Friday, 18 May 2007, 3:00 am | 1,078 views
By Leong Sze Hian
This is
part one of a three-parts chronological treatise on healthcare
issues over the last 2 years or so, like means-testing,
non-priority for subsidised rates healthcare, wards down-grading,
medical fees competition, costs of medicines and alternatives,
healthcare spending, MediShield, ElderShield, implications for
foreigners, PRs and Singaporeans, etc.
What will the future of
healthcare be like for Singaporeans? What are some issues that we
may need to be concerned with? What are your fears? What sort of
healthcare system do you want? How do we compare with other
countries?
Here are the first 3
issues with our healthcare system.
F1. May 2007 -
REVERSE MEANS-TESTING:
I went to the Travellers’ Health and Vaccination Clinic
at Tan Tock Seng Hospital
for a Yellow
Fever vaccination recently. The charge was $130.20, compared to
just $15 for the same vaccination I had at the same clinic 10 years
ago. This is an increase of 768 per cent or a 24 per cent
compounded increase per annum.
The clinic was furnished
lavishly with leather sofas, leather chairs, paintings on the
walls, flowers in vases, etc, like a five-star hotel. The same
vaccination costs about HK$200 (S$39), A$50 (S$63) and 35 euros
(S$72) in Hong
Kong, Australia
and
Ireland, respectively.
Why has the cost of
vaccination increased by so much over the last 10 years, when
inflation in Singapore was less than 2 per cent per
annum?
When I paid the $130.20
fee, the staff gave me a brochure and said that if I had a platinum
credit card, I would receive a 12 per cent discount for health
screening.
Why do the more affluent
who qualify for a platinum card get a discount of 12 per cent,
whereas the lower income have to pay 13.6 per cent more, in a
government restructured hospital?
Is this not, in a way,
like reverse means testing - the rich pay less, the poor pay
more?
F2. April 2007 -
ELDERSHIELD:
The MOH has announced that the two insurers of ElderShield
will give a one-time rebate to policyholders because of low claims
relative to the premiums collected, since the scheme
started.
Why pay a rebate, and
increase premiums at the same time? Why not just use the excess
funding accumulated to reduce future premiums or increase
benefits?
At the end of last year,
there were about 750,000 policyholders, with a total of 2,366
successful claims. About 16 per cent of claims declined. The claims
payout last year was about $8.5 million (2,366 claims x $300
monthly x 12 months).
Even if we assume all
750,000 policyholders paid the lowest premiums at age 40 of $169.74
(male $148.84 + female $190.63 divided by 2), premiums per year
were $127.3 million ($169.74 x 750,000 policyholders).
This means the claims
ratio was only about 6.7 per cent ($8.5 million in claims but
$127.3 million in premiums).
As the 2,366 claims were
the cumulative total for the four years since the scheme started,
the claims payout over premiums per year is actually much
lower.
What was the claims ratio
for each of the four years of the scheme? I believe this may be the
most profitable insurance scheme in the history of insurance in any
country.
How much profit has been
made since the scheme started?
Notwithstanding the
proposal to increase the monthly payout by $100 and the payout
period from five to six years, in view of the above, how is it
possible that the proposal now is to have existing policyholders
pay a one-off adjustment to make up for lower premiums paid in
earlier years under the current ElderShield scheme, increase
premiums of about $10 a month for the older age group, and have
policyholders registered automatically for the new scheme after
September pay premiums of $1 to $2 more a month?
As to the opt-out rate
having gone down steadily from 38 per cent when the scheme was
launched to 14 per cent last year, there are 1.26 million residents
(Singaporeans and PRs) aged 40 to 64, according to the Department
of Statistics’ ‘key statistics demography Singapore residents by
age group end June 2006′.
So, isn’t the opt-out rate
about 40 per cent (with about 750,000 policyholders among 1.26
million residents)?
Does the Ministry of
Health’s study on the opt-out rate refer to the current opt-out
rate of new entrants who reach age 40, or the overall opt-out rate
of those eligible?
F3. April 2007 -
HOSPITAL WARDS DOWNGRADING:
The Health Minister clarified in Parliament on April 10
that downgrading to subsidised wards is a two-day process and his
plans to introduce means testing in hospitals within a
year.
Some Singaporeans who can
afford higher class wards might be reluctant to opt for them,
fearing that their hospital stay might be prolonged due to
unexpected complications and the charges incurred might exceed
their Medisave account balance, medical insurance and cash
reserves.
Thus, higher-income
Singaporeans might opt for Class C or B2 subsidised wards if, for
example, they believe that they could be required to stay in
hospital for longer than, say, five days. The logic is that if it’s
five days or less, they might think that they can afford the luxury
of higher class ward facilities. But, since there is always the
possibility of them staying for an indefinite period, they might
think it is better not to risk opting for a higher class
ward.
Now that this worry is
being exacerbated by means testing, the problem of overcrowding in
Class C wards may get worse.
In any case, when the
Class C or B2 ward is full, one can go to a higher class ward and
still pay the lower rates. So, why risk opting for a higher class
ward in the first place?
In this regard, I would
like to suggest that patients and their families be assured that if
they opt for a higher class ward, and end up staying for much
longer than expected, such as over three weeks, they will
automatically be allowed to downgrade to C class or B2.
This may result in fewer
people opting for C class or B2 on admission to the
hospital.
Currently, those who opt for a higher class ward, and
subsequently request for downgrading, are subject to means testing
— this I believe is what Singaporeans fear most. Thus, this may be
the root cause for many patients opting for subsidised
wards.
It was clarified in
Parliament that it takes two days or longer to process a
ward-downgrading request, if patients are unable to produce the
relevant documents to support their applications when means-testing
is involved.
Only those with a per
capita family income of $1,000 a month or lower can downgrade to
Class B2, and $500 or lower to Class C. For outpatients applying to
downgrade, it takes an average of two weeks to secure an
appointment with a medical social worker to assess whether the
patient qualifies.
So, for say a three-person
family with a household income of just $1,501 a month, downgrading
to Class C is not allowed. Only 1 per cent of patients in Class A
or B1 wards who sought to downgrade were successful.
Judging from this, no
wonder Singaporeans are opting for lower-class wards — due to the
fear of not being able to downgrade.
