Angry Doctor

Wednesday, April 25, 2007

Subsidy and Other Preoccupations 11

The ST Forum published a letter from Gerald today:

Have disease-specific time limits for means testing

I REFER to the editorial, 'Means testing a minefield' (ST, April 19). Most people would agree with the principle that the less well-off should receive more subsidies. However, follow-up questioning would likely reveal that none of them would consider themselves as 'well-off', and therefore they, too, should be deserving of subsidies.

Therein lies the difficulty of means testing - everyone agrees with the principle, but the devil is in the details of the implementation. I would like to make the following suggestions for the public and Health Ministry to consider.

Firstly, on the qualifying criteria for subsidy, no matter how the cut-off line is drawn, there will be unhappiness among those above the line. The use of a sliding scale, so that everyone enjoys at least some subsidy, is to be commended.

Furthermore, the criteria should keep pace with healthcare inflation. For example, the current maximum of $500 per capita family income for downgrading to C class was implemented in 2001. Data from Statistics Singapore shows that health-care costs have risen by almost 10 per cent since then, and only 238,000 households met this limit in 2005.

Secondly, the proposed limit of five days' stay in a public hospital is too simplistic. Certain conditions, by their very nature, necessitate a stay of more than five days, e.g., colon-cancer operation. It is also for these very conditions that we worry about chalking up large bills, rather than one-off admissions like childbirth, hernia surgery or knee replacement. With disease-specific data readily available from Casemix, the ministry should instead set disease-specific time limits.

Lastly, the public is apt to view this exercise as a cost-cutting measure. To assure us otherwise, the Government should channel the projected savings back to us, especially to those who will be affected adversely by means testing. This could be in the form of an upgrade of our MediShield packages, to assure us that although we may no longer qualify for C-class subsidies, we would still be able to afford the necessary health care when the need arises.

Gerald Tan Jit Shen

Setting disease-specific time limits sounds like a way to fine-tune means testing. Perhaps we can go one step further and implement different cut-off income levels for different diagnoses too. The background work will probably be a nightmare, but it does sound like something the ministry should look into.

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  • The whole logic of means testing is to make people pay what they can afford. However, it does not take into account what the final bill can be $1000 or $150K.

    If I fainted and enter the hospital, it can be just low blood pressure, a stroke or a brain tumor. Different problem different final bills. How much subsidy you NEED depends on what is your problem. Means testing does not take into account what the final outcome, it is a mechanical way to put people into different class wards.

    How much subsidy you NEED depends not only on your 'means' but more on the medical problem you have.

    The govt dress it up nicely to say they are doing this so they can give more help to the poor. Just the same reason they gave for implementing the GST.

    By Blogger Lucky Tan, At April 30, 2007 4:23 pm  

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