By Leong Sze Hian and Roy Ngerng
This part 4 of the “Unofficial history of the poor in Singapore” brings us to two topics which are bankruptcy and medical assistance from the state.
History of Bankruptcy in Singapore
Referencing to the article “Relief for some bankrupts” published on Straits Times in 30 August 1994 states,
“Relief for some bankrupts BY ITSELF, the more than three-fold increase in the number of undischarged bankrupts in Singapore from 4.297 in 1984 to 13,733 at end-1993 is not reason enough for a major overhaul of the bankruptcy laws.”
There are 4,297 undischarged bankrupts in 1984.
Moving on to the 19 May 1997 edition of Business Times Singapore, “S’PORE HAS MOST BANKRUPTS PER MILLION PEOPLE IN REGION.” by Siow Li Sen,
“S’pore has most bankrupts per million people in region. High number reflects efficiency of bankruptcy process, says survey . SINGAPORE has the highest number of bankrupts per million population in the region despite a decline in the number of new bankrupt cases within the last three years..”
In the article, it states that in 1997 Singapore had the highest number of bankrupts per million population in the region.
The number of discharged bankrupts was 1,926 in 1996. And by the end of 1996, Singapore had 13,696 undischarged bankrupts – or 4,033 per million population.
And there were 1,252 new bankrupts in 1996.
So how much did the bankrupts owe in total? In an article published in the 30 October 2012 edition of the Straits Times, “Bankrupts who owe more than $1m pile up $2.2b debt“, it writes
“Those who owe more than $1 million make up only about 9 per cent of Singapore’s 25,061 bankrupts, but together they are in debt to the tune of at least $2.2 billion.”
There were 25,061 undischarged bankrupts in 2011, and together they owe a grand total sum of at least $2.2 billion.
Undischarged bankrupts increase from 4,297 in 1984 to 25,061 in 2012?
So looking from past till the recent year, the number of undischarged bankrupts had increased from 4,297 in 1984 to 25,061 in 2012. While in 2011, the number discharged from bankruptcy was was 1,391, compared to 1,926 in 1996.
An interesting question to ask is how many discharged bankrupts in total over the years?
As there are no cumulative statistics on the total number discharged from bankruptcy over the years, so how many discharged bankrupts are there in addition to the 25,061 undischarged bankrupts in 2011?
The number of new bankrupts has increased from 1,252 in 1996 to about 2,000 a year, in recent years.[divide]
Medical Care Assistance
Parliament report published on 28 February 1990 edition of the Straits Times,
“Fewer depended on free medical care at SGH and govt hospitals”
Not many of those who cannot pay in 1989?
“Replies to questions by MPs in parliament ————
Fewer and fewer people have relied on free medical care at the Singapore General Hospital (SGH) and government hospitals in the past three years.
Between April and December last year, 465 bills were remitted at these hospitals, compared to 689 in financial year 1988, and 758 in 1987.
The figures showed that 142 in-patient bills were remitted at SGH last year, compared to 157 for 1988 and 142 for 1987.
At government hospitals, such as Toa Payoh and Kandang Kerbau, 323 in-patien t bills were remitted last year (April-Dec), 532 in 1988 and 616 in 1987.
There were also 6,786 free cases – destitute cases, those on the public assistance scheme or with medical fee exemption cards – at government hospitals, and 269 at SGH (April-Dec ’89). Figures for 1987 and 1988 were not available.
As for outpatient bills, excluding free cases, 167 were remitted at government hospitals last year between April and September, compared to 378 for the whole of 1988 and 343 for 1987.
In the same period, 64 SGH bills were remitted, compared to 61 for 1988 and 37 for 1987.
Over the past two years, SGH bills paid for by more than one Medisave accoun t dropped from 3.1 per cent (’88) to 2.9 per cent (’89) for B1 beds, and from 2.8 per cent (’88) to 2.1 per cent (’89) for B2 beds.
At the National University Hospital, the proportion went up – from 4.6 per cent (’88) to 5.3 per cent last year for B1 beds, and 4.2 per cent (’88) to 4.3 per cent (’89) for B2 beds.”
0.5 million Medifund successful applications plus 4,000 benefit from hospital charities?
The state of Medical Care in recent years
Commenting on this revelation in 1990 and fast forwarding to today – at least 4,000 patients benefit each year from charity funds run by the public hospitals (Financial pain eased by hospital charities”, Straits Times, Apr 22), as well as more than 500,000 successful Medifund applications in a year, compared to less than 10,000 in 1989 (as indicated in the above media report). (“Medifund helped over 0.5m patients?“, Feb 23)
From Chart 1, you can see that the number of applications seeking assistance from Medifund has been increasing every year.
In Chart 2, you can also see that the Medifund grants disbursed has also been increasing every year.
In Chart 3, you can see the change in percentage terms. Overall, from 2007 to 2011, there was a 45% increase in the number of Medifund applications approved and a 83% increase in the grants disbursed.
However, we are not able to obtain the following information – How many patients needed Medifund assistance? How much were they actual bills? Was Medifund enough to cover them?
According to the Ministry of Health, “Of the successful Medifund applications, more than 93 percent received full assistance, i.e. 100 percent assistance for the outstanding subsidised bill. On average, the amount of assistance given was $1,295 per inpatient episode and $103 per outpatient episode.”
However, if we perform some simple mathematics, we can see in Chart 4 that the average grant per application is about $160. So how did the $1,295 and $103 come about?
Also, if we compare this to the period 1993 to 1995, we can see in Chart 5 when Medifund first started out, the average grant per application was $265.
This is peculiar because if healthcare costs are more expensive now than in the 1990s, shouldn’t there be a higher average disbursement now? If not, are patients actually receiving enough financial support through Medifund?
Also, sometimes patients find it inconvenient to have to apply for Medifund. On top of that, when they apply for Medifund, they are also required to present the income statements of not only themselves, but of their family members as well. Because of the inconvenience and the embarrassment of having to approach their family members, some patients do not seek Medifund support and would rather miss out on care and treatment and fall even more sickly.
If this is so, how many patients are there who need care and support but who are actually not getting it? How many patients have chosen to see their health fail, rather than seek financial support for their medical bills?
Just a few days ago, it was reported that the number of suicide cases in Singapore have arose to reach a 20-year high. According to The Straits Times, “people aged 50 to 59 made up the largest proportion of suicide victims in Singapore last year… and there was also a worrying rise in suicides among people in their 60s and older.” The Straits Times also reported that, “Reasons for elderly suicide could include … financial issues.”
So, is our healthcare system adequate for the poor and elderly in Singapore? Is our healthcare system able to provide for and protect them? Why do we have a system which makes it difficult for the poor to access support, when they are the ones who need the most immediate and easy-to-understand assistance? Can we simplify the system?
I concur with what Dr Carol Tan said in her article “Ensuring healthy outcomes for all” (Straits Times, Apr 22) – “It’s about time we reduce the out-of-pocket medical payments and reduce the anxiety of falling sick in Singapore. Hospital bills arising from chronic diseases can result in large out-of-pocket payments, even for those with some form of insurance.”
Already, Singapore is the richest country in the world by GDP per capita. However, the Singapore government spends the lowest proportion of our GDP on healthcare as compared to other developed countries and also spends the lowest proportion out of our healthcare bills. The governments of other countries with a similar GDP per capita to Singapore’s pay for around 80% of the healthcare bills. However, in Singapore, our government pays for just around 30%.
With the highest reserves per capita and where GIC and Temasek Holdings, which manage our reserves, are ranked the 8th and 10th largest sovereign wealth funds in the world, the Singapore government can clearly provide more financial support for the poor in Singapore.
We need to start a conversation where Singaporeans are provided with the full range of health and financial information and statistics, where we are able to decide how much more funding assistance should be given through Medifund, whether Medifund applications should be made more accessible and even automatic, whether there should be a higher interest rate for our Medisave, or at least for the poor and the elderly, and whether the government should give a higher payout for our Medishield.
Increasingly, the robust healthcare system that Singapore has built is being crippled by its lack of care for the poor and elderly. If we are not able to provide for the poor and elderly, no matter how good the healthcare infrastructure is, our healthcare system would have failed the very people that it should serve.