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HEALTH Minister Khaw Boon Wan appears cautious, about allowing the use of Medisave for mammograms, but as a matter of principle is not opposed to activating it for costly health screening. In this, he has been consistent despite intercession by Mrs Lim Hwee Hua, the senior-most woman in Cabinet, concerning mammograms. Medisave is for hospitalisation. Breast cancer screening is affordable - around $100 or $50 in polyclinics, with subsidies. During promotional campaigns, it can cost as little as $25. According to Dr Donald Poon of the National Cancer Centre, response "is dismal even at heavily discounted rates".
Cost does not look like an obstacle. Lack of awareness is more likely the reason for the weak response. Efforts in public education, including those of Mrs Lim's Women Inspiring, Nurturing, Grooming Singaporeans (Wings), should improve screening numbers even without an assist from Medisave. Except for hepatitis B vaccination, Medisave covers only curative or therapeutic care, and this largely only in hospitals. It began allowing a $300 annual limit three years ago for medication in managing chronic illnesses, including diabetes, high blood pressure, high cholesterol and stroke. Disease prevention, including screening, has not been part of its strategy despite clear advantages in community health management.
Notwithstanding the minister's reluctance in widening unduly the use of Medisave, it is better to detect and treat disease early than let it progress to a stage when hospital treatment and rehabilitation will cost much more. Besides giving better treatment outcomes, it will be less expensive. Breast cancer is the most common cancer among women here. More than 1,000 are diagnosed with it every year. Associate Professor Adeline Seow of the National University of Singapore has estimated that if 70 per cent of women go for regular mammograms, fatality rates would fall by 20 per cent to 30 per cent.
There is thus room for cost savings, if screening is reliable. New methods including thermography, costing not much more than mammography, have increased accuracy. A study reported in the Journal of the American Medical Association found however that 20 years of screening experience had not reduced deaths from fast growing cancers in patients in the West. Besides taking into account genetic differences between Asian women and those of other races that might affect cancer growth, ways have to be found to distinguish high-risk cases from low-risk ones. With better approaches to early diagnosis and prevention Medisave may yet be found to be an ally.
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