Finally insurance coverage for mental health conditions... in Singapore! What does this mean for Malaysians?
We applaud this move by AIA Singapore. Insurance companies in Malaysia: It's time to serve the nation. We are waiting for you!
AIA Singapore announced that they will provide coverage for:
1 Major Depressive Disorder (MDD)
2 Schizophrenia
3 Bipolar Disorder
4 Obsessive Compulsive Disorder (OCD)
5 Tourette Syndrome (up to age 21)
Under the Beyond Critical Care plan.
Relate Malaysia advocates for equality between mental health care and other medical treatments. In 2013, the USA government set the international precedence of mental health equality and parity. Mental health conditions are equally covered and treated like any physical health condition because all are health conditions.
As the USA Surgeon General said: "There is no health without mental health".
Let's look at how this will look like for someone with depression according to AIA Singapore's new plan.
1. You can only file one claim per illness. This means, if you have major depressive disorder - you can only make a single claim for depression in your lifetime.
FACT: 50% of people who recover from depression will have another episode of depression in their lifetime. (Kessler et al., 1994).
Why is the recurrence of physical illnesses like cancer covered but not depression?
2. AIA Singapore will provide an additional 20% of the coverage amount up to $50,000 per claim. This depends on how much coverage you have paid for. If you paid for $100, 000 - you will get $20, 000 (capped at 50,000).
FACT: Depression is costly.
i: Depression cost time. A depression episode will last on average 4 months but 35% of people will have depressive episodes lasting more than 1 year (Patten, 2006).
ii. Depression causes disability. The World Health Organization recognizes that depression is the leading cause of disability and one of the major contributors of the burden of disease. In Malaysia, depression is the 4th cause of disability. Over 95% of people with depression will have significant impairment in their work/school responsibilities, home/family life, and social life (Kessler et al., 2003).
iii. Depression cost money. It is estimated that for every dollar spent on treatment for depression, 2X more is spent on indirect cost such as absenteeism and presenteeism (Greenberg et al., 2015).
iv. Treatment is expensive. Psychotherapy and medication is the recommended treatment for moderate to severe depression. About 12-18 weekly sessions of psychotherapy is recommended for a single episode of depression, while it is recommended that people stay on antidepressants for 6 - 9 months. Given the length of treatment + the average cost of seeing a psychiatrist privately (RM300-400), psychologist (RM 200-400), and medication = $$$.
Why is mental health coverage limited to only 20% when other major illnesses are covered 100% of the coverage?
Mental health conditions are debilitating health conditions and treatment takes time and money.
3. There is a waiting period of 3 years before you claim for another illness. For instance, if you are diagnosed with OCD, you can't claim for depression.
FACT: Mental health conditions commonly co-occur. About 30% of people diagnosed with OCD will experience depression AT THE SAME TIME. 60-80% of people diagnosed with OCD will experience an episode of depression in their lifetime (Perugi et al., 1997). People should be able to get treated for co-occuring mental health conditions which are highly debilitating, and not have to wait to be treated. This only delays recovery and causes further impairment.
There is no waiting period or mutually exclusive criteria for different types of physical illnesses according to the brochure. For instance, you could have a major head trauma AND be in a coma at the same time. Both major head trauma and coma are covered as separate conditions.
Why is there a waiting period between claims for mental health conditions?
AIA's move is a giant leap for mental health care in South East Asia. There is still more to be done however for the 30% of Malaysians with poor mental health. Let's aim higher and provide a better mental health care health care for our family and friends. Let us set the standard for SEA for mental health equality and parity.
To read more about the insurance plan:
https://www.aia.com.sg/content/dam/sg/en/docs/product_brochures/critical-illness-protection/aia-beyond-critical-care-brochure.pdf
References
http://www.healthdata.org/malaysia
https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
https://www.who.int/bulletin/volumes/91/1/12-115063/en/
Greenberg, P. E., Fournier, A. A., Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). The Journal of clinical psychiatry, 76(2), 155-162.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., ... & Wang, P. S. (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Jama, 289(23), 3095-3105.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., ... & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of general psychiatry, 51(1), 8-19.
Patten, S. B. (2006). A major depression prognosis calculator based on episode duration. Clinical Practice and Epidemiology in Mental Health, 2(1), 13.
Perugi G., Akiskal H. S., Pfanner C., Presta S., Gemignani A., Milanfranchi A., Lensi P., Ravagli S., Cassano G. B. (1997). The clinical impact of bipolar and unipolar affective comorbidity on obsessive-compulsive disorder. J. Affect. Disord. 46, 15–2310.
