MOH data on hospital bill sizes has not allayed people's worries
ST 25.8.2006.
(add: to prove its sincerity- gov should publish how the extreme
5% of bills were paid instead of resorting to excuses like extreme
data are meaningless and misleading)
By SALMA KRALIK Health Correspondent (ST Review):
NEED FOR MORE INFORMATION
What would be helpful and reassuring... would be for the ministry
to provide even more data. For example the top 10 bills in each
ward class; how much of these were paid for by insurance; how much
by Medisave and how much from the pocket.
HEALTH Minister Khaw Boon Wan believes in giving people as much
information as possible so they can make rational health-care
choices. So the ministry this week released the cost of
hospitalisation based on all bills at six public hospitals for last
year.
But how useful are those figures?
Three members of the Government Parliamentary Committee for Health
were immediately able to spot their shortcomings. The biggest bill
sizes revealed were at the 95th percentile. This meant that 5 per
cent of bills were bigger than the figures given. The question that
nags at people now is how much bigger can those bills go?
The Straits Times asked the ministry for the size of the biggest
bills in the different ward classes at these six public
hospitals.
The reply: "For macro data analysis, the extreme data are
meaningless and misleading. In statistical analysis, it is common
to chop off the outlier data, as they confuse and distract from the
main message. Very large bills which occur rarely, while newsy,
will unduly worry and frighten the people. So publishing the
largest bill in public hospitals, far from reassuring the people,
will only serve to frighten the people."
But as MP Josephine Teo pointed out, when people worry about
health-care costs, it is the fear that they may be part of that
small number who face a massive bill that could wipe out their
entire life's savings. Rarely do people worry about getting
normal-sized bills. These can be planned for- It is the extremes
that make people worry. This is why people buy insurance.
But the latest data released on Monday on hospital bill sizes,
Medisave accounts and medical insurance coverage showed that not
everyone buys insurance, and half the people with Medisave had
$8,900 or less in their accounts.
As GPC chairman Halimah Yacob said, unless there are details of who
has what, "we don't know how much savings the elderly have and
whether this is sufficient to take care of their future needs,
including paying for the MediShield premiums and the outpatient and
specialist outpatient treatment".
The three in four adults here with medical insurance refer to
adults aged. 21 to 60. What about those who are over 60 years old?
They are the ones who are more likely to fall sick, and with more
serious problems. Should their families worry about being able to
meet their medical bills?
For those with heart ailments, the picture is even more somber.
While the latest figures show that only 5 per cent of C class
patients had bills that were more than $2,747, the proportion is
higher for those with heart surgery and stroke. In C class, 10 per
cent of patients pay more than $3,790 for heart surgery and more
than $3,630 for stroke with complications.
Madam Halimah also pointed out that people running up big hospital
bills may not be the ones with adequate insurance and large
Medisave accounts.
As for those who have insurance, the data released does not
indicate if the cover is adequate. Even after reforms were made to
MediShield last year to ensure better coverage of bigger bills, the
insurance payout is just 60 per cent or so of big hospital
bills.
What would be helpful and reassuring to the public would be for the
ministry to provide even more data. For example, the top 10 bills
in each ward class; how much of these were paid for by insurance;
how much by Medisave; and how much from the pocket. In how many
cases did the social safety net, Medifund, kick in to pick up the
tab?
It would also be good to know the proportion of people facing big
hospital bills who ask to pay in installments.
This indicates those who, while able to pay their bills, do so only
with difficulty.
In sum, while releasing information on average bill sizes is to be
lauded, incomplete information can cause undue worry. The question
I've been asked most since the news report appeared is this: "So
how high were the top 5 per cent of bills?"
That showed two things: that people are concerned about medical
costs, and that the figures released by the ministry had not
allayed those concerns. After all, we should always plan for the
worst case scenarios, not the average or most likely ones.
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