SINGAPORE HEALTHCARE SYSTEM

Transcription

1 SINGAPORE HEALTHCARE SYSTEM Samuel Tan Senior Manger, Actuarial & Underwriting Services Singapore Actuarial Society Health subcommittee chair 17 th April 2015

2 Agenda 1. Overview of Singapore Healthcare 2. Integrated Shield Plan (Private) 3. From MediShield to MediShield Life 4. Comparison with VHIS 5. High Risk Pool 6. Employee Benefits 29/04/2015 2

3 Overview of Singapore Healthcare

4 Background Overview of Healthcare in Singapore and Hong Kong Singapore Healthcare financing System: S+3Ms 29/04/2015 4

5 Overview of Healthcare Singapore Hong Kong 29/04/2015 5

6 A White Paper 1993 To nurture a healthy nation by promoting good health To promote personal responsibility for one s health and avoid over-reliance on state welfare or medical insurance To provide good and affordable basic medical services to all Singaporeans To rely on competition and market forces to improve service and raise efficiency To intervene directly in the health care sector, when necessary, where the market fails to keep health care costs down 29/04/2015 6

7 Bloomberg ranked Singapore s healthcare system the 1 st most efficient in the world in Quality and affordable basic medical services for all. Promotes healthy living and preventive health programmes for all. Maintains high standards of living, clean water and hygiene to achieve better health for all. With a financing system anchored on the twin philosophies of individual responsibility and affordable healthcare for all. To ensure that everyone has access to different levels of healthcare in a timely, cost-effective and seamless manner 29/04/2015 7

8 Singapore Healthcare Financing System S+3Ms - Universal coverage, multiple layers of protection 29/04/2015 8

9 In-patient care (Restructured Hospitals) Class A is a single bed room, equipped with private shower facilities, phones, television, hot-beverage making facility and safe. Class A does not qualify for government subsidy. Class B1 is a four-bed room, equipped with private shower facilities, phones, television. Class B1 receives up to 20%* in government subsidy. Class B2 is a six-bed room, with naturally ventilated open ward with shared facilities in shower and television. Class B2 receives up to 65%* in government subsidy. Class C is a naturally ventilated open ward, with shared facilities in shower and television. Class C receives up to 80%* in government subsidy. * Subject to Means Testing, Singaporean vs PR 29/04/2015 9

10 Sample of Hospital Bills (SGD) in Singapore* Condition Description: Hysterectomy (surgical removal of the womb) for non-malignant (benign) conditions; no serious complications Hospital Type Ward Type Average Length Of Stay (days) 50th Percentile Bill Size 90th Percentile Bill Size Public Class A ,185 16,650 Private Class A ,002 31,446 Public Class B ,263 13,749 Private Class B ,441 19,067 Public Class B ,896 6,759 Private Class B ,435 17,307 Public Class C 3.2 2,379 3,468 For the period of 1 Mar 2014 to 28 Feb 2015 Extracted from MOH website 10

11 Sample of Hospital Bills (SGD) in Singapore* Condition Description: Admission for pneumonia (lung infection); uncomplicated Hospital Type Ward Type Average Length Of Stay (days) 50th Percentile Bill Size 90th Percentile Bill Size Public Private Class A Class A 2.8 2,243 4, ,102 12,353 Public Class B ,704 2,589 Public Public Class B2 Class C , ,335 For the period of 1 Mar 2014 to 28 Feb 2015 Extracted from MOH website 11

12 Sample of Hospital Bills (SGD) in Singapore* Condition Description: Percutaneous Transluminal Coronary Angioplasty (PTCA); procedure to enlarge a narrowing in a heart vessel with a stent; no serious complications Hospital Type Ward Type Average Length Of Stay (days) 50th Percentile Bill Size 90th Percentile Bill Size Public Class A ,224 28,706 Private Class A ,266 50,758 Public Class B ,069 27,041 Private Class B ,014 46,694 Public Class B ,808 10,367 Public Class C 1.7 5,135 8,111 Public N/A Day Surgery 6,476 9,592 Private N/A Day Surgery 22,679 31,317 For the period of 1 Mar 2014 to 28 Feb 2015 Extracted from MOH website 12

13 MediSave Central Provident Fund (CPF) Ordinary Account Special Account MediSave Working Singaporeans and their employers contribute a part of the monthly wages into CPF s MediSave account to save up for their future medical needs and this is portable across jobs and after retirement. A compulsory individual medical savings account scheme which allows practically all Singaporeans to pay for their share of medical treatment without financial difficulty subject to certain limits 29/04/

14 MediShield A low cost catastrophic medical insurance scheme that introduced in To help members meet large Class B2/C hospitalisation bills. Operates with co-insurance and deductible where patients share part of the responsibility for his/her medical expenses. Opt-out basis with minimal underwriting The Premium of MediShield, co-insurance and deductible can be paid using MediSave Private Integrated Shield Plans (sold by private insurers) to cater for different insurance coverage needs for different Singaporeans. New enhancement: MediShield Life; to be implemented in late /04/

15 MediShield Plan BENEFITS Inpatient/Day Surgery Daily Ward and Treatment Charges 1 -Normal ward -ICU ward - Community Hospital 2 - Psychiatric 3 Surgical procedures 4 - Table 1 (less complex procedures) -Table 2 -Table 3 -Table 4 -Table 5 -Table 6 - Table 7 (more complex procedures) Implants 5 Radiosurgery 6 Outpatient Treatments Chemotherapy for Cancer - Per 7-day treatment cycle - Per 21- or 28-day treatment cycle Stereotactic Radiotherapy for Cancer Radiotherapy for Cancer - External or Superficial - Brachytherapy with or without external Kidney Dialysis Immunosuppressants for Organ Transplant CLAIM LIMITS $450 per day $900 per day $250 per day $100 per day $150 $360 $720 $800 $840 $960 $1,100 $7,000 per treatment $4,800 per procedure $270 $1,240 $1,800 per treatment $80 per treatment day $160 per treatment day $1,000 per month $200 per month Erythropoietin for Chronic Kidney Failure $200 per month Maximum Claim Limits Per policy year $70,000 Lifetime $300,000 Maximum Coverage Age 7 92 (age next birthday) 29/04/

16 MediShield Plan Deductible 1 For ages 80 and below, as of age next birthday - Class B2 and above -Class C - Day Surgery $2,000 $1,500 $1,500 For ages 81 to 92, as of age next birthday - Class B2 and above -Class C - Day Surgery $3,000 $2,000 $3,000 Co-insurance 2 All Ward Classes & Day Surgery Claimable Amount 3 $0 - $3,000 $3,001 - $5,000 Above $5,000 20% of claimable amount above Deductible (if applicable) 15% 10% Outpatient Treatments 20% 16

17 MediFund A medical endowment fund set up by the Government to act as the ultimate safety net for needy Singaporean patients who cannot afford to pay their medical bills despite heavy subsidies, MediSave and MediShield. Set up in April 1993 with an initial capital of S$200 million, the Government will inject capital into the fund when budget surpluses are available. With an ageing population, the government decided to carve out a portion of MediFund as MediFund Silver to deliver assistance to needy elderly Singaporean patients in a more targeted manner. 29/04/

18 Integrated Shield Plan

19 Integrated Shield Plan Private Shield plan started in early 1990 s. Due to cherry-picking by private insurers, MOH decided to integrate the private shield Since 1 July 2005, each of these MediSave-approved plans have been integrated with basic MediShield to form a single integrated plan (Integrated Shield Plan, IP). Policyholders on the MediSave-approved IPs retain the benefits and coverage of the basic MediShield tier, while enjoying enhanced coverage provided by their private insurers. About 60% of Singaporeans are covered under IP. Premiums are paid directly to the private insurers who will service all the policyholder s needs. Similarly, private insurers will service all claims and sort out all back-end arrangements with CPF Board to include any payouts from MediShield. Marketing by private insurers and commission only on private insurer s premiums 29/04/

20 Integrated Shield by Plan Type Basic Integrated Shield Plan Rider Plan Cover up to Private Hospital (depending on the choice of plan) As-charged basis with co-insurance and deductible. Come with Letter of Guarantee Act as Last-payer. No co-ordination with other private insurer (not integrated Shield) Supplement the Basic Integrated Shield Plan by covering the Coinsurance and Deductible. Additional benefits like Daily Hospital Income, Post-Hospitalisation alternative Medicine Benefit and etc. Premium can only be paid by cash Premium can be paid by CPF MediSave account 29/04/

21 Integrated Shield by Private Insurer Structure of Integrated Shield Plan + Optional Riders MediSave, MediShield + Integrated Shield Plan IPMIS MediSave, MediShield + Integrated Shield Plan + Optional Rider MediShield Out of pocket MediSave Supplementary rider 29/04/

22 Integrated Shield by Private Insurer Market Share as of Year 2013 by Premium 29/04/

23 From MediShield to MediShield Life

24 From MediShield to MediShield Life Announced on Singapore National Day Rally in Aug 2013 and will come into force in end of Year Major shift towards Universal Insurance Coverage. Enhancement over the existing MediShield scheme To better protect all Singaporeans/PRs against large medical bills Distributing Premium more evenly over lifetime 29/04/

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26 Key Comparison of MediShield and MediShield Life MediShield MediShield Life Daily Ward up to S$450 per day Lifetime claim limit of S$300,000 Annual Claim Limit of S$70,000 Maximum Coverage Age is 92 (ANB) Up to S$3000 of annual deductible and Up to 20% of co-insurance. Pre-existing Conditions are excluded. Opt-out basis Premiums - $105 (31-40 yrs old) Daily Ward up to S$700 per day No Lifetime claim limit Annual Claim Limit of S$100,000 Maximum Coverage Age is 100 (ANB) Up to S$3000 of annual deductible and Up to 10% of co-insurance. Pre-existing Conditions are included with extra premiums (30%). Compulsory (Universal) cover Premiums - $310 (31-40 yrs old) 29/04/

27 Implications on MediShield Life Review Development of a standard Integrated Shield Plan Provide adequate coverage at Class B1 level Benefits regulated by Government As an option to all new and existing Integrated Shield Plan policyholders to downgrade from their current plans to a more affordable plan Managing Coverage for Pre-existing Conditions (High Risk Pool) Reviewing Regulations of Integrated Shield Plans and Industry Practices Tighten of the regulations and more pro-policyholder environment.

28 Comparison with VHIS

29 MediShield vis-a-vis VHIS Similarities Guaranteed Acceptance Guaranteed Renewal Inpatient (Tertiary) treatment care No Lifetime Benefit Limits Whole Life coverage Coverage of Pre-existing conditions High Risk Pools (30% vs 200%) Offer product enhancement top up Defined benefit structure and coverage Tax exempt basis 29/04/

30 MediShield vis-a-vis VHIS Differences MediShield VHIS Objective all Singaporean and PRs to be covered for all illness (including Preexisting conditions) CPF Board (government) underwriter Universal cover Co-payments to ensure personal responsibility Public Hospitals on B2 and C wards Objective to reduce utilisation of public hospitals by encouraging insured to purchase private plans Private Insurers Voluntary No cost sharing except for advanced diagnostic tests Private Hospitals 29/04/

31 Integrated Private Shield vis-a-vis VHIS Similarities Underwritten by Private Insurers Currently offered on guaranteed renewal, whole life coverage Benefit structured, design and limits are somewhat defined Marketing, administration and claims are handled by private insurers Currently premiums are tax exempt basis Continuation of Group cover 29/04/

32 Integrated Private Shield vis-a-vis VHIS Differences Integrated Private Shield VHIS Fully underwritten cherry pick Top-up plans High Risk pools (?) Premiums might be out of pocket (TBC) Coverage of pre & post hospitalisation Guaranteed Acceptance Base Plans Cover High Risk Pools Tax Deduction premiums Pre & Post Hospitalisation cover(?) 29/04/

33 High Risk Pools

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35 High Risk Pools Considerations for establishing a High Risk Pool To differentiate MediShield premiums vis-a-vis standard lives To improve stability of premiums for standard lives A transition arrangement for those not on MediShield cover Cost management tool to monitor experience Access into Integrated Shield plan Financing of High Risk Pool Additional loadings (may not be adequate) Subsidy from non High Risk Pools Government coffers 35

36 High Risk Pool managed within the Main Pool Advantages Disadvantages Larger Pool will benefit from economic of scale in administration More effective risk pooling, in terms of managing claims volatility All members (irrespective of health status) share the initial health cost Future premium increases may be significantly more than the standard s life experience due to this high risk claims 29/04/

37 High Risk Pool managed separately from the Main Pool Advantages Disadvantages Main pool premiums rates will be more stable; future premium increase to be more controlled Claims experience of High risk pool can be easily monitor & analyse Specific claims & care management can be targeted at these High risk pools More volatility due to smaller portfolio size Additional infrastructure will be required to maintain 2 different pools Process to define who is on high risk pool or main pool Future pricing (+ subsidy) can be performed more accurately Private Insurers may be keen to provide insurance support 29/04/

38 Employee Benefits

39 Employee Benefits The Present State of Employee Medical Benefits Currently, more than 80% of companies in Singapore provide both inpatient and outpatient medical benefits. Majority of GHS does not ride on top of the MediShield framework Inpatient coverage tend to be of lower benefit limit (not as charged) and therefore some out of pocket expenses are required Government and government linked companies do not offer Inpatient group cover Additional monies into MediSave for employees to purchase individual Shield plans

40 Employee Benefits The (Possible) Future State of Employee Medical Benefits Restructure of the Employer Medical Products Promote healthy lifestyle and focus on preventive healthcare and long term health coverage instead of basic inpatient plans. But is NOT straightforward. Remove the duplication of insurance coverage during employment? For example, High Deductible Plans that integrated with MediShield Life covering copayments

41 Employee Benefits Portable Medical Portable medical was encouraged by LIA but not successful (less than 2% of total group portfolio) An additional 5% premiums Additional cost to employer Co-ordination issue between 2 employers coverage Minimal value to employees as most have Shield plans (more than 85% covered) Job movement timeframe tend to be short (less than 1 week break) Low unemployment Pre-existing conditions will be covered immediately upon re-employment Possible demise with Universal healthcare MediShield Life 41

42 Thank you