Mr Tracey Evans Chan1
1Faculty Of Law, National University Of Singapore, Singapore
Biography:
Tracey Evans Chan is an Associate Professor in the Faculty of Law, National University of Singapore, and specialises in biomedical law and ethics. He has published in the field both locally and internationally, and served in a number of Singapore expert committees on matters such as surrogacy, transplant ethics, human-animal combinations in biomedical research and mitochondrial germline modification. He currently sits on the Singapore Ministry of Health’s National Medical Ethics Committee and NUS’s Institutional Review Board.
Abstract:
In September of 2022, the Ministry of Health Singapore announced the implementation of the Cancer Drug List (CDL), which would indicate oncology drugs that were assessed to be cost-effective and therefore reimbursable under the national health insurance scheme known as MediShield Life. This significant development instantiates the first major instance in which cost-effectiveness criteria have been introduced in the Singapore healthcare financing landscape, since the country moved towards a universal health coverage insurance scheme in 2015. One immediate implication of the CDL is that it relies on clinical evidence of cost-effectiveness. This leaves patients with rare cancers, whose low incidence rates imply the economic non-viability of conducting clinical trials to evaluate efficacy and cost-effectiveness, effectively excluded from protection under MediShield Life. This paper reviews the ethical principles of healthcare rationing in Singapore, and evaluates if these principles support the current CDL policy in the way that it allocates limited healthcare resources, namely MediShield Life funds and other government healthcare subsidies, for the treatment of cancer in particular.
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