Myth Of The Three Ms

Both Dr Fatimah Lateef (Marine Parade GRC) and Non-Constituency MP Gerald Giam of the Workers' Party made mention of elderly parents' heavy reliance on their children's Medisave accounts to settle medical bills. Despite the announcements of more hospital beds in the pipeline, such as the extra 200 beds for Kwong Wai Shiu Hospital, the affordability of healthcare remain a thorny problem to be addressed.

According to the World Health Report 2000, Singapore is ranked 6th for Overall Performance. However, if you look at Annex Table 7, "Fairness of financial contribution to health systems", Singapore is ranked 101th, sharing the dubious honor with Lebanon, in a list of 191 countries. The measurement of achievement in fairness of financial contribution has reference to a household's payment towards the health system through income taxes, value added tax (GST), social security contributions (CPF), private insurance and out-of-pocket payments. Singapore spends only 3% of the national GDP for healthcare, the balance of the burden rests on co-payment. No wonder the system has been described as potentially a "very difficult system to replicate in many other countries."

Singaporeans contribute 6.5 - 9% (up from 6 - 8% before September 2010) of their earnings to Medisave, a significant chunk of the CPF cut. According to the Ministry of Health (MOH), the average out-of-pocket hospital bill for C Class hospitalisation, after the 80 per cent subsidy, is about $ 1,097. The level of savings in MediSave as at end 2006, is $ 9,300 at the 50th percentile, but what is the MediSave account balance for the 20th percentile ? How many have less than $ 1,097 in their MediSave accounts?

Even for the better off, big bills are always a threat. To ensure that Singaporeans can afford catastrophic bills - and have to depend on a caring Government to help out - they are strongly encouraged to 'risk- pool' by taking up MediShield. The brochure says MediShield will pay up to 80% of the actual expenditure, always subject to the claimable limit. You need cash for the co-insurance and deductible, a deductible that starts at $1,000 and goes up to $3,000 for the aged who really need the financial cover. Although Medishield was conceived for longer hospital stays, the daily charges - $450 (normal ward), $900 (ICU) - are not exactly peanuts.

Medisave will not be enough for wards higher than Class B2 and private hospitals, is the explicit warning on the CPF website. For stronger protection, private medical insurance plans are recommended under the Private Medical Insurance Scheme (PMIS). From October 2005, the Central Provident Fund (CPFB) privatised its MediShield Plus plans through a Tender Evaluation Committee (TEC) chaired by Mr Gerard Ee, same guy taking his time evaluating the bloated ministerial salaries. Funny how his name pops up in all the right places.

Medifund is an endowment fund set up by the Government to help needy Singaporeans who are unable to pay for their medical expenses. SGH makes it clear Medifund help is for patients who are facing financial hardship. It is not an entitlement. Patients have to fulfil certain income criteria before the applications can be approved. In most cases, the program will only assist with 60 percent of the expense. In 2006, $39.6 million from Medifund was given to 20,000 to 30,000 patients for a record 301,126 successful applications - average payout of $132 per application. Be prepared to beg.

So has Singapore’s Healthcare policies met the needs of the people? If they have, the Government would not have bothered to announce plans to boost healthcare infrastructure and manpower in the next 5 years. The Ministry of Health is also re-looking means testing, introduced in 2009, "While continuing to target subsidies, we will rationalise and streamline the means-testing approaches." One last word on means testing in Singapore: People with no income, such as retirees or housewives, have their subsidy rate pegged to the Annual Value of their homes. The IRAS in its infinite wisdom has determined that AV is the estimated annual rent of your property if it were to be rented out. Even if you are using it as a basic roof over your head. Rationalise that.