By Leong Sze Hian
I refer to the article “Medifund supported more than half a million needy patients in 2012” (Straits Times, Feb 23).
It states that “Medifund supported more than half a million needy patients who needed financial aid to pay for their medical bills last year – an 8 per cent increase over the previous year.”
Medifund applications’ success rate?
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.
Patients’ applications’ success rate?
I believe the “more than half a million needy patients” refers to the successful 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, and may be told that they do not even need to apply?
I have tried to ask many medical social workers for the criteria to qualify for Medifund, but have been told that it is confidential.
As I understand it, all family members’ Medisave, as well as the bulk of their savings, must be depleted, before one can qualify for Medifund. What this may mean is that by the time one qualifies for Medifund, the entire family may in essence be left with almost nothing already.
Therefore, I would like to suggest that the Medifund criteria be made public, so that Singaporeans may not have a false sense of complacency, that if they cannot pay for medical costs, they can always rely on Medifund.
For example, some important information that Singaporeans may need to be made aware of, are that as I understand it, about one out of five patients who apply may be rejected, Medifund generally cannot be used for polyclinic out-patient treatment and medicine, patients who are referred by a general practitioner cannot select subsidized Class C and B2 hospital wards and medical treatment and thus may not qualify for Medifund, the maximum Medifund subsidy for B2 is 60 per cent, etc.
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.
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.
Medifund have surplus?
Despite the above statistics and Medifund use restrictions, I understand that about $86 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, May 2006 and 2011. 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 the last reported total assistance given by Medifund-approved institutions (MFIs) to patients formed less than (98%) of the Medifund and Medifund Silver grants disbursed by MOH to MFIs in FY10 – utilisation of allocated funds increased compared to FY09, and 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 sufficient for the whole year. So, it may not be 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 may be 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 in the last financial 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.