Regular check-ups could cut health-care spending for an ageing population

HERE'S a poser: Why do only 40 per cent of Singapore women go for breast cancer screening, despite an extensive subsidy?

It can't be ignorance, not with the campaigns run by the Breast Cancer Foundation and the personal letters and subsidies from the Health Promotion Board (HPB).

So is it something in our psyche? A fear of receiving bad news or a complacent it-can't-happen-to-me attitude?

In the United States, a far more populous country, 60 per cent of women get their mammograms done.

Being diagnosed with cancer is not necessarily a death sentence, especially when caught in its early stages.

In the US, 39 per cent of colorectal cancer cases are diagnosed before the cancer has spread. In Singapore, only 10 per cent of such cases are caught this early, said colorectal surgeon, Professor Adrian Leong, deputy director of the National University Cancer Institute (NCIS).

A cheap and simple faecal occult blood test clone annually can give advance alert of cancer polyps growing in the intestines. In the majority of cases, this is a slow-growing cancer and once the polyps are snipped off, the cancer is prevented.

So it is not surprising that while heart diseases have outstripped cancer deaths in most developed countries, cancer remains the top killer here.

The opening of the NCIS last week is an opportune time to reflect on what can be done to increase disease screening.

The last national health survey conducted in 2004 found that half the diabetics here do not know they have the disease. Similarly, 38 per cent of people had no idea they had high blood pressure.

Not being aware, they do nothing about their illnesses, leading to the diseases becoming chronic and severe before they are diagnosed. By then, it might be too late to do much.

Again, cost is unlikely to be the reason for the low rates of screening, since these are affordable tests that are also offered at polyclinics at subsidised rates.

Whatever the reason, unless some thing is done to change this attitude, Singapore will not be able to cope with the growing burden of disease, especially since it has a rapidly ageing population.

Perhaps a new tack should be tried.

The best way to get to the majority of people is through MediShield, the nation al health insurance which covers about three million people.

If MediShield were to make screening every two or three years compulsory for people above a certain age, it would cover the majority of adults here.

Let's put the age of screening at 40, when the annual premiums top $110 be cause that is the age when many of these diseases start appearing.

People will have to get themselves checked to enjoy continued coverage at current rates. This would be the case regardless of the outcome of the checks.

So someone found to have high cholesterol levels, for example, will not be penalised. Knowing the problem, few people would leave if untreated - resulting in a generally healthier population.

To make it more palatable, insurance firms might want to provide this screening service at a subsidised rate, or even for free.

After all, aside from the patient, the insurer will be the biggest beneficiary. When cancers are discovered early, the cost of treatment is far cheaper than if they are diagnosed after the cancer has spread.

Insurers will bear a large part of this cost. MediShield is a contract which the insurer cannot unilaterally terminate, so insuring a cancer patient means a heavy toll that could stretch over many years.

On the other hand, diagnosing a cancer early could result in thousands of dollars saved for the insurer.

So it might make economic sense for insurance firms to underwrite some of the screening for its subscribers.

For the more expensive tests, such as mammograms to detect breast cancer, MediShield could work with HPR, which already offers a 50 per cent discount to women aged 40 years and older.

It could levy a "penalty" premium on people who refuse to screen regularly, for not taking charge of their health.

It would also be in the Health Ministry's interest to support such a scheme to reduce the heavy health burden on the nation.

With three million people insured under MediShield, even if the scheme applies only to older subscribers, and is done biennially, it would still number in the hundreds of thousands, so economies of scale would kick in.

Making it a compulsory feature - or people would have to pay a loading on the insurance premium - could result in a screening tsunami.

This, hopefully, will be followed years later by significant falls in cancer deaths, of people in.need of kidney transplants or dialysis, and in the number of patients suffering from heart attacks or stroke.

The benefits of regular health screening are not simply a theory. Screening has been shown to work in countries like the US and a number of European countries.

It is cost effective, boosts a population's well-being and is obviously the smart thing to do.

As Professor John Wong, head of NCIS, said, it is better to spend more up-front in prevention and early diagnosis, than to spend it on treating a severe disease.