I read with much sympathy the letter “
Insurance policies must evolve with rising cancer diagnoses among younger people
” (Jan 28).
In Singapore, existing funding frameworks such as MediShield Life and the associated Integrated Plans currently exclude coverage for many preventive interventions despite being medically recommended, leaving patients at risk of shouldering substantial out-of-pocket costs.
As a public health specialist, I am concerned that our health financing framework is not keeping pace with how medicine is increasingly practised today.
As the writer relates, healthcare needs to be prevention-focused, addressing high-risk states before progression to disease.
Future healthcare needs to take advantage of advances in genomics, metabolomics, proteomics, microbiome medicine and others to also be personalised.
In an era of precision medicine, insurance should help patients access the right drugs and interventions to personalise treatment for each person’s disease.
However, drug and other intervention reimbursement policies are often binary – a drug or intervention is on the approved list, or it is not.
These are blanket policy decisions binding to everyone without regard for exceptional situations.
What happens then to patients for whom drugs deemed “not cost-effective” are actually highly efficacious for them because of their particular genetic and epigenetic profiles?
This may be uncommon today but will become mainstream in precision medicine.
Binary policies based solely on the cost-effectiveness of a drug or intervention at population level, such as the Standard Drug Lists and the Cancer Drug List, are useful for pricing negotiations with manufacturers and as formulary starting points.
However, as Singapore embraces precision medicine and invests billions in genetics and epigenetics, we have to ensure our financing models and philosophies keep pace, and in timely fashion.
Like preventive interventions, personalised medicine can save lives and be cost-effective, but only if financing mechanisms are aligned and supportive.
Dr Jeremy Lim