June 1, 2007
Demand for C-class beds at hospitals up sharply
Cost of subsidised care may go up again if trend continues
By Salma Khalik, Health Correspondent
MORE and more patients are opting for highly-subsidised care at
public hospitals, resulting in a huge jump in demand for C-class
beds over the past five years.
In 2001, only 27 per cent of all patients chose C-class beds, where
the Government foots 80 per cent of the bill.
Last year, 40 per cent did so, and this has put a strain on
hospital finances.
The demand for B2 class, where the Government pays about 65 per
cent of the bill, remained at about 35 per cent.
But demand for the private A class fell by 8 per cent, while that
for the B1 class dropped 25 per cent. Of the 5,000 public hospital
beds, 29 per cent are C class and 41 per cent, B2.
The reason higher demand for C-class beds puts a strain on hospital
finances has to do with the way Government subsidies are given
out.
In the past, the money was given out based on the number of
subsidised patients served.
But now, hospitals get a fixed sum and have to divide it among a
greater number of patients.
The strain that has resulted is likely a major reason prices for
both inpatient and outpatient subsidised care were increased
recently. If the trend towards C-class beds continues, more price
increases could result.
Industry watchers say the increased demand for highly-subsidised
beds can be attributed to an ageing population requiring long- term
care and the growing realisation that health care is
expensive.
Health economist Phua Kai Hong says people are becoming more aware
that their Medisave money may not be enough for their lifetime
hospital needs.
Dr Lim Suet Wun, who heads the National Healthcare Group of
hospitals and polyclinics, said better quality C-class care is
another reason for demand - more people consider it 'value for
money'.
In fact, some of the patients who opt for C-class wards can afford
better quality beds, but choose otherwise because of the value for
money factor.
Madam Halimah Yacob, head of the Government Parliamentary Committee
for Health, said people with chronic illnesses who need long-term
care are more likely to pick subsidised wards so they do not
deplete their Medisave and personal savings.
She added: 'This, coupled with the general sense that it is
difficult to downgrade once you are in a higher class ward, could
lead many more people to opt for the C class.'
But she said this does not mean that these patients are 'abusing'
the system.
Both Dr Lim and Madam Halimah also pointed out that many older
people do not have much in their Medisave accounts. Only a third of
those over 60 years old have Central Provident Fund accounts, Madam
Halimah said.
Health Minister Khaw Boon Wan told The Straits Times that many
factors are at play.
'It is partly caused by ageing of population as the elderly stay
longer in hospitals and tend to opt for C or B2 classes to save on
cost,' he said.
But Mr Khaw said that the shift towards C class is not the trigger
for means testing, which is a 'standalone policy option'.
The minister had said in April that means testing - to ensure that
subsidies go to those who need it most - is necessary to prevent
abuse of public health services by the well-off.
Once means testing is introduced, possibly by next year, demand for
C-class beds will likely ease.
Details are not out yet, but it is likely to start with patients
who stay five days or more. Many of the older patients with
multiple problems will fall into this category.
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It can be seen that with the cost of medical treatment on the
rise, patient becomes more aware that the money in the medisave
account will not be enough for their future needs. Furthermore, the
rules that once the patient opt for B2 or above, it is not possible
for them to downgrade and they will be stuck with paying the higher
class medical fees. By selecting the appropriate class, it shows
that Singaporeans are becoming more prudent with medical
expenses.
when means testing is being implemented, it will force the patients
to pay more even and service that is not required.