Dreams

angry doc hasn't been sleeping well this week. He’s been having dreams. Too many dreams. Some he cannot recall, some which he can, like this one below...


MOH: What's wrong, angry doc? You look preoccupied.

angry doc: It's the latest press release from the ministry…

MOH: The Data on Affordability of Healthcare?

angry doc: Ya.

MOH: What's the matter? You don't think healthcare is affordable?

angry doc: Well, it's not that – but I don't think the data tell you that.

MOH: It's pretty straightforward, isn't it? The average Singaporean has more than $13,000 in his Medisave account, and the average hospital bill for B2 or C class is below $1,100. An average Singaporean can afford to stay in a hospital once a month for a year, or once a year for twelve years.

angry doc: But an average Singaporean does not stay in a hospital once a month, or even once a year. In fact, the Health Facts tell us that fewer than 10% of all Singaporeans are admitted to the hospitals each year; and we know that some Singaporeans are admitted more than once a year. If the average Singaporean chalked up the 95th percentile bill of $2,747, he would deplete his Medisave in four admissions. The averages look good, but the outliers are the ones who need the most help.

MOH: If. He might not chalk up the 95th percentile bill, he might not be admitted four times, and you forget that he might still be contributing to his Medisave in the meantime. To be fair, we need to work on averages here when presenting the data to the public. And even if he was a 'non-average' patient who had depleted his Medisave, we have Medifund. We have been giving out more money from the Medifund, you know?

angry doc: Then again, even if he did have money in his Medisave account, he might still have to pay out of his own pocket because of the withdrawal limits.

MOH: Yes. We realise that and we've increased the withdrawal limit this year as part of the reform. At $400 a day, the average Singaporean can pay for a three or four day stay and pay for almost all of it with his Medisave. You still don't think the figures tell you that healthcare is affordable?

angry doc: No. They tell you that hospitalisation is probably affordable for the 'average' Singaporean. But hospitalisation is only a fraction of the nation’s total healthcare costs. In fact, if the 315,149 admissions to public sector hospitals in 2005 were all under B2 or C class (which I am sure they are not, but for argument's sake…), and the mean bill size is close to the median bill size of $1,100, we are looking at about $350 million. And if the nearly 100,000 admissions to private sector hospitals were close to the median bill size of $2,400, that will give a sum of $240 million. Adding the two gives us 590 million, or about 13% of the total annual health expenditure of about $4.3 billion?

MOH: It does. But we're talking about 13% of the total cost, for what you've noted earlier to be probably fewer than 10% of the population. Hospitalisation cost is a disproportionately high part of the total cost, and what most Singaporeans worry about too.

angry doc: It is, but then almost 100% of Singaporeans will need outpatient care, including those who need hospitalisation care. And 87% is a higher percentage than 13%.

MOH: I agree. Which is why we are also going to allow Medisave to be used for outpatient bills. We'll provide the figures when we have them. You need to be patient.

angry doc: OK.

MOH: Tell me - do you think I am really trying to make healthcare affordable here?

angry doc: Honestly? I do. I just don't think the data published make a very convincing argument that healthcare as a whole is affordable.

MOH: They are only the first set of data. Do *you* think healthcare is affordable?

angry doc: For the vast majority, I think it is, even when you take into account the fact that 'affordability' is largely a subjective term. I think for most people healthcare is something they would rather not have to pay for rather than something they really cannot afford to pay for.

MOH: There will always be those who believe healthcare should be free.

angry doc: So why did you bother to publish the data then? These people are not going to be convinced by the numbers anyway.

MOH: Well, I know you like numbers - they fire your imagination.