medical cost affordable, it should just cut off the private doctors and hospitals from the national health insurance.

    And

    If the government is sincere about keeping medical cost affordable, it should just cut off the insurance companies from the doctors and hospitals.

    The medical cost may even drop from today’s ridiculous level.

    The private doctors, hospitals and insurance companies cannot feed on the general population to benefit their customers and themselves.

    Those who can afford pay cash/cpf to the private doctors and hospitals.

    Those who cannot afford private doctors and hospitals can go to the restructured hospitals. PAP assures no one will be left behind (the hospital door to die)

    Caveat is restructured hospitals will still increase their fees to make the medical industry sustainable, to sustain the doctors and hospitals.

    People in the mainstream media and Mr Foong talk about fairness to doctors, insurers and/or their customers.

    How about the non-customers who are subsidizing these customers (and indirectly paying and enriching the private doctors, hospitals and insurers) and worst of all bearing higher medical cost day after day.

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