Hospitals: 80% of patients pay less than $100?

By Leong Sze Hian

According to an article in Zao Bao (Mar 11), 80 per cent of hospital patients in Class C and B2 pay less than $100 of out-of-pocket expenses for their hospitalisation.

It has been said that in “Statistics”, whenever you are given statistics to show that most people don’t have problems, you should also try to find statistics that may show otherwise, so as to have an alternative and balanced perspective of the subject matter.

Let’s attempt to apply this to healthcare costs.

What about the higher percentiles?

What is the out-of-pocket expenses for Class C and B2 patients at the 90th and 95th percentile?

According to the Ministry of Health’s (MOH) web site, the 90th percentile hospital bill size at public hospitals for knee replacement surgery range from $5,124 to $7,164 for Class C, and $5,789 to to $7,737 for B2.

Another example is – the 90th percentile hospital bill size for stroke with serious complications, range from $5,754 to $12,178 in Class C.

No cap to healthcare costs?

The problem with our healthcare system is that there is no cap even in the lowest Class C ward. So, there is no limit as to how much one’s medical costs can be.

This “no cap” issue is underscored by the fact as reported in Parliament, 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”.

35% elderly don’t have MediShield

What happens if you belong to the 35 per cent of elderly Singaporeans aged 76 to 85, or the 8 per cent of the general population who are currently not insured under MediShield? (“Health Ministry urges uninsured Singaporeans to apply for Medishield coverage” (Channel NewsAsia, Nov 14)

No Medisave?

What about those who don’t have MediShield, and have nothing or very little in their Medisave?

Even for those who have MediShield, but have nothing or very little in their Medisave – can they afford to pay cash for the increased deductibles and co-insurance from 1 March? (“MediShield: Deductibles increased by 5 times historically for elderly?“, Nov 12)

So, their last resort may be to apply for Medifund. I understand that the maximum Medifund subsidy for B2 is 60 per cent.

What is the criteria for approving Medifund applications?

What is the criteria for approving Medifund and Medifund Silver applications? Why is this not public information?

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.

How many patients (not the number of applications) who apply are rejected, and how many may be told that they don’t even have to apply because they don’t meet the criteria?

Healthcare system that some may fall through the cracks?

What if you are like the “more than 90 people who had Class C or B2 annual medical costs exceeding $50,000″, and do not have MediShield because your are uninsurable, and don’t qualify for Medifund?

What if you are a Singaporeans whose foreign spouse’s citizenship, permanent residence or long-term visit pass-plus (LTVP-Plus) application has been unsuccessful, and thus have to pay up to five times more for hospitalisation than a citizen?

B1 and A wards – just a matter of choice?

I also understand that in order to be admitted to Class C and B2 ward for treatment, which are the only classes whereby Medifund can be applied for, a patient must be referred by a polyclinic, or the patient has a medical benefits card referral from a private clinic participating in the Community Health Assistance Scheme (CHAS), or was a direct Accident and Emergency (A & E) admission.

When you are shown statistics for Class C and B2 only, you need to be aware that some patients may opt for Class B1 or A, because they literally “fear for their lives” due to the long waiting periods for subsidised Class C and B2 treatment.

14 months to diagnose?

To illustrate this with an example – 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”)

Patients owe $110m?

If healthcare affordability is not a problem as the “80% pay less than $100″ statistics seem to suggest – why is it that after writing off $90 million, patients still owe public hospitals $110 million?

Public sector spending declined to 40%?

If healthcare affordability is not a problem as the “80% pay less than $100″ statistics seem to suggest – how is it possible that  public sector spending on healthcare, as a percentage of total healthcare spending, has declined gradually over the years, from about 75 percent to about 40 percent or less now?

Lowest public healthcare spending in the world?

If healthcare affordability is not a problem as the “80% pay less than $100″ statistics seem to suggest – why is our public healthcare spending as a percentage of GDP still so low? 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.