“Affordable” healthcare all depends on your luck

By SY Lee and Leong Sze Hian

We refer to the article “Musculoskeletal patients face highest risk of large hospital bills: Study” (Today, May 13).

Luck and the type of illness?

The article describes how studies have shown that those with musculoskeletal diseases, which include back pain and osteoarthritis, had a 5.6 per cent to 14 per cent chance of incurring over S$10,000 in hospital bills after government subsidies (but before insurance, self-funded payments and Medifund kick in, where applicable).

The probability was 1.3 per cent to 8.3 per cent for those with cancer, and 2 per cent to 8.8 per cent for those with heart disease.

In contrast, patients without these conditions faced a 0.85 per cent to 5.6 per cent chance of incurring net expenditure exceeding S$10,000.

Class C bill can be $38,721? 

After government subsidies of 65 per cent to 80 per cent, patients in C Class wards pay a bill between S$38 and S$38,721, with an average of S$1,466. It is also said that 99 per cent of them pay no more than S$9,004.

Class B2 bill can be $95,615?

The article added that B2 patients receive 50 to 65 per cent in subsidies and incurred net bills ranging from S$68 to S$95,615, with the average of S$1,727.  99 per cent of the patients pay no more than S$10,083.

The highest net bill was said to be S$207,741, for an A Class patient.

“Affordable” healthcare that depends on “luck”?

The above examples may have highlighted a crucial fundamental flaw with our “affordable” healthcare system – that even if one has MediShield and choose Class C treatment – you may still have to depend on your luck as to the type of illness you have – and that you and your family may face financial difficulties in paying your medical fees.

Financial counselling, referral from private clinics?

Singapore General Hospital (SGH) said that prior to admission, patients undergo “detailed financial counselling” based on their choice of ward class, expected length of stay and types of treatment. SGH was the only hospital out of five contacted that responded to media queries.

Why is it that patients who are referred from a private clinic are not allowed to choose class C or B2 treatment?

Also, why are patients typically told that they may have to wait for months for diagnostic tests or treatment, if they choose subsidised treatment against non-subsidised treatment in class B1 and A?

What if you can’t pay?

With regard to “Patients who stay for at least a week are given an interim bill to keep them updated and informed, said Ms Ong Mei Ling, SGH’s business office senior manager. The hospital explores assistance options if patients have difficulties paying”

Downgrading requests?

Why is it that the last time that a reply was given in Parliament – the success rate of downgrading requests was only about 1%? If the interim bill raises the patient’s concerns about his or her ability to continue to pay the medical fees – Why the difficulty in downgrading which as I understand it, is subject to means testing?


The newspaper then quote a spokesperson of Ministry of Health saying,

“A useful perspective on hospital bill sizes, and how the appropriate choice of ward classes coupled with heavy government subsidies, Medisave and MediShield work to reduce bill sizes and keep healthcare affordable for Singaporeans”. Those with financial difficulties despite these schemes can tap Medifund”

Why is it that the statistics on the rejection rate for MediFund applications has never been disclosed – only the successful applications rate (not the patients’ rejection rate) are disclosed annually.

Public share of healthcare spending?

The spokesperson added, “We will continue to refine our healthcare financing system to ensure that it continues to meet Singaporeans’ needs,”

But why is our public healthcare spending as a percentage of GDP, at about 1.4%, still amongst the lowest in the world? Why is our public share of healthcare spending at about one-third – also amongst the lowest in the world?


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