Angry Doctor

Sunday, April 08, 2007

Subsidy and other Preoccupations 4

After years of anticipation and uncertainty, we finally have a projected date for the implementation of means testing.


Means testing may kick in within next 12 months: Health Minister
By Hasnita A Majid, Channel NewsAsia

Means testing may kick in within the next 12 months, says Health Minister Khaw Boon Wan.

And the first to be affected will be patients in C-class wards who stay more than five days in hospital.

Patients in C-class wards now enjoy an 80 percent subsidy.

But the Health Ministry realised that not all patients need such a subsidy, as there are some in the high income bracket who choose to be hospitalised in such wards.

To ensure that there is no abuse of the system, the Health Minister says means testing must be done on those who stay more than five days in hospital - the average length of stay.

Means testing, which is a way to determine how much subsidy a patient should get, is already done in nursing homes and community hospitals.

Mr Khaw says: "We are in this business where all of us want to constantly improve our service level. But if your prices are wrong, if they are heavily subsidised or free or whatever, you are going to attract more and more patients to you, including those who can go to Gleneagles Hospital and Mount Elizabeth and so on. And we have very good doctors, very good specialists. So we know that at the end of the day, means testing are important.

"And until you introduce proper means testing, I'm afraid all these problems will remain, will simmer. I'm seriously thinking about all those who are long stay, who should now be discharged to community hospital, we should do means testing on them. Now they are saying that if they go to nursing homes they will be means tested but if they remain at SGH they are not means tested, therefore it's cheaper - then we will never solve this problem."

Mr Khaw says for those who can afford to pay more, their subsidy may be reduced to less than 80 percent but they will not be asked to move to a higher class ward.

However, he is not keen to extend means testing at the polyclinic level for practical reasons.

Mr Khaw says: "It's not just looking at your personal income - we are talking about family income here. The whole family should be supporting the patient. So therefore I need to know how many children you have and how much are they earning. And we cannot have self-declaration because everybody will say they are poor, they earn $800 when actually it may not be so. So you begin to see the complexity of means testing.

"We know that at our polyclinics, waiting time is already very long. If at the counter we are going to start asking all these questions, you know, I think we cannot do business. We will end up doing only means testing and no treatment. So it's not practical unfortunately."

Mr Khaw was speaking at a dialogue session on on Saturday with unionists in the healthcare sector, where he answered several questions.

(click here to read rest of article)

Announcing the decision at this time is really bad timing.

Timing aside, angry doc wonders what life in a C-class ward where not everyone pays the same fees will be like. Will those who receive say 70% subsidy feel that they are entitled to better care and service compared to those who receive 80% subsidy, since they pay more? How will the staff and 80%-subsidised patients feel towards them? Will they simply decide that they should just upgrade to B2 class and receive 65% subsidy instead?

angry doc is still ambivalent about the whole concept of means testing; he believes that the right way to control government healthcare spending should be rationing based on need (for the treatment) rather than ability to pay.

For angry doc to embrace the concept of means testing, it will require him to make a paradigm shift and see subsidy not as a form of entitlement which all citizens should enjoy equally if they wished, but as a form of, well, subsidy for those who need them.

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