ENSURING GOOD OUTCOMES
While placing limits on IPs may prompt providers and patients to think twice about using unnecessary treatments and help to reduce spending, experts said it is important that treatment outcomes are not compromised.
“The increase in cancer drug spending through MediShield Life and the IPs will almost certainly be moderated through the Cancer Drug List (CDL) and the claim limits,” said Assoc Prof Lim.
“However, we have to ensure that this spend reduction is not accompanied by poorer outcomes and I hope the government is actively tracking cancer survival rates – for example, the quality of life – especially in lower income groups that may not have the means to afford riders.”
Oncologists who CNA spoke to said patients who do not have a rider would be most affected by the changes.
According to them, the maximum IP claim limit for cancer treatment – five times that of MediShield Life – is “too low” to cover the cost of most treatments in the private sector.
This is because the MediShield Life claim limit for cancer drug treatments is based on subsidised prices at public hospitals.
“The reimbursement rate is pegged at an unrealistically low level and the acquisition cost for drugs in the private sector remains as high as before,” said one private oncologist.
Speaking to CNA on the condition of anonymity, he said most of his patients who are currently taking non-CDL drugs have either advanced or incurable cancer.
“It’s not a matter of being kiasu (the fear of losing out). Many of them will run out of options eventually because their disease can’t be cured, which is why those with incurable and advanced diseases are often the ones who are using all these very expensive drugs that could not get on the CDL.”
He added: “We must also remember that advanced cancer patients cannot be treated and so there is no end date to their treatment. All we can do is to try to retain control of the cancer and extend their life as much as possible until the disease becomes resistant, gets worse and the patient dies.”
Mr Ong said that all insurers will maintain the current IP coverage of policyholders at least until Sep 30.
Beyond Sep 30, cancer patients whose treatments are not on the MOH list may still be covered by IP riders or other insurance plans they have. If not, they would have to shift to treatments that are on the list.
Those who require drug treatments not on the list and are unable to pay can opt for subsidised care at public healthcare institutions, where they may apply for financial assistance.
For some private healthcare providers, matching their cancer drug prices to public hospitals is simply “not possible”, they said.
“We have no leverage with the pharmaceutical companies in the private sector because we are not united,” said another oncologist.
“Even a group practice with 10 doctors – which is already considered quite big – won’t be able to get it at the same price as public hospitals because there’s no bargaining power.”
WAIT AND SEE
With Singapore’s spending on cancer drugs projected to reach S$2.7 billion (US$2 billion) by the end of this decade, experts said the country has to rein in healthcare spending as the current trajectory is unsustainable.
However, they stressed that efforts need to be based on data and guided by patient outcomes.
“There is a ‘price to life’ and we need to know as citizens the price we are paying as we trade off managing costs with restricting access to medicines outside the Cancer Drug List,” said Assoc Prof Lim.
He added that a wait-and-see approach might be needed so that the government can see how the situation evolves and make policy adjustments as needed.
Assoc Prof Wee said IP riders remain relevant as it is important that such coverage options are available.
“This will allow those with the means to seek care in the private sector to do so and relieve the patient load in the public sector,” she said.
“My greater concern is one of equity. It will be most unfortunate if only a small proportion of the population can afford higher coverage.”