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Singapore generally has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organization’s ranking of the world’s health systems in the year 2010. Singapore has in place a comprehensive healthcare delivery and financing system built on pursing the following objectives:

  • Promote Good Health and Reduce Illness
  • Access to Good and Affordable Healthcare
  • Pursue Medical Excellence

The government’s healthcare system is based upon the “3M” framework. This has three components: Medisave, a compulsory health savings scheme which allows practically all Singaporeans to pay for their share of medical treatment without financial difficulty. The second level of protection is provided by Medishield, a low cost catastrophic medical insurance scheme. This allows Singaporeans to effectively risk-pool the financial risks of major illnesses and Medifund, which provides a safety net for those who could not otherwise afford healthcare. In 2008, 31.9% of healthcare was funded by the government. It accounts for approximately 3.5% of Singapore’s GDP.

Many middle and higher income Singaporeans have also supplemented their basic coverage with integrated private insurance policies (“Integrated Shield plans”) for treatment in the private sector. Singaporeans must subscribe to the basic MediShield product before they can purchase the add-on private Integrated Shield Plans.

Although Singapore has a multilevel healthcare system, it may not be able to support sustainable treatment that Chloe requires for life. The current system just doesn’t work for rare disease patients who are undergoing ultra expensive treatment like Chloe and here’s the reason why it cannot work:

1. Under MediShield Life coverage

Claim limit under Medishield life is $700.00 in general ward per day. Chloe is admitted only for a day (for her ERT) and her total bill added up to be more than $10,000. So, it’s not even a 10% coverage…

2. Under Medisave

MediSave withdrawal limits were set at $450.00 per day for hospitalisation and we are not allow to utilise any amount we wanted. As parents, we have to reserve MediSave for our own use, my child’s need and even for our parents’ needs in the event if we are admitted to the hospital. Even if I have a lump sum of $45,000 in MediSave, it will only last me 100 days…

3. MediFund

MediFund is an endowment fund set up by the Government. It provides a safety net for patients who face financial difficulties with their remaining bills after receiving Government subsidies and drawing on other means of payment including MediShield Life, MediSave and cash. MediFund Silver and MediFund Junior are carved out from MediFund to provide more targeted assistance for the needy elderly and the young respectively.

As an endowment fund, interest income generated from the capital sum are allocated to approved healthcare institutions , for them to assist with the medical bill payments of needy patients.

…… From MOH’s website

Define ‘needy patients’ please…

4. MAF Pus (Medication Assistance Fund Plus)

In 2011, the MAF scheme was expanded to the MAF Plus scheme, where instead of a MOH pre-determined drug list, the MAF Plus scheme allows each institution to determine for itself, through a specific set of guidelines and a peer-review mechanism, whether a non-basic drug should be subsidized under the fund.

While MAF Plus is able to help a group of rare disease patients, it may not be enough for all and also, applicant are subject to mean testing.

5. Integrated Shield Plans

If you have an Integrated Shield plan, you will also receive subsidies for the MediShield Life component, if you are eligible. While MedisShield Life covers congenital and pre-existing conditions, they are not covered under the ISPs from your private insurers.

ISP comprise two components:

  1. MediShield Life component run by the Central Provident Board (CPF) Board.
  2. Additional private insurance coverage component run by the insurance company, typically to coverA/B1-type wards in public hospitals or private hospitals.

At the moment, Chloe is relying on ISP to cover almost the entire treatment procedure. Although there isn’t the daily claim limit at the moment (which we hope it remain this way), ISP does have a yearly and life time claim limit (depending on the coverage). So what happen if her treatment hit the claim limit? What is there for us?

6. Rare Disease Fund

MOH has not release information on this although it was mentioned in the parliament that MOH will set up a separate fund to support rare disease patient with the expensive drugs.

What’s happen around our region?

We realised some of the developed countries in Asia Pacific region have introduced legislation and government funding to take care of patients with rare disease. Therefore, we believe we should fly Singapore flag in the rare disease map too.

As parents, we hope all Singaporean will get together behind us to rally for this to happen. What we do today will benefit the next generation because rare diseases can happen to any family. Rare diseases do not recognize race, colour, nationality or social standing…. they could happen to anyone.

We encourage you to read our research (conducted in 2011) on how countries such as Taiwan, Hong Kong, Malaysia, Korea, Japan and Australia are doing to help Pompe patients and other rare disease patients. Base on population, the incidence of rare diseases in Singapore will definitely be lower than other countries.

In 2018, we have seen countries like Vietnam, Thailand and Philippines introduced funding to help with the medical treatment of their people living with rare disorders.

In Malaysia, the funding for treatment was increased from RM10 million to RM16 million recently.

In Australis,, the Western Australian Department of Health is currently developing a state strategy for rare diseases and the National Rare Diseases Working Group convened by the Australian Paediatric Surveillance Unit (APSU) is also preparing a draft for such a nation-wide strategy.

Such an approach could be helpful for Singapore, to study the short and long-term impact of rare diseases on her constituents, and to also devise strategies that tackle issues of research, clinical practice and financial sustainability in this area.

However, there are still more to be done in order to ensure the coverage will last us for life. Please read about it and offer your feedback so that Ministry of Health could improve on it .

Thank you!


Click the below image to read on our research:

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