MediShield Life can be made more effective. Its review holds the key

We must incentivise outpatient treatment and accept that, in some cases, personalised medicine can save lives.

- Jeremy Lim

Singapore's Health Minister Ong Ye Kung announced earlier in 2024 that the MediShield Life Council would undertake a comprehensive review of the scheme. It would look at expanding the coverage of this basic, mandatory health insurance plan, including funding for innovative treatments such as cell, tissue and gene therapy products (CTGTP). A review is most timely as the last review was in 2020 and so much has changed in these intervening years.

Healthier SG is one such major change. In 2022, Mr Ong described the need for a "fundamental reorientation and reform of our healthcare system, to focus on preventive care instead of curative care, emphasise health instead of sickness, shift the centre of gravity of care away from hospitals into the community". Advances in technology, especially in the field of artificial intelligence (AI) also create opportunities to improve healthcare. At the Milken Institute Asia Summit in September, Mr Ong highlighted the potential of AI in precision medicine and predictive preventive care, tailoring health and healthcare approaches to the individual based on genomics, healthcare, lifestyle and socio-economic data, and declared that Singapore would launch such initiatives nationally in the next one-to-two years.

What principles should guide this review and future reviews? There are myriad considerations, but I would put forward especially four design factors and one ideological caution.

LET THE DOG WAG THE TAIL

The aphorism "Don't let the tail wag the dog" comes to mind here. For too long, patients have been admitted to hospital needlessly because the claim limits are more favourable compared with outpatient settings. Funding and financing should be servants to the appropriate care model and not the other way around, and MediShield Life, in combination with other government financing levers of MediSave and subsidies, can be a powerful lever for change. What would this look like in practice?