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Bone marrow transplants and health insurance in Singapore

In the past couple of decades, there have been some incredible advancements made in the medical field, especially when it comes to the treatment of cancer. While the prevalence of cancer is increasing in Singapore, a 2015 report from the National Registry of Diseases Office found that the number of cancer diagnoses grew from 11,431 in 2010 to 13,416 in 2014, the survival rates for many types of cancer are increasing. This increase in survival rates can be attributed to a number of factors, including increased public awareness, better diet, etc., but possibly the biggest contributing factor is medical advancements. One such medical advancement that has increased our ability to fight certain types of cancer is the bone marrow transplant.

What is bone marrow?

Before we look into bone marrow transplant, it would be beneficial to look at what exactly bone marrow is. As you may remember from your biology lessons in school, bones are hollow. Inside these bones is a soft, spongy tissue filling the hollow spaces in our bones, this tissue is the bone marrow.

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The marrow isn’t there simply to fill the hollow space in our bones, however. In fact, it plays an essential part in keeping us healthy as the bone marrow contains what are called stem cells, which are used to create the three major types of blood cells:

  • Red blood cells – Cells that carry oxygen and carbon dioxide to and from other cells around the body.

  • White blood cells – Cells that circulate the body and eliminate foreign substances like diseases.

  • Platelets – Cells that circulate the body and help to repair damaged blood vessels.

Bone marrow isn’t just for creating blood cells. In fact, it is also a key part of our immune (lymphatic) system. It is in our bone marrow where lymphocytes (cells that are a type of white blood cell that allow the body’s lymphatic system to function) are created.

What exactly is a bone marrow transplant?

Like other parts of the body, there is a chance that our bone marrow may not develop properly, or will stop working effectively. Some of the most common causes of this include:

  • Certain cancers like lymphoma, leukemia, and multiple myeloma that have essentially caused the marrow to stop working.

  • Immune system disorders like sickle cell anemia, and aplastic anemia, that affect the production of cells.

  • Removal/destruction of bone marrow caused by intense chemotherapy.

If your doctor finds that your bone marrow is not functioning as it should be, they will usually order a bone marrow transplant. When it comes to a transplant, there are actually three different operations that can be done:

  • Autologous bone marrow transplant – Also referred to as a ‘rescue transplant’, this is where doctors will remove stem cells and marrow from your body and then administer high power chemotherapy or radiation therapy. Once this is done, they will put the cells back into your body where they find their way to the marrow and start to produce blood cells again. This is used to help treat patients with leukemia and other similar cancers of the blood.

  • Allogeneic bone marrow transplant – Stem cells from another person who has a similar genetic makeup as you are injected into your body, usually after intense chemo or radiation therapy, with the goal of essentially jump-starting cell creation and encouraging the body to fight diseases. This is most commonly used to help treat patients with leukemia, myeloma, anemia, and other bone marrow diseases.

  • Umbilical cord blood transplant – Similar to allogeneic bone marrow transplant, only the stem cells come from the umbilical cord right after a baby is born. These cells are essentially less mature than those found in adults – which means they are more adaptable – and can, therefore, be used in more patients, including patients with rare genotypes, with greater success.

Regardless of the type of transplant used by doctors, it has been proven to work. For example, according to SingHealth’s bone marrow transplant¬†page, “The survival rates for allogeneic haematopoietic stem cell transplant stands at 68%. The results are comparable to the best centers in the world.”

The thing about bone marrow transplants, especially the ones that are allogenic (from donors) is that you actually need a supply of stem cells in order to be able to enable the transplant to take place. What’s more, the donor needs to be an incredibly close genetic match if the transplant is to be successful. In many cases, the donor will usually be a close family member (e.g,. biological sister, brother, or parents), but sometimes a match can’t be found. If this is the case, then doctors will turn to volunteer donors. These donors are usually tracked via a database or donor program that almost any person can join.

How can I donate bone marrow?

In Singapore, bone marrow donors are tracked by the Bone Marrow Donor Programme (BMDP). This non-profit program was first established in 1993 and tracks all of the volunteer bone marrow donors in the city, it also helps doctors and patients search for matches when a transplant is needed.

According to their 2016 fact sheet, they have helped nearly 500 patients find a donor, a sound achievement considering the chance of finding an appropriate donor in the city is around 1 in 20,000. This means that the more people who sign up to be a donor, the greater chance there is to find a donor.

The question is, how exactly do you sign up to become a donor? First off, the process of donating your bone marrow/stem cells is actually fairly simple. You sign up, take a quick test, and – should you be a match to someone who needs a transplant – will undergo a relatively painless procedure that involves a short stay in the hospital. The BMDP have some great information on their website about how the whole process works.

They have also streamlined the donor application process via a program they call ‘Project Tomorrow’. In fact, to become a donor, which is free, all you have to do is apply online and complete the medical swab the BMDP sends you.

Does my health insurance cover a bone marrow transplant?

The short answer here is: Yes, almost all medical insurance plans in Singapore will cover bone marrow transplants. That said, the cost of a transplant can be extremely high, especially for expats who may require an overseas transfer as their donor may not be in Singapore. One important thing to consider here is that, unlike other diseases, bone marrow transfers are usually only a small part of a larger overall treatment, which will require numerous inpatient and outpatient visits.

To that end, many local insurance policies likely won’t have limits high enough to cover the whole treatment. While residents of Singapore do have access to universal health insurance to offset costs of treatment, expats don’t have access to this. If you have a plan that offers health insurance coverage only in Singapore, then it is highly likely that treatment will see you quickly reaching coverage limits leaving you to pay out of pocket. Therefore it is recommended to go with an international health insurance plan. These plans tend to offer much higher coverage limits, which means you will be better covered should you need a bone marrow transplant.

It is important to point out here, however, that almost all health insurance plans will only cover the cost of the actual treatment/transplant. They will not cover the cost associated with finding a donor, which can be a costly endeavor. That’s why it’s so important to support organizations like the BMDP by becoming a volunteer donor or donating.

If you would like to learn more about insurance coverage and your options, please contact Pacific Prime Singapore today.

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