By Leong Sze Hian

I refer to the article “Seniors ‘need not worry’ about affordability of healthcare” (Today, Jan 24).

It states that “Mr Gan assured that “senior citizens will always receive the necessary healthcare services without (having to) worry about affordability”.”

What is the criteria for approving Medifund applications?

How can seniors not worry when we do not know what is the criteria for approving Medifund and Medifund Silver 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 larger than 5-room 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 applied for, 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 Community Health Assistance Scheme (CHAS).

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.

Patients owe $110m?

How can the elderly not worry when after writing off $90 million, patients still owe public hospitals $110 million?

35% elderly don’t have MediShield

How can the elderly not worry when 35 per cent of elderly Singaporeans aged 76 to 85 are currently not insured under the scheme, compared to only 8 per cent for the general population. (“Health Ministry urges uninsured Singaporeans to apply for Medishield coverage” (Channel NewsAsia, Nov 14)

Reach out, more awareness?

Health Minister Gan Kim Yong said his ministry is reaching out through events like public talks run by the Central Provident Fund Board.

The ministry is also encouraging children to apply for Medishield coverage on behalf of their elderly parents”.

Over the years, we have been getting almost the same reply along the lines that more will be done to reach out and have more awareness to encourage Singaporeans to apply for MediShield.

We have failed our senior citizens?

Any country that has a so called national health insurance scheme, whereby 35 per cent of the very old – age  76 to 85, do not even have the most basic cover of MediShield, is a failure by any measure. We have failed our country and more importantly we have failed our senior citizens, when they need healthcare most.

Why can’t the reply tell us the percentage of those age 76 to 85 who may have nothing or so little in their Medisave that they may not be able to afford the MediShield premiums?

How can awareness be repeatly replied as the main cause of so many uninsured elderly?

Has the percentage of uninsured elderly been increasing over the years?

What are we doing to solve this problem, and how are we going to help them?

80% subsidy – so affordable?

As to “”Beyond MediShield, the elderly can also receive help for their health care costs. All elderly Singaporeans will continue to enjoy government subsidies of up to 80 per cent for subsidised health care treatment at our public health care institutions, regardless of their insured status”, the fact as reported in Parliament, was that more than 90 people had annual MediShield claims exceeding $50,000 (after the deductibles and co-insurance) in both 2009 and 2010, shows how expensive healthcare is in Singapore, even in the two lowest class wards of Class C and B2 despite continuing “to enjoy government subsidies of up to 80 per cent”.

How many elderly patients who could not pay, were able to get help under Medifund to fully cover their bills, and how many were rejected?

Medifund top-ups help you?

Under the GST Voucher scheme, the government will also provide annual Medisave top-ups for the majority of elderly Singaporeans to help with medical expenses. But, how many elderly had their Medisave top-ups consumed by increasing healthcare costs within say a year of receiving their top-ups?

If your top-ups are consumed by medical costs, how do you pay for your MediShield premiums even if you are aware of the scheme?

Just insure the uninsured?

Since we know who are the citizens aged 76 to 85 who don’t have MediShield, why don’t we just use the Medisave top-ups to directly pay for their MediShield premiums and insure them?

Medishield deductibles and premiums will increase?

How can seniors not be worried when Medishield deductibles and premiums will increase from 1 March 2013 which affects the lower-income elderly more? – if we really want to help, we could spend some money on Medishield.

After all, Medishield does not cost the Government any money, as it is a self- funding scheme paid by policyholders. (“MediShield: Deductibles increased by 5 times historically for elderly?“, Nov 12).

14 months to diagnose?

How can the elderly not worry when It can take 14 months for a patient just to be diagnosed in our polyclinic and public hospital system? (Margaret Chong’s letter ”14-month wait needed before elderly father can be diagnosed” (Straits Times Forum, Dec 29), in which she said “This will make it some 14 months before his condition can be diagnosed and treated”)

Medisave – paying for parents?

How can the elderly not worry when perhaps the most alarming indicator that our healthcare system is failing, is that out of the total amount of Medisave withdrawn for the elderly’s healthcare expenses in the year 2010, about 45% was from their children’s Medisave accounts (Parliamentary reply, Oct, 2011)?

What this means is that the current generation is already using up a lot of their Medisave for other generations – in healthcare funding terms, this may be what many countries fear most and try very hard to avoid – that the current generation is paying for older generations and depleting their own healthcare funding in the future.

21% in debt due to healthcare?

How can the elderly not worry when the last available statistic was that about 21 per cent of Singaporeans who sought help from Credit Counseling Singapore cited healthcare costs as one of the reasons for getting into debt?

Down-grading 99% unsuccessful?

How can the elderly not worry when the last time that a reply was given in Parliament, about 99 per cent of down-grading requests to a lower ward class in hospitals were unsuccessful due to means testing?

Public sector spending declined to 40%?

How can the elderly not worry when public sector spending on healthcare, as a percentage of total healthcare spending, has declined from about 75 percent to about 40 percent now?

Lowest public healthcare spending in the world?

How can the elderly not worry when even with the Government’s announced plans last year to double yearly health-care spending from $4 billion to $8 billion over the next five years – five years is a very long time?

With the previous year’s public healthcare spending as a percentage of GDP at about 1.6 per cent, which is one of the lowest in the world – even with the announced gradual increase in spending – after accounting for the expected rise in GDP, the population increase, aging population and inflation, I estimate that our public healthcare GDP spending may remain as amongst the lowest in the world in the next few years too.


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