Subsidy and Other Preoccupations 19

After a long period of speculation, we now know how means-testing for inpatients will take:

(emphasis mine)

Healthier coffers, rising costs
MOH gets 19% budget boost to meet subsidy and manpower needs
Tan Hui Leng

AS Singaporeans grapple with medical costs that shot up by 7.4 per cent last year on the back of imported inflation, the Ministry of Health (MOH) is getting a rare 19-per-cent boost to its budget this year — a necessary prescription to meet the need for more manpower, rising expectations and subsidies to help patients cope.

For one, $1.9 billion will be spent over the next five years to grow the pool of doctors, nurses, pharmacists and allied health professionals by 40 per cent.

"Our doctors and healthcare professionals are overworked and at some point, they need a life too," said Health Minister Khaw Boon Wan, noting how director of medical services K Satku was "sleeping less and less", juggling between surgeries and meetings, while younger doctors were "working day and night to meet the needs for increasingly more demanding patients and relatives".

Apart from overseas recruitment — last year, 438 doctors came from abroad, nearly twice the 230 who graduated locally — the bigger budget allows for twice the number of scholarships for allied health professionals this year, plus a new overseas degree-conversion scholarship for Nanyang Polytechnic graduates.

More competitive salaries, too, are needed to retain those enticed by competitive posts abroad and even from the booming local hospitality sector.

But the bulk of the $421-million increase in the MOH's coffers will go towards subsidised patients. Indeed, direct subsidies for class B2 and C ward patients will likely exceed $1.7 billion this year, said Mr Khaw, who unveiled the finalised details of the means-testing scheme to kick in next January at public hospitals.

Sporting "more generous" criteria following feedback from public dialogue sessions and Members of Parliament (MPs), the scheme will not affect 80 per cent of Singaporeans — including all housewives, retirees and children living in HDB flats as well as lower-annual value private properties.

Patients with a personal monthly income of $3,200 or less will continue to enjoy the full subsidy of 80 per cent in class C and 65 per cent in class B2 wards. The higher up the salary scale one is, the smaller the subsidy entitlement.

"We will be flexible at the margins to help those who may appear to be of high income, but who have exceptional financial liabilities," said Mr Khaw.

Similarly, at the other end of the income scale, many of the people in need "end up paying nothing" after some help from Medifund, he said to Nominated MP Siew Kum Hong's suggestion to give an even bigger subsidy to such patients.

And while the minister acknowledged that — as some MPs pointed out — per capita household income was a better gauge of financial ability than personal income, this would be costly to implement and "intrusive to every patient". Should one feel unfairly treated, a thorough means-test can be done upon appeal.

Rising costs will continue to be a worry as health spending goes up from 4 per cent of GDP to as much as 6 per cent in the medium term, said Mr Khaw.

"Last week, (MP) Dr Ahmad Magad related a personal experience during which his daughter was hospitalised in a private hospital. He said he almost fainted when he saw the bill of $2,300 for a two-day stay."

But what is contributing partly to cost increases are Singaporeans' higher expectations. Take the 11-per-cent jump in attendance at emergency departments last year, said Mr Khaw, which creates the need for prices to be adjusted to deter non-emergency patients.

Likewise for subsidised wards, the continual upgrading of services is drawing more higher-income patients — hence, the need for means-testing.

But while the MOH's bigger budget will result in improved clinical care and hopefully shorter waits for medical services, Mr Khaw had some words of caution. Don't expect "on-demand service" like that in five-star hotels. And beware that it does not lead to a vicious cycle of even higher expectations and more cost spikes.

Non-constituency MP Sylvia Lim asked if the MOH shouldn't in fact moderate such expectations. Mr Khaw responded that even as he would be "the last one to be fanning expectations", he could not ignore the growing demands for better public healthcare standards.

For instance, one such improvement will see the bed-to-patient ratio, which stands at 1.6 per 1,000 population now, improve to 1.8 by 2015.


The news article on the CNA site gives more details, and tells us that:


"Higher income earners will get subsidies on a sliding scale of one percentage point, depending on their income range. This is capped at 65 per cent for Class C wards and 50 per cent for Class B2 wards for those earning more than S$5,200.

Economically inactive patients will also receive full subsidies unless they live in a property with an Annual Value exceeding S$11,000.

...

As for those who feel the simplified approach has treated them unfairly, a thorough means-test will be conducted upon their appeal and will be based on the approach that is currently used by nursing homes."


angry doc must say that he is impressed by this new scheme. It leaves a large proportion of patients unaffected, and still gives those who earn more than $3200 a month a substantial amount of subsidy (essentially they may pay B2 prices for a C class bed, or B1 prices for a B2 bed).

There are still a quirk or two in the system, like say how a family with the father as the sole bread-winner earning more than $3200 may be better off if the mother or a child fell sick since they will enjoy full subsidy, than if the father fell sick, since he will not pass the means-test and it will at the same time leave the family without income.

The actual savings in terms of subsidy not given out will probably not amount to much, especially if those who find themselves faced with a large bill and failing the means test can appeal for a 'thorough means-test'. angry doc also notes that the actual amount of money the ministry expects to save is never mentioned in any of the news articles on the subject.

At the end of the day, angry doc suspects, this scheme is probably not aimed so much at reducing government healthcare expenditure by subsidy saved alone but - despite what the minister said - a way to 'moderate expectations'; if this step in introducing the concept that one's inpatient subsidy entitlement is tied to one's wealth is accepted, then it may in the future be easier to implement it in other levels of healthcare, as it has been for nursing homes.

Whether that is a good thing or not will depend on your point of view.