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Poor Gini Coefficient signals for policy to make healthcare more affordable. Leong Sze Hian

What has Gini got to do with Medifund?

Leong Sze Hian >> TOC Columnists


 

I refer to the article “Countries with the Biggest Gaps Between Rich and Poor” (BusinessWeek, Oct 23). Singapore’s Gini score of 42.5 is ranked number 2, with the Share of income or expenditure of the Poorest 10% at 1.9 and the Richest 10% at 32.8, and the Ratio of Income or expenditure, share of top 10% to lowest 10% at 17.7.

When theonlinecitizen’s founder, Andrew Loh, asked me if I would like to write an article about Singapore’s latest Gini, my initial thoughts were that since I have written so many articles about the Gini over the years, what else can I say about it? The following day, I attended the 30th Singapore Lecture by the Prime Minister of the Netherlands Dr Jan Peter Balkenende.

During the Q&A, a Singaporean ambassador asked Dr Jan Peter Balkenende if he acknowledges that the Netherlands is so economically and socially advanced, when it has many differences with Singapore, such as you have a minimum wage, welfare, social security, acceptance of gays, drugs consumption, etc?

I was struck by this question, as it dawned upon me that any comparison of the Gini between countries, may be quite meaningless, unless we also look at whether economic and social policies mitigate the plight of the lower income. For example, is there a minimum wage like in the United States (Gina ranked No.3 at 40.8)? Is there welfare and social security like in Hong Kong (Gini ranked No.1 at 43.4)? Is there universal public healthcare? How affordable is public housing? What is the relative cost of living?

Actually, I think what really matters is not any fanciful comparative analysis, but what the Gini really means to ordinary Singaporeans. I try to put myself in the place of ordinary Singaporeans (median income and the lower-income), and try to imagine what are the questions that they may ask? Well, I think many may ask about whether they can afford healthcare, public housing, and whether they will have enough money to retire.

Why is it that our emphasis on skills upgrading over the years, has resulted in the trend of declining real wages for lower-income Singaporeans? Has our liberal foreign labour policies contributed to declining productivity and wages? Why is it that despite once-off benefits like the Progress Package, our Gini continues to be on a worsening trend over the years?

So, I intend to write a multi-part article on some of the current new issues that Singaporeans face, rather than to dwell on past issues for which much may already have been written. For a start now, here’s my take on the latest issues on healthcare.

In response to the media enquiry "Make Medifund Criteria Public", the Ministry of Health (MOH) replied that the criteria for Medifund is public information which is published on the Ministry of Health web site

The MOH web site merely says that the criteria is that any Singaporean who has received subsidised medical treatment and is unable to pay for the medical charges incurred, may approach the medical social workers at the relevant medical institution who will help to assess eligibility for Medifund, and can guide you in filing out the application form if required.

In other words, it is akin to saying that anyone who cannot pay can enquire. There is no information as to what criteria is used to assess the eligibility for Medifund. As to the Medifund approval rate being 99 per cent, with about 360,000 approved Medifund applications in a year, this refers to the approval of applications, and not the approval rate of patients who apply.

For example, a patient who has 12 medical treatments in a year may be counted as 12 approved applications. Whereas, the approval rate in terms of the number of patients who apply has never been disclosed. It was reported in 2008, that 301,126 approved applications were made by about 20,000 to 30,000 patients. In this connection, the number of rejections increased dramatically by 2,900 per cent from 210 to 6,456 in 2006, and then declined dramatically by 79 per cent from 6,456 to 1,266 in 2007.

What about those who were told that they do not meet the basic criteria, which is not public information. In 2008, Madam Halimah Yacob, chairperson of the Government Parliamentary Committee for Health, expressed some concerns that the conditions for Medifund was too stringent, some procedures are excluded, and that for some ailments, B2 is the lowest class of ward available which only gives a maximum Medifund subsidy of 60 per cent.

With regards to all Singaporean patients who require admission are free to choose their ward class, it has been the policy for many years that patients referred from GPs cannot opt for Class B2 and C wards. So, when was this policy changed? Was this change ever announced to the media or the public?

In conclusion, the issue of Gini, may not so much be the income gap per se, but whether countries with poor Gini, like Singapore, have healthcare polices which truly and effectively make healthcare affordable for lower-income Singaporeans.