Healthcare costs: How to sweeten the pill

Ignatius Low - AUG 7, 2016

Q. The cost of healthcare has become a political issue and the Government has done quite a bit in recent years, introducing MediShield Life, the Community Health Assist Scheme (Chas) and so on, to address this. Looking back at the last 20 years at how the cost of drugs, treatments and surgery has changed, and looking ahead at the next 20 years: Will the real cost of healthcare - the relative cost of falling sick compared to what you earn and the standard of living you are used to - go up, go down or remain the same?

JEAN-LUC BUTEL: You have now a convergence of technology, analytics, and the ability to predict diseases way ahead of time. So you're avoiding the acute care setting, which is the most expensive. The cost of care in the next 20 years will probably go down. Also, it has to go down because with the ageing of the population, we cannot afford higher costs. On average in OECD countries, 70 per cent of your lifetime spending on your health happens in the last five years of your life. This is a very acute problem but some countries are starting to see there are different options and it's a wise thing to consider. In Europe, they don't deny treatment, but they say: "At this stage of your life, there are three other treatments that are a quarter, a tenth of the cost of what you would otherwise get."

There's a broader issue in terms of people's choices. In the past, all the knowledge about medical care was in the head of the doctor. Now, it's in our iPhone - it's a huge transformation. Of course, the responsibility for care still lies with the surgeon, but there is a need to make our population accountable for their lifestyle choices. If I become alcoholic, why should society pay for my treatment? It was my choice... Many insurance companies in the US have started to look at your lifestyle and give you points and discounts on your premium. If the incentive becomes strong enough, people will change their behaviour.

Q. This links to the idea of genetic screening. I've seen sci-fi films where the population is screened according to their family history and likelihood of getting this or that disease. If the probability of getting diabetes is quite high, then the state demands that you have very low sugar intake and that is its way of managing healthcare costs. In 20 years' time, will we be anywhere near this kind of dystopia?

BUTEL: I don't have a position on that. But if there is a place where it could be done, it's in Singapore, because the trust factor between the Government and the people is one of the highest in the world. The science of genomics and genetics are huge assets that we should find a way to utilise. If we find a way to use this data properly and reasonably with total transparency, maybe there's a way to benefit from such screening.

Q. We have an ageing population in Singapore which will put tremendous strain on the system. But now there are probably many people who are thinking about retiring in Malaysia, where the standard of living is lower. With the high-speed rail to Kuala Lumpur that will be ready in 10 years, it could well be a very viable solution. And what that means is that your primary care is going to be in Malaysia. So in a way, we could end up exporting the problem, if I may use that word.

BUTEL: The issue of social separation with the ageing population will be a huge problem in the future. People remain healthy and engaged intellectually, mentally and emotionally when they are in contact not just with other 80-year-olds, but with younger people. You cannot zone people by age.

Q. And still be subsidised by the Singapore Government?