Medifund: How many patients rejected?

~by: Leong Sze Hian~

I refer to the report “Over S$78m in Medifund aid given to needy in FY2010” (Channel NewsAsia, Mar 12).

It states that “Successful applications also went up by 22 per cent to more than 480,000 in 2010”.

In previous years, the statistics would also say what percentage of Medifund applications was successful. I believe the last reported figure was that about 99 per cent of applications were successful.

However, for this year, I am unable to find any mention of this statistic.

Actually, what is perhaps an even more significant statistic may be – what percentage of patients who applied was unsuccessful? (Note: “Applications are not equivalent to patients. A patient may make multiple applications for each hospitalisation and/or outpatient attendance bill”)

A patient who applies say 12 times in a year would be counted as 12 successful applications. Whereas a patient who is unsuccessful the first time, may never apply again.

Medifund criteria – secret?

What is the criteria for approving Medifund applications?

As I understand it, the only public information that is available in this regard, is that those who cannot pay for their medical bills can apply through the medical provider.

I have been told that to be successful, basically all family members must have hardly any Medisave in their accounts that can be used, have hardly any money in the bank, cannot stay in a 5-room HDB or bigger HDB flat or private property, etc.

I also understand that in order to be admitted to Class C and B2 ward or treatment, which are the only classes whereby Medifund can be used, a patient must be referred by a polyclinic or if the patient has a medical benefits card referral from a private clinic participating in the Primary Care Partnership Scheme (PCPS).

Medifund cannot use for polyclinic?

Medifund also cannot be used for polyclinic out-patient general consultation treatment, such that the medical providers have been raising funds through their own efforts to help such patients who cannot pay.

After writing off $90 million, patients still owe public hospitals $110 million.  

Medifund have surplus?

Despite the above statistics and Medifund use restrictions, $76 million of Medifund unultilised (surplus) has been transferred to the protected reserves. (Note: “The protected reserves comprise accumulated unutilised interest monies that were locked-up at the change-over of Government in December 2001 and May 2006. Authorisation from the President is required before the protected reserves can be used”)

Funds not allocated based on patients' needs?

I am rather puzzled as to why once again, the total assistance given by Medifund-approved institutions (MFIs) to patients formed less than (98%) the Medifund and Medifund Silver grants disbursed by MOH to MFIs in FY10. Utilisation of allocated funds increased compared to FY09. Any unspent funds will be carried over to assist patients in the next financial year.

As I understand it, MOH allocates a grant to each MFI at the beginning of the year for the whole year, and MFIs have to be prudent in ensuring that the grant is sufficent for the whole year. So, it is not based on the needs of patients for the year, but rather like how well the MFI is able to keep within the allocation for the whole year. In such a system, is it any wonder that there is always under-ultilised  funds, as no MFI would want to find itself in a situation whereby there is no money left for needy patients before the year ends?

So, does it mean that total disbursements from Medifund for the year may be more dependent on the interest from the Medifund Endowment Fund, rather than the needs of patients?

Endowment transfers means less Budget surplus?

The Medifund and Medifund Silver Endowment funds now stand at $1,973.3 million, with a capital injection of $200 million last year. In this connection, our Budget surpluses may have been in a sense, under-reported in comparison with other countries, as such transfers are made almost annually to the various endowment funds, like Medifund and the ComCare fund.

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