There are tricky questions regarding the possible inclusion of cell, tissue, and gene therapy product (CTGTP) treatments under MediShield Life (Healthcare experts laud inclusion of state-of-the-art therapies in MediShield Life review, March 11).

Should everyone’s premium be raised significantly to fund sky-high CTGTP treatments, especially for rare diseases which will very likely not affect the majority?

I suggest a three-wallet strategy to decide, through analysing epidemiology studies and health economics, how much funding is needed and the utilisation criteria for CTGTP treatments in rare diseases, CTGTP in other treatments, and conventional treatments. 

We need to ensure that these wallets are non-porous to one another to avoid misallocation of funds.

While one disease can be considered rare, the aggregation of all rare diseases is no longer a rare event. 

It is estimated that 2,000 to 3,000 people in Singapore are afflicted with chronic rare diseases. 

We need to be clear and transparent about trade-offs. Only in this way can we have our cake with different groups eating their piece too.

Lim Teck Koon