Angry Doctor

Thursday, November 10, 2005

Other People’s Money 2

This letter is from the ST Online Forum yesterday, but I thought I would comment on it relation to today’s ‘Clues for the Clueless’.

Nov 9, 2005

Govt should relook at the means test for medical subsidy

My mom suffered three strokes and was bedridden since 2002. Ever since her discharge from the hospital, Touch Home Care (THC) has been taking care of her. It started with free service provided by THC.

Beginning this year, I had to pay for each visit ie. $29 for a nurse and $88 for a doctor. When the nurse comes, she checks my mom's blood pressure, cholesterol and conduct other tests.

When the doctor comes, it is a routine check on my mom's heartbeat etc and he writes a prescription for her medication. The nurse and doctor rotate to come once every month. So on average I have to fork out $58.50 per visit per month.

But starting next year, I have to pay a monthly premium of $148 regardless of the number of visits. This is because THC has implemented a new fee structure and I failed the means test. So I am not entitled to any form of subsidy, which comes directly from the government.

Why I failed the means test? It's because my family head-count consists of only two members ie. my mom and I. I am the only child in the family.

I am earning over $2,000 a month. I hired a maid to look after my mom full-time. Therefore I am not entitled to any subsidy. Subsidy provision is only for those who pass the means test with $750 and below per head. In this case, my means test is $1,000 per head.

It does not take into consideration my hiring a full-time maid to look after my mom. This costs me $300 (salary) + $200 (levy). It does not take into consideration that my mom has to wear adult diapers, which cost $100 a month.

It does not take into consideration that my mom's medication costs $35 a month. It does not take into consideration the daily expenses incurred ie. three meals a day for my mom and the maid, about $10 a day or $300 a month.

How about my own personal expenses? I have to work, eat and pay for transportation, insurance, etc. Or maybe I should not work, just so that I can pass the means test to enjoy the subsidy from the government.
Sure, I can look after my mom without the maid. But without any income, who's going to pay for my mom's diapers, medicines, food, etc? Can the government provide these necessities as well?

On one hand, our government encourages its citizens to work even beyond retirement age. Our government also encourages us to stay with our parents to help look after them in their old age.

Does this include sending our aged parents to an old folks home when they are no longer of help to the family and considered 'useless' when they are helpless? Is this the only solution?

Can we as their children provide some form of filial piety at home instead of sending them to a lonely and cold home? Even if we choose to send them to a home, it doesn't come cheap. Again, depending on the means test, we may have to pay between $1,500 and $2,500 a month.

So what is this means test all about? To turn away people who may really need the government's aid? Is this a fair measure? Maybe the government should weigh the means test on a case-by-case basis. Or maybe the government is inflexible about handing out subsidies?

I guess my family is not the only one affected by the new fee structure implemented by THC. But then, other families may not voice their woes like I do.

Ever since I received the 'service agreement' letter from THC, I have been calling many 'home medical service providers' for help. Most of them were helpful in answering my queries but they were of no assistance.

That's because my mom's case is under THC, and THC is the only community provider in the precinct which my family resides. Given no choice, I have to continue with THC, which I feel is unjustifiable.

It's not because of the money problem, but I feel 'cornered'. If I do not continue with THC, my mom would not be able to get her medicines unless I 'force' her to go to a (polyclinic). In this case, I have to pay for the ambulance service to fetch my mom there and back.

Or maybe my mom should just forget about taking any medicine if she thinks it is becoming too troublesome, which she might just do. But being filial, being the only child, I have to continue providing my mom the best when she is alive and it's not fair for her to suffer.

Probably that's why there is this saying that goes: 'You can die here but cannot fall sick.' Dying is so easy and it is a one-off payment, whereas when one falls ill, the amount to spend is without limit.

I sincerely hope the government will relook at the means test. Is this really the fairest way to measure one's wealth? I wonder.

Wendy Teo Whee Chin (Miss)

Ms Teo’s situation is as she said by no means unique, and I hope she gets the help she needs.

Means Testing is by no means perfect, and letters like hers highlight the deficiencies should be taken seriously by the policy-makers. The letter must also have made many readers aware of this entity called 'Means Testing'. Being aware of it is the first step towards understanding it and having an opinion on whether it should exist, and if so in what form.

However, I take issue with the tone of her letter in the form that it appeared. (The editors are sometimes over-enthusiastic in their duties.)

She gives no word of thanks for all the time when she and her mother had received the care free of charge, and in fact dismisses the doctors’ and nurses’ visits as 'routine', which she only accepted because she wanted the medication. The polyclinic, which also provides subsidised healthcare, is a place so unpalatable to her that her mother has to be ‘forced’ to go to.

Ms Teo does not ask why THC is the only service available in her precinct. The answer is
THC is part of a not-for-profit voluntary welfare organisation. With every visit they make, they LOSE MONEY! Believe me, if they were making money, there would be more than one service vying for her customs. The money that funds such community services comes from somewhere, and in this case it’s donations and grants. One should be thankful for receiving even if it doesn’t cover all one needs.

It's one thing to criticise and question policies (in fact I think we all should), but another to dismiss the efforts of voluntary welfare organisations and the men and women who work in them, some of who could actually command a higher salary elsewhere but choose to do this work instead.

Charity is not an entitlement.

(angry doc is not affiliated with Touch Community Services)

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  • I think for her to demand free healthcare when she's earning $2000 plus a year is a tad absurd. I earn far less than that but I at least have the shame to realise that polyclinics are for the masses. If I want specialised 1st class care, I go to the GP.

    There's only the 2 of them, and a maid. What about families with 3 children and 2 eldery grandparents and the man of the house is the sole breadwinner? Shouldn't they deserve it much more?

    I understand her frustration - she had it free and now she had to pay. But let's be fair here. You're considerably wealthy (as compared to the previous senario) and less burdens as well. With $2000, I'm sure she can manage if she lets go of some luxuries.

    Sometimes, humans just want to take take take. Including me.

    By Anonymous Anonymous, At November 10, 2005 10:40 am  

  • Wah! you even harsher than angry dc. :)

    Actually, I feel her frustrations. She earns S$2000 and so is probably in a white-collar job. She probably went through school and professional training to get where she is today, and expected renumerations accordinging. But now she has to face a situation that her relatively high income is just enough to get by.

    She didn't tell us whether she had to finance housing loan. How much free time does she have for herself? Does she have a social life?

    I think the suffering one bears when one is putting children through school is different from the one one bears looking after a sick parent who will never get well. In the latter case there is little hope of a better future.

    She will spend the best years of her life feeling 'trapped' in something she did not choose instead of pursuing her childhood dreams, and she probably feels guilty when she thinks that the only way out is for her mother to pass away.

    As a society we must decide how much help we want to give to people in need and in position like hers, because ultimately we as taxpayers pay te price. We should be able to have a say on how much pain in other people we are willing to tolerate, and how much we are willing to spend to relieve that.

    By Blogger angry doc, At November 10, 2005 11:58 am  

  • i think what she faces is quite typical of middle class people.

    income not so low as to qualify for financial aid, but got to work around a tight budget.

    that said, there are ways to get around in her situation.

    has she considered asking relatives / neighbours to help out?
    need not be 1 relative / neighbour all the time.
    even if the relative / neighbour is not going to be by her mother's side constantly, it's still ok to drop in and check on her in the day.

    a token sum of money to give to that relative / neighbour surely wouldn't exceed 300 + 200 = $500 per month.

    about feeling trapped.. i think you alone can decide how you want to feel about the whole thing.
    if you view your mother as a burden, then life will probably be hell for you.
    sometimes you just gotta try and be happy, no matter what kind of crap you're in.
    but yeah, there's always the thought of what you could have done, if not for that burden.

    ultimately, i don't believe that increasing taxes is the way to go.
    encouraging the growth of VWOs, and encouraging the public to donate to them puts less stress on the taxpayer and it's totally (almost) voluntary.

    (but then again, if you're too successful in raising money, you might end up like NKF)

    hmm.. may i quote from 2 Cor 8.

    13Our desire is not that others might be relieved while you are hard pressed, but that there might be equality.
    14At the present time your plenty will supply what they need, so that in turn their plenty will supply what you need. Then there will be equality, 15as it is written: "He who gathered much did not have too much, and he who gathered little did not have too little."

    cheers =)

    By Anonymous Anonymous, At November 10, 2005 8:36 pm  

  • I sympathise with her actually...

    By Anonymous Anonymous, At November 11, 2005 12:14 am  

  • I realise my sympathy for her stems not really from her financial difficulty, but the fact that she is the only person in her family to look after her mother.

    I wonder when was the last time she took a holiday for herself.

    By Blogger angry doc, At November 11, 2005 8:20 am  

  • If an unmarried person with monthly salary of $2000 per month has so much difficulties, how about most of my patients making much less, some at $1000 per month and having a family 2-3 kids and also to look after parents?

    Sure, from it stems many questions:
    1) Why did her mother get stroke in the first place? Anything done about secondary prevention? There are many patients out there who refused to take prescribed medications for various reasons and just do not entertain the thought that such medical calamities could happen to them and become a burden to their children.

    2) One must be realistic and be grateful to support provided to them FOC or subsidised. Nobody owes you a living, so if you are subisidised more than what you pay for in taxes, I think you should make internal adjustments in your lifestyle. If only you are aware of how others are coping, but you may not be interested and think that its their problem, not yours...

    3) You are unlikely to stop working because you will then have no income and would rely heavily on social services to provide money, not only in quantity but also on time. You would be even more miserable.

    4) If only people take what they say seriously about "cannot die but cannot afford to fall sick", then they would adopt healthy lifestyle instead of coming up with thousands of excuses why they reject the idea.

    5) So is she going to do her part? Or should everybody be like her and thinking of stopping work and rely on social services? How could we, as a nation, move forward if our people have such mentality?

    I think she and others like her needed counselling and reality check.

    By Anonymous Anonymous, At November 11, 2005 10:29 am  

  • I wish I had my father back, and I'd pay any amount to be able to have him alive, even if it meant caring for him at home and for any amount of money. At least her mother is alive, my dad died of his stroke. : (

    By Blogger Kim, At November 11, 2005 3:03 pm  

  • caring for the chronically ill is more than just money. the daily grind & mental toil is something which one has to experience to understand. you want your loved one to be with you but on the other hand, you want their suffering to end. a lot of people who had close ones die after a long illness tell me of the relief they feel and the accompanying guilt (for feeling relieved). i spent my teenage and med school years caring for a chronically ill elder. i have no wish to be in the situation again. i believe that the writer's lament about her own financial situation is but a reflection of the deeper frustration she feels, day in, day out, of going home (at the end of a very tiring work day) to face another set of problem. of not being able to go anywhere during her free days. of always worrying even when she does go out to relax. this is an issue that all of us have to face, as family units, and as society as a whole.

    By Blogger andrew, At November 13, 2005 4:27 pm  

  • andrew, thanks for reading and commenting at a time when you must be incredibly busy.


    I know Faith has a good father.

    By Blogger angry doc, At November 13, 2005 4:42 pm  

  • By Anonymous Anonymous, At December 31, 2012 1:41 am  

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