Ms W was diagnosed with third-stage ovarian cancer in October 2020 and is being treated at the National University Cancer Institute as a subsidised patient.
Her treatment cost was fully covered by national insurance scheme MediShield Life and national medical savings scheme MediSave, until December 2022, when she had to top up $268.50 in cash. This came as a shock.
She has yet to receive her January bill. But she is afraid she might have to continue to pay cash every month due to the change in the way cancer treatments for subsidised patients have been covered since Sept 1, 2022.
The change essentially lowered her claim limits for both MediShield Life and MediSave.
The September policy change was meant to slow down spiralling cancer costs as well as to help patients better afford cancer care, including more expensive drugs.
Since then, both MediShield Life and MediSave were allowed to cover only approved cancer drug treatments. Treatments not on the Cancer Drug List cannot be covered. The same will apply to Integrated Shield Plan coverage from April 1, 2023.
Before the change, subsidised patients could claim up to $3,000 a month for their total cancer treatment costs. They could also use an additional $1,200 a month from MediSave.
They may also claim up to $1,200 a year for cancer services, which include consultations, scans, lab investigations, chemotherapy preparation and administration, supportive care drugs and blood transfusions. Up to $600 a year from MediSave may also be used.
The Ministry of Health (MOH) had said that with the change, 90 per cent of subsidised Singaporean patients would have their cancer bills fully subsidised, subject to the 10 per cent co-payment, which MediSave can pay for. Before the change, 70 per cent of subsidised Singaporean patients had their cancer bills fully subsidised.
But oncologists from the public sector have told the MOH that the $1,200-a-year MediShield Life cap on cancer services is inadequate. Several oncologists told The Straits Times that almost half of subsidised cancer patients, who used to be fully covered, will face similar problems as Ms W.
A check with various public hospitals showed that fees for a repeat consultation for subsidised patients range from $21.60 to $72.50. Lab tests, even with subsidies, often cost more than $100, and for some, will top $200. Often, these need to be done every few weeks.
Some patients need medication for side effects of treatment, such as nausea or elevated blood pressure, but such drugs also now come under cancer services.
Some need antibiotics when their immune systems are compromised by the medication, and these too come under cancer services. Other procedures such as blood transfusions for patients with blood cancers also add to their costs.
Several oncologists, who asked not to be named, said this is clearly not enough. One public sector oncologist said the coverage “needs to be multiple times the current cap”.
Ms W has no problems with cancer drug costs. It is with the cancer services that she finds her insurance coverage inadequate.
By her December bill, she had used up the $1,200 yearly coverage limit for cancer services. Her bills for these services range from $400 to more than $800 each month, depending on the tests and medications she requires.
The MOH said on Saturday that the MediShield Life cap on cancer services claims will be raised to $3,600 a year from April. The cap on MediSave withdrawal for cancer services remains at $600 a year.
“For cancer drug services, we received feedback that the MediShield Life claim limit may not be adequate for some patients. We have therefore reviewed the limits and have decided to increase it,” said Health Minister Ong Ye Kung on Saturday on Facebook.
“Like many policy changes, the recent moves on cancer drugs serve to make treatment affordable. But it requires the support of stakeholders, and feedback like this that can help us improve and fine-tune the policy.”
On hearing about the change, Ms W said: “I’m glad to know that they are revising the current MediShield coverage to better help cancer patients. I do hope that the revised amount can at least cover all the necessary tests and scans that we patients have to undergo on a frequent basis.”
But the higher yearly cap – which works out to $300 from MediShield Life and $50 from MediSave a month – will still not be enough to cover her bills for cancer services. Ms W added: “With cancer, my life is already uncertain. Every time I do the test, I worry that my cancer might flare up again. Now, I also face financial problems. I don’t know how I’m going to deal with it.”
Because of her illness, she has stopped full-time work and is currently working part-time. But this is enough to put her out of reach of MediFund aid, which is a government safety net for the poor.
“At least if insurance can’t pay for this, I should be allowed to use my MediSave. I may not have many more years to live. Why limit MediSave withdrawal to $600 a year?” she asked.
Subsidised patients could claim up to $3,000 a month for their total cancer treatment costs. They could use an additional $1,200 a month from MediSave.
Since September, cancer treatment claims have been split - with separate claim limits for drugs and services.
Cancer drug treatment:
Patients can claim $200 to $9,600 a month.
Patients may claim up to $1,200 a year. Services include consultations, scans, lab investigations, chemotherapy preparation and administration, supportive care drugs and blood transfusions. Up to $600 a year from MediSave may also be used.
The MediShield Life claim limit for cancer services will be increased from $1,200 to $3,600 a year.