Angry Doctor

Tuesday, April 17, 2007

Subsidy and other Preoccupations 8

Sometimes angry doc has difficulty deciding whether letter-writers to the ST Forum are cleverly subtle, or just clueless.


Worry and questions about means testing

I REFER to the article, 'Means testing in hospitals within a year' (ST, April 8).

The problem that means testing is trying to resolve is the 'abuse of subsidised health care'. I disagree with this approach.

By applying for C-class wards, a patient is sacrificing level of service, comfort and reduced waiting time. Hence middle-class citizens who can afford better wards must be applying for C-class wards for pure cost savings.

This should be a personal choice. Why can't middle-class citizens elect to get subsidised health care?

Imagine securing a C-class ward, and, after enduring the long queues and a more crowded environment, having to pay B-class prices after five days.

Furthermore, the definition of what a person can afford may vary. Do we use taxable income? Or disposable income? What about the number of dependants? There are many complexities in this financial decision, and devoting the Health Ministry's resources to perform credit assessments on everyone may generate a substantial cost in itself.

If the patient load in C-class wards is getting heavier, wouldn't it be more efficient if more B-class wards are converted to C-class wards?

With the reduced number of B-class wards, their prices can be subject to market forces. Citizens can hence freely elect to pay B- or A-class prices to enjoy better service. I believe this would be a better way of reducing patient load.

The same argument against middle-class citizens enjoying health-care subsidies can be applied to education subsidies. Do we really want to move in that direction?

Soo Kuo-Ooi


What do you think?

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posted by angry doc at 5:00 pm

6 Comments:

  • I think Soo is right.

    Anyway I am of the view that the whole exercise in means testing is to limit government expenditure on healthcare.

    All the talk about managin resources so that people get what they need etc is just a smokescreen.

    MOH doesn't want to pay. So means testing would be the way to go to ensure that those who can pay (this is unilaterally decided by MOH) will pay.

    The danger here is that MOH may decide a lot more people are "able" to pay than what people think.

    $290 is after all enough for a person to survive in Singapore. How many of you make more than $290 a month? Sorry no C class for you. I won't be surprised if it was like that.

    I expect to see the number of C class wards drop in the future because "demand" for them has dropped and thus more and more B2 and B1 class wards.

    By Blogger Dr Oz bloke, At April 18, 2007 11:30 am  

  • Angry doc,

    Since you are a medical professional, may I know if I have bought a private medishield is that sufficient? I am kind of scared by the system and I had a bad encounter on the mean test. Two years ago, my dad was hospitalized and although I am not in good relation with him but I feel that I have the obligation to give him a better medical treatment. Being naïve and also not having any knowledge about the present system, I decided to put my dad in the B1 ward. My nightmare started….

    The admin staff gave me a quotation of $2000+ (about 5 days stay) bill before he was admitted. I understood that this was a rough estimation and did not include any other investigation cost. My thought was the estimation couldn’t go too far from the actual bill. But I was wrong. He was hospitalized for 12 days. The total bill came close to $8000. During his stay, my blood pressure would go up every time when I saw the bill. I requested to let him downgrade to B2 and they asked me to go for mean test. I was quite surprised because I was only requesting to downgrade to B2 and not C ward. When I took the mean test, I realized that the criteria was quite stringent. Take for example if you have a family of 4 and 2 of them are working earning $2000 per month then your total family income will be $4000. They will use this figure (before deducting CPF) and divide by 4. If each person has about $1000 then they will say that you can afford the entire cost of the treatment. In the end I was not successfully in downgrading my dad. The worst thing was after spending close to $8000 my dad was ‘half-cured’. He had some urology problems but he was hospitalized for another problem. The staff told me that they would not interfere with his urology problem because before he was hospitalized, he already had fixed an appointment with the urologist which would be due soon and they discharged my dad with the urine bag. He had to go back again another treatment. In the end he was in and out several times. Is this an efficient and cost saving way? I am in doubt.

    After the incident, we upgraded the whole family’s medishield except my dad as he is quite old and not eligible anymore. Are we safe enough with private medishield plan? I am scared because I know I won’t be able to pass the mean test. Is private medishield plan sufficient to cover most of the bill in B1 ward?

    I hope everyone can enjoy good health. I have come to realized that health is the most important thing in life.

    By Anonymous Anonymous, At April 18, 2007 3:11 pm  

  • This comment has been removed by the author.

    By Blogger Dr Oz bloke, At April 18, 2007 4:59 pm  

  • In Singapore people only see the doctor when they are sick.

    Sick liao then fix. The "healthcare" industry in Singapore is really the sickcare industry if you think about it.

    However if a doctor tried to talk to you about lifestyle modification,exercise, preventive measures in the consult, well Singaporeans won't take him/her seriously, would give 101 excuses and lastly would not be willing to pay for such advice or preventive treatment.

    Being not sick is not = healthy. Taking more medicine does not make anyone healthier.

    Think about it. But then I also know what the ideas, concerns and expectations are for Singaporeans. Too bad.

    By Blogger Dr Oz bloke, At April 18, 2007 5:03 pm  

  • Anon,

    Thank you for sharing your experience.

    I think your story highlighted one of the key points in the issue of healthcare subsidy: the difference between subsidised and non-subsidised healthcare at the inpatient care level.

    While the difference at the promary care level (between GP and polyclinic) may be small, at the hospital level where the figure is in terms of thousands of dollars the absolute amount can be painful.

    I don't know enough about the insurance plans to comment in depth, but I think it is important to find out from your agent what diseases and conditions are NOT covered under your plan.

    As for the sums insured for, again you probably sit down with your agent and discuss them in the context of your age, current assets and earning potential.

    Call him; after all, that's what you pay him for... :)

    By Blogger angry doc, At April 18, 2007 5:16 pm  

  • I agree that means testing is really a means for MOH to cut costs, but what alternatives are there? I think dr ozbloke is not being fair to MOH: it is not a matter of MOH not being willing to pay. Ultimately subsidized healthcare is paid by the taxpayer and we are not willing to pay more. Given that only 40% of Singaporeans are eligible to pay tax and with an aging population, the healthcare burden on tax payers will only increase. Yet raising taxes is politically unattractive and so means testing is the only other option left. No doubt some will be penalized by the system (I don't think a fair means testing system exists) but it will have the effect of encouraging those who can afford it to buy private medical insurance.

    By Anonymous Anonymous, At April 20, 2007 6:43 am  

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