The Singaporean Ministry of Health (MOH) recently announced changes to the subsidy framework for inpatient care and specialist outpatient clinics, which took effect on 1 January 2023.
According to the MOH website, the new framework replaces the previous individual income means test with a per capita household income (PCHI) means test, as well as takes into account the type of dwelling a patient resides in.
While the government’s aim is to target subsidies more effectively towards those who need it, these changes may result in subsidised patients with higher PCHI or dwelling type paying more for healthcare.
The new subsidy levels are between 30% to 80%, with permanent residents receiving 25% subsidies. Patients who live in “higher AV $13,000” dwellings or have higher PCHI may see a reduction in the amount of subsidies received, resulting in higher out-of-pocket costs.
While the government’s intention to target subsidies more effectively is commendable, it is important to ensure that the new subsidy framework does not unduly burden those who are already struggling financially.
The Government should also take into account the broader context of healthcare costs in Singapore, which are known to be among the highest in the world.
The focus should be on finding ways to reduce costs while ensuring that everyone has access to the care they need, regardless of their income level or dwelling type.
Given that the new subsidy framework for healthcare means that patients with a higher per capita household income or dwelling type may have to pay more, a question arises regarding fairness.
For example, a lower-income or no-income patient who received an 80% subsidy in the past, may have his subsidy reduced to 30%, because his annual value (AV) is more than $13,000, or his PCHI is more than $6,500; or to 60% for PCHI between $2,000 to $2,200
If low-income or no-income individuals, or those living in higher-value dwellings, are unable to afford the higher fees, is it fair for their other household members to help them pay?
On the balance of probabilities, arguably, how likely is it that a high-income patient will pay less due to PCHI, and how likely is it for a lower-income patient to pay more due to PCHI?