Need to reconcile some issues on
means testing
Thu, Jan 10, 2008
The Straits Times
I REFER to the Ministry of Health (MOH) proposal to use means
testing to determine medical subsidies.
While I agree the rich should be subsidised less than the poor, I
am unable to reconcile some issues.
- One, how much will MOH save? Resources will be funnelled to
implement this project. Will the end results more than justify the
costs? Minister Khaw Boon Wan cited the example of a patient
earning $10,000 choosing to stay in a Class C ward to get an 80 per
cent subsidy on hospital charges. Are there many such people? If
his stay is short, would this patient mind paying a few hundred
dollars more for greater comfort? If his stay is longer, would he
mind paying more so he can recuperate in a better ward?
- Two, how will the middle class be impacted? The sandwiched class
seems to get squeezed further. The individual earning $1,000 should
be given his subsidy but what of one earning $3,000 but with $2,900
of liabilities, who has to pay for another hospitalised family
member?
- Three, treatment of income. Using tax or CPF statement is a
backward-looking approach. Those who can return to the same
income-generating capacity have no issues. But what of those who
may have to change their vocation because of their illness? They
may have to settle for lower income or even none for prolonged
periods. Does this new proposal add to their financial burden?
Again, my concern is not with the rich but with the middle
class.
- Four, where will the money saved go? The rich will be subsidised
less, but are the poor subsidised more? Will MediShield coverage be
improved or its premiums reduced? Will more accessible financial
schemes be launched to help those in need?
- Five, repercussions on health-care supply-demand dynamics. If the
objective of moving richer patients to better wards is achieved,
will it lead to overcrowding in Class A and B1 wards? If the
increased demand for these better wards is not met by public
hospitals, patients will seek treatment at private hospitals, whose
charges will go up. Demand still exceeds supply. It's a
reallocation of burden, not a solution.
Felix Ang Kok Hou