Alternative proposals for a better Singapore
I am glad to read that, in response to the calls from several Singaporeans, including Tan Kin Lian and myself, the government is now considering covering under MediShield, the national health insurance scheme, children with congenital illnesses.
—
Get my latest updates. Join my Facebook Page.
Two letters to the Straits Times forum in the past week shed light on a little known fact that our national health insurance scheme, MediShield, does not provide the universal coverage that many Singaporeans would have expected it to.
On September 2nd, a parent wrote in to express dismay that his newborn daughter was refused MediShield coverage because she was born with a suspected cyst in her lungs, a condition diagnosed during pregnancy. He said the CPF Board, which manages MediShield, denied her coverage, citing “the higher insurance risk posed by her pre-existing health condition”.
—
Get my latest updates. Join my Facebook Page.
Medical doctor Ng Liang Wei wrote a letter to the Straits Times forum today suggesting that a fund be set up to help mothers to defray the cost of their pregnancies so as to give them less reasons to abort their babies.
I fully support this idea. I have blogged about the issue of the staggering number of abortions in Singapore before. I think for too long, the debate on abortion (at least in the US — we haven’t debated much about it in Singapore) has been centred on pro-life vs pro-choice. Pro-lifers say abortionist are killing babies, while pro-choicers say anti-abortionists are restricting the freedom of women to do what they want with their own bodies. The argument goes on and any attempt to find common ground is squashed.
—
Get my latest updates. Join my Facebook Page.
I became one of probably hundreds of patients who were hauled to Tan Tock Seng Hospital (TTSH) in the past week for suspected Influenza A (H1N1), also known as swine flu. It wasn’t a very pleasant experience, but I’m in a way glad I got to witness first hand the fight in the trenches against this viral illness.
The episode started with my 4-day business trip to Australia last week. When I returned on Monday evening, I had a little runny nose and sore throat so decided to head straight from the airport to my GP clinic, even though I had breezed through the thermal scanners at Changi Airport without incident.
—
Get my latest updates. Join my Facebook Page.
Health Minister Khaw Boon Wan has announced that means testing will likely be implemented in restructured hospitals by the end of this year. Although the details of how it is going to be administered have not been confirmed, one fact seems clear: Many middle-income Singaporeans are going to have to foot larger medical bills in the near future.
Low income Singaporeans can probably breath easy as means testing is unlikely to negatively affect them, since the Minister has said that only the top half of income earners who stay in Class B2 or C wards will undergo a means test.
Currently, patients admitted to Class C wards in restructured hospitals enjoy an 80 per cent subsidy on their hospital bill. With the introduction of means testing, many of them may no longer receive that subsidy, or may have to accept a lower subsidy.
The Government’s rationale for introducing means testing is to reduce overcrowding in Class C wards and ensure a sustainable healthcare financing system by providing heavy subsidies to only deserving low income patients.
Having heard the government’s arguments for means testing, many Singaporeans may be questioning whether it is really necessary, and if there are other better ways to contain rising healthcare costs.
Show us the numbers
The means testing concept makes sense in theory: Rich folks ought to be subsidised less than poor folks. Means testing could prevent “cheapo” rich people from consuming taxpayer funded subsidies when they can well afford to pay for their own medical expenses.
However I wonder whether the rate of abuse of the system is really as high as the government makes it out to be. Singaporeans have been presented with the rationale for means testing, but not the numbers to back it up.
The Minister has said that means testing is likely to be administered only for patients in the upper 50th percentile income bracket. How many patients currently in Class C wards are in the upper income bracket?
The median monthly income for Singaporeans last year was $2,330. That is not very much. Is it fair to consider a sole breadwinner who earns $2,400 a high income earner not entitled to Class B2/C ward subsidies?
Will the cost of planning and administering means testing exceed any savings for the government? These costs could be significant. They could include extra medical social workers to conduct assessments and investigations, new computer systems to manage the data, and time and effort spent by officials to respond to questions and complaints.
Mr Khaw, in fact mentioned that he is considering a graduated reduced subsidy from 80 per cent, point by point down, to 60 per cent for the top 20th percentile income earners. So after all this debate, we may be looking at just a 20 per cent reduction in subsidies for top income earners.
At the end of the day, the savings from means testing may not even justify implementing the system. It may be more efficient to keep the current system of letting patients decide which ward they want to go to, based on their own assessment of what they can afford.
Medical insurance and Medisave
Since means testing will be targeted at middle income earners, it is important to look into why so many of them would rather stay in Class C wards rather than more comfortable and less crowded B1 or B2 wards. Why do they still have to depend on government subsidies and why can’t their health insurance adequately cover their costs?
Most Singaporeans are insured under MediShield, Singapore’s national insurance scheme. MediShield helps cover the costs of catastrophic illnesses which require long hospital stays and result in crippling medical bills. The premiums for MediShield can be paid using Medisave, the national medical savings scheme. Typically, employees contribute 6.5 to 8.5 per cent of their wages to their Medisave accounts.
Unfortunately, MediShield’s coverage does not cover the entire hospital bill. For patients staying in Class B2 or C wards, an average of 40 per cent of their medical bill must be paid using cash or Medisave. Class A, B1 or private patients can expect to pay even more. Most of this payment is due to deductibles and co-payment. The deductible ranges from $1,000 to $3,000, depending on the ward chosen. Co-insurance will be 10 to 20 per cent of the claimable amount.
This means that for a claimable amount of $8,000, a Class A patient will have to pay a deductible of $3,000 and co-insurance of 10 per cent on the excess of $5,000. Hence, he will have to fork out $3,500 on top of the portion of the medical bill that wasn’t claimable under MediShield. Is it any wonder then that many relatively well-off people choose to be warded in Class C where the base charges are lower?
There are riders offered by private insurance companies to offset the co-payment and deductibles, but the premiums for these riders cannot be paid using Medisave. Consequently, most people do not take them up as it involves having to fork out additional cash.
This results in a vicious cycle of large hospital bills that MediShield doesn’t adequately cover, leading people to try to incur smaller bills by staying in Class C wards and costing taxpayers more.
To help to lessen this problem, the government should allow Medisave to be used to purchase not just MediShield, but also the riders to offset the deductible and perhaps even part of the co-payment. If CPF members are allowed to use Medisave to pay for these riders, surely many more will sign up for them. After all, many of them have more money stashed in their Medisave accounts than in their Ordinary accounts, as the latter is usually used to pay for their HDB mortgage.
This proposal was raised in Parliament by Nominated MP Cham Hui Fong during the budget debate in 2006. The Health Minister’s response then was, “This is not wise and we do not encourage this. That is why we do not allow Medisave to pay for the premiums of such riders, as proposed by NMP Cham Hui Fong. But if Singaporeans want to buy such riders out of their cash savings, I cannot stop them.”
I can imagine what the government’s concerns with this proposal might be: Excessive drawing down of one’s Medisave; over-consumption by patients and over-servicing by hospitals, leading to higher premiums across the board; and people buying unnecessary policies from aggressive insurance agents.
Fears that people will exhaust their Medisave by paying medical insurance premiums don’t make sense when Medisave can already be used make direct payments for huge hospital bills, and even the bills of one’s family members (including parents). These direct payments surely amount to much more than insurance premiums.
The concern that patients will opt to stay in hospitals for longer than necessary won’t apply to the majority of patients. Who in the right mind would want to stay in hospital if they have recovered from their illness? There may be exceptional cases, but these can be dealt with by doctors who have the authority to send patents home after they have recovered, or to step down care in community hospitals. As for over-servicing, surely we should have a little more faith in the integrity and professionalism of our doctors!
Lastly, to lessen the confusion about which rider to purchase, the government could simplify things by opening a tender for private insurers to provide a single, low-cost MediShield rider that people can choose from — much like how MediShield Plus was transferred to a private insurer (NTUC Income) through a competitive tender in 2005.
If most Singaporeans and permanent residents sign up for this proposed MediShield rider, the insurance companies may be able lower their premiums. With a system like this in place, Singaporeans will benefit from low cost and more comprehensive coverage and the government too will spend less on subsidies. Even insurance companies will find something more to cheer about.
Conclusion
Means testing is probably going to be one of the hot button political issues this year, as would any issue that involves the removal of key government subsidies. The Health Minister has got his work cut out for him convincing Singaporeans that it is the right way to go. Less than two years ago, his first attempt to impose it got beaten back during the heat of elections. This time, he will need to present more convincing arguments to an increasingly sceptical populace, or better still, explore a win-win solution by allowing Medisave to be used to pay for more comprehensive health insurance.
This article was written for theonlinecitizen.
—
Get my latest updates. Join my Facebook Page.
Blood shortage was not cause of death: Raffles Hospital
By Ng Baoying/Chua Su Sien, Channel NewsAsia | Posted: 11 July 2007 2214 hrsThe woman who died after giving birth to twins over the weekend was not denied blood, and her death was not because there was insufficient blood available at the time, according to Raffles Hospital.
It explained that an emergency blood transfusion was immediately started for Madam Swee Lay Kuan when massive bleeding occurred during surgery.
More blood was also immediately obtained from the blood bank.
The hospital said Madam Swee’s death was due to Disseminated Intra-vascular Coagulopathy (DIVC), an acute blood coagulation problem arising from massive bleeding and transfusion.
On Tuesday, it was reported that her husband had been told by hospital staff that if the family wanted more blood, they would have to round up others to donate some at the blood bank.
But Raffles Hospital clarified that while it is common practice to ask relatives and well-wishers to help replenish stock, it is never a requirement for blood to be released by the blood bank.
This is a stand supported by the blood bank.
Dr Diana Teo, Bloodbank@HSA, Centre for Transfusion Medicine, Health Sciences Authority, said: “It is not customary for the blood banks to request that hospitals ask family and friends to come forward to donate blood.
“However, we do know that some hospitals do try to help the blood programme by asking some of the patients to ask their family to come and support us. But I assure you that this is never a requirement from the blood bank.” – CNA/yy
I watched the original Channel 8 interview with the poor, sobbing husband as he described how the blood could not be released to his wife because of bureaucratic red tape. The next day, after reading the TODAY report, I got confused.
Raffles Hospital claims the patient was not denied blood. So why did the husband claim otherwise? Are they saying he was lying? Why then would he round up 200 of his friends and family (no easy task, if I might add) to donate blood to the blood bank so as to replenish its stock?
I don’t think Raffles Hospital should get off so easily with this simple explanation. It might be true that Mdm Swee died of causes other than a blood shortage, but sometime during the saga, one of its staff must have given the husband the impression that his wife had exceeded her limit. The hospital needs to explain in more detail why this happened. Is the hospital sure that all its staff are aware that no management authorisation or family blood donations are required to release more blood for emergencies? Or were they just reiterating a policy?
My deepest condolences to the family of the late Mdm Swee, especially her husband.
I hope this tragedy will spur more people to donate blood. I’m guilty of not doing donating for the last few years and really should do so soon.
—
Get my latest updates. Join my Facebook Page.
I’m not an avid TV-watcher, but the Health Promotion Board (HPB)’s latest anti-smoking ad has got to be the most disgusting and shocking one I have ever seen — and I applaud HPB for it!
This ad has caused unease among some parents of young children who are concerned that their kids’ delicate psyches would be damaged by the graphic image of a mouth cancer sufferer. One mother complained that her nine-year old daughter (that’s a primary 4 student, not a toddler!) was so traumatised by the commercial that she had a nightmare that night, waking up at 3am screaming for her daddy. Others had complained that screening the ad during dinner time turned them off from their food.
In response to public complaints, HPB has revised its advertising timing and channels “to minimise causing any alarm to young children”, according to its CEO Lam Pin Woon. The ad will now be aired only after 8pm.
I’m glad that it will still be aired early enough for most children to watch during “Prime Time” TV programmes. In my opinion, it is children and young teens who should be the target of anti-smoking ads, not older teens or adults. Trying to get an older smoker to quit is almost as hard as getting him to change his religion — it is possible, but not easy. If, however, such ads can sear in impressionable young minds the shocking consequences of smoking, it will forever be a subconscious deterrent to even pick up the habit, regardless of peer pressure when they hit adolescence.
I don’t know what the statistics are showing, but I seem to notice many more teenagers smoking nowadays. I believe teens are not ignorant of the health risks when they take up smoking. But if it is a choice between looking cool in front of your friends, or suffering some disease when you are 60, teens who are already suffering from self-esteem issues would likely choose to light up.
Thus, the thrust of the anti-smoking message to teens should not be to focus solely on the health risks, but to work with families, youth organisations, religious organisations and other social service organisations to raise the self-worth of teens. If they really loved themselves, do you think they would pick up a habit that is not only destructive to their health, but damages their image as well?
This might appear to go beyond the responsibility of HPB, but what is the use of tackling superficial issues alone without tackling the root problems? A multi-agency approach is therefore necessary to lower the smoking rate among our young.
——–
Update: This is Health Promotion Board’s reply to my feedback:
Dear Gerald
Thank you for your support and feedback. Since the launch of our Campaign, HPB has seen a 5-fold increase in the number of calls to QuitLine from smokers desiring to quit smoking. We have also received many compliments from smokers and non-smokers alike. Nonetheless, we give all feedback due consideration. In addition to re-scheduling our advertisement to run after 8pm, we will! also preface it with a warning.
2 This TV advertisement is the first phase of our 3-month long smoking control campaign and presents a fatal and debilitating consequence of smoking to motivate smokers to quit and encourage non-smokers to urge their loved ones to stop smoking. The second phase of our campaign adopts an encouraging tone to urge smokers to quit and non-smokers to support their efforts.
3 The reality is that 1 in 2 smokers will die from smoking-related diseases. Each smoker will on average die 13 to 14 years earlier than non-smokers. Disability, disfigurement and early death due to smoking are very real. As you have correctly pointed out, we need to use a multi-pronged strategy which starts with our children. We are engaing schools, youth organisations, family service centres and other like-minded organisations to help our youth lead a smoke free life. Our National Smoking Control Programme also includes mass media campaigns, public education, provision of smoking cessation services, legislation and tobacco taxation. These strategies has helped Singapore lower its smo= ng prevalence rate from 20% in 1984 to 12.6% in 2004, one of the lowest smoking prevalence rate in the world. We hope to continue to help more smokers quit the habit.
4 A survey conducted by HPB, also showed that the median age of children picking up smoking is about 12 years. Thus we hope that parents can also take this opportunity to educate their children on the fatal consequences of smoking as well.
Regards
Mr Norman Chong | Manager | Smoking Control, Adult Health Division | Health Promotion Board |
—
Get my latest updates. Join my Facebook Page.
Sidebar3 : Please add some widgets here.
I am a non-constituency MP from the Workers' Party. I blog in my personal capacity. 
