By Terence Lee / Youth Editor
13th DECEMBER — HEALTHCARE in Singapore is affordable as long as one is willing to accept the B2 and C-class wards without fear of losing face, said Mr Tan Kin Lian at a forum on economic rights.
He asked the audience: “Why complain about the bill when you go the the A-class ward?”
According to him, B2 and C-class wards are highly subsidised and of good quality, and a “cap on bill” exists to ensure medical fees in these wards do not escalate too much.
Held at the URA Centre on Saturday by the Society of Financial Service Professionals in conjunction with U60, the forum also saw financial consultants Leong Sze Hian and Lyndon Chew speak on different topics.
Singapore’s healthcare system enjoys a high world ranking, said Mr Tan, and this is due to the fact that responsibility for healthcare is placed on the individual. The state does not pay for everything, preventing overconsumption and keeping costs down.He also advised that Singaporeans stick with Medishield as it is adequate enough to cover medical costs in subsidised wards.
Mr Tan estimated that the lifetime cost of a private shield plan could run up to $100,000, but a Medishield plan will cost only about $40,000.
“If you are happy to contribute to the AIGs of the world, then its okay, you can go ahead,” he added.
“Some have told me: It’s better to die than to fall sick in Singapore,” said Mr Tan, citing a common refrain among lower income groups here.
“But is the situation really that bad?” he asked. “Apparently not.”
Singaporeans pay only about $800 for healthcare annually, constituting “less than 5%” of the nation’s GDP, he said.
This is in stark contrast with countries like the US and Germany, which stand at 15.3% and 10.7% respectively, he said.
A check with a World Health Organisation (WHO) report confirmed that Singapore ranked 6th in overall performance of the health system in 1997 (no later figures were available).
“The 3Ms — Medisave, Medishield, and Medifund, are there to help make healthcare services more affordable here,” he said.
He added that “healthcare costs are manageable, despite rising costs and the aging population.”
The biggest concern for Mr Tan, in fact, is that people are not educated about making the right choices when it comes to accessing and funding healthcare.
However, this is not helped by the lack of clarity about means-testing.
“If I’m a multi-millionaire, am I allowed to go to the C-class ward? The answer is still yes, just that I’ll enjoy less subsidies than someone from a lower-income household,”
“The Singapore system is so complicated — there’s too much criteria — that you are excused if you don’t know, even I myself don’t know until I found out!” he said in mock exasperation.
33)Sgcynic
Thank you for your comments.
The arrangements between you and your insurance provider is a personal choice. If the insurer changed its policy, you can change provider too – like what Mr. Tan KL has supposedly done?
“Next year, under the means testing, citizens can conceivably see a 75% increase in medical bills.”
I do not know how you reach this conclusion but I hope you understand that means testing is needed as a fair and pragmatic way to allocate limited health-care resources. It will enable the Government to provide better care for the poor in the Future, without also attracting the well-off to compete for scarce resources.
The poor would love means-testing. The well-off will not care much for a little less subsidy. It’s only the sandwiched in-between middle-income group who feared that means testing would drive up costs considerably. For this group, I would say: do not worry. This fear is totally unfounded as the Government has promised to err on the side of generosity. They also will be increasing the premiums for Medishield so that you can get more in reimbursement.
Means testing may be a small step for the Ministry (the reduction in subsidy is not much) but a big leap forward for the national healthcare policy. Over the long term, people would be more prudent when seeking medical help and no poor person will be denied a good health care.
If really money is not enough for health care provision, there is still the last option – Advance Medical Directive.
I urge all forummers to think a little further. You will see that the foresight of PAP government has again lead the way.
I think its all an issue of preference. I mean, unless its something very major, most of the public wards in Singapore are pretty OK and comparable to hospitals in allot of places.
Mr Tan is correct here. A sane person would think, why don’t you take advantage of a government subsidy as long as the care is of a decent standard. Of course if you feel that you can afford to go private and should not use that subsidy so that someone else who can’t afford it can use, that is also admirable too.
aiyoyo
is it not there’s the medical shield shield thing?
is it working OK for commoners or not huh?
think the ELITEs need to work harder to make a easy, simple plan to commoners,
so that no need worry so much on medical care thing,
some more economy gloomy also,
so many thing to worry here & there in this homeland.
commoners lead simple easy life, ok liao ma..
aiyoyo
45) 1st Lady Beware also that once you check into the higher class ward ie. B1 or A class it is more difficult for you to downgrade to a B2 or a C class ward.
It is difficult but not impossible. If you had been admitted to an A-class ward before and choose to downgrade thereafter, you will need to open a new episode of your subsequent visits to the same hospital. It means, you have to get a referral letter from say, a polyclinic, for your next appointment and, without naming the doctor of your choice, you will be charged a subsidised rate accordingly. Your A-class, or Private Class, classification would be changed to Subsidised class. The doctor whom you will be consulting with may not be the same one who saw to your previous admission and it could be an MO or a Registrar instead of a Senior Consultant.
46) plopp I know someone who recently went for a major op at NUH. The doctor was quite against the idea of C-class wards…
There is no reason why the doctor cannot treat your friend at the C-class ward. Even senior consultants have to conduct their daily ward rounds at whichever wards or class of wards their patients are warded at. You might want to ask your friend to take this up with MOM. Do check with the hospital first whether it is the admin staff supporting the doctors that gave this impression or it is really the doctor himself who was against it.
47) Ravi Philemon Not all hospitals are ‘equal’…so how can the wards be…does the one in the ‘c’ wards get the kind of treatment the ones in the ‘b1′ gets???
If you really ask me, I would say the big difference would be the A-Class wards against all the other wards. In most hospitals, A-Class equals Premium Class. When we talk about ‘class’ we are referring to the physical settings/layout within the ward. A-class has its own special features that sets it apart from the other classes. The difference is the preferred level of comfort during admission.
However, you will still be seen by the same senior consultant who sees to other patients in the lower class wards. So in that sense, you are paying extra for comfort and not for better treatment or consultation. Treatment and consultation are still the same with or without A-Class status.
48) isa What Singaporeans want to hear is healthcare reforms like that mentioned by some of the readers here of the UK healthcare system and Taiwan Healthcare system.……… This should be the focus of the government as they are able and have always gone overseas on “Study trips” to world-class countries to study the various aspect of operations.
Indeed, but sad to say, our hospitals are more concern in exporting our model to other countries, especially those within our region. Many neighbouring hospitals have sent their staff on feild trips to Singapore’s hospitals to learn our model.
On the other hand, I have seen how our hospital staff are sent for yearly expensive trips to US, Spain, Portugal, Germany etc but when they return, nothing seems to have changed. It is just like yearly vacation trips for these senior management people.
49) Enlightened She is wondering how long can she keep up with paying the medicine.
You did not mention the stage of cancer. Ask the doctor how effective this cocktail drug is since it is a fact that no one has survive cancer in its terminal stage while in its early stage, Chemo-therapy would oftentime be the best option to fight the disease.
I also agree with 51) alky that you should try to source for alternative medication in one of our neighbouring hospitals if such drug cocktail is deem necessary.
a belated friend of mine
have a taste of the bitter medicine when he was diagnosed with brain tumour
his 1 tablet cost him $8000 nia
and he still dropped DEAD
poor family of his
his wife never worked in her whole life
now must resort to an overpriced hdb stall as hawker
the 2 sons who used to sleep in their individual 24/7 aircon rooms with builtin fridge that have cans and cans of the infamous cokes in a semi detached brand new bungalow with a view of their beautiful $100,000 pond
now squeeze in a 3 room 2nd hand hdb flat..
~sigh~
I think facilities and services at restructured hospitals have improved over the years. The doctors and nurses are indeed well trained and friendly.
In my opinion, the 3M framework of Medisave, Medishield, Medifund is a good healthcare financing policy. With the current system, I think generally one is still able to manage their medical bills if one choose the right ward according to one’s financial status in restructured hospitals.
The rich should be given the right to choose lower class ward if they want to save on their medical bills. But the government should not be subsidizing them. They have more than enough means to foot the hospital bill in lower class ward than the poor or the middle class. Those who stay in landed or private property should not be entitled to subsidy in C class ward. Priority in C class ward should always be given and reserved for the poor. Probably, it is a way to ensure that there are no abuse in the healthcare system.
Although mean testing may be necessary to clearly define who are the real poor and who are the rich, it needs to be more comprehensive and fair.
I do share the same sentiment as 27) Gilbert Goh on mean testing.
I’ve seen one case where the mother has dementia. She fell down and was admitted to TTS. She had her total knee replacement done. As there are no one to take care of her at home and due to her condition, the doctor had advised her children to put her in the community hospital in order to have proper care after discharging from TTS.
As out of her 6 children with 4 of them working, she couldn’t get much discount with mean testing.
Of her 6 children :
The eldest is around 60 years old with slight mental problem,
Two are gamblers with family,
One has diabetics and her leg is amputated,
One is normal but has her own family commitment and obligations,
The youngest one is already struggling to make ends meet while sustaining her own family and trying to help her elder brother and sister.
In the end, the children decided not to send their mother to the community hospital but to leave her at home. Her condition has since deteriorated. It’s a sad case.
How can the healthcare system in Singapore be world class if more and more people are less willing to seek treatment in their own country due to higher cost associated with mean testing ? How can Singapore healthcare system be accessible and affordable to all then ?
Has anyone ever considered having no ward classifications for restructed hospitals at all? Why can’t there be just one single class ward where all, rich and poor alike, are treated as they are, patients seeking treatments.
If you think you are rich enough to want to be pampered whilst sick, then go to a private hospital.
Having no ward classification in restructured hospitals eliminates the need to carry out means testing and what other administrative tasks we now have. These costs can be saved to help the patient lower his treatment bills.
LOL #58 Gemami
Welcome to the RED-man club. You are thinking communism here. However, this will never work when all person wealth are not equal.
The rich will complain they deserve better. The poor will ask why the rich are being subsides too? However, don’t worry. It will come truth one day when currency become only a digits. But not in our generation.
If you watch the star trek movie, where whole world become a frederation and people start to work toward basic need rather than wealth. We will then become aware of our surrounding and truth going forward as humankind. One big community and it is the truth communism.
This scenarios might need a world war 3 to achieve, on the scariest version!
#59) This has nothing to do with communism. This is human nature to distinguish oneself from others whenever possible.
In Capitalism, the rich followed by the influential followed by the rest.
In Communism, the influential followed by the rich followed by the rest.
In Military junta, the military followed by the influential followed by the rich followed by the rest.
So you see.. whichever ideology you go with. The outcome is clear.
Be the best in whatever society you are in.
If you are not the best, then you can only hope that a system is created that will hopefully benefit you and the rest. Unlikely in any system available.
48) isa on December 15th, 2008 6.15 pm
The article merely suggest the author’s view that based on the current healthcare system, the medishield and subsidized wards are the best value for money as compared to the more exclusive wards or private healthcare plan.
I believe he have done his due diligence and is best entitled to his opinion.
I am sure no one is suggesting that TKL cannot give or is entitiled his own opinion or even use anecdotal evidence to argue his case.
But then what is wrong with debating or providing a counter-point to his opinion? Or even question the validity of his anecdotal evidence?
However, the views are based on the choices that exist in the current healthcare system.
Well if that was his opinion about making choices within the system as it existed in Singapore why then he somehow launched into international comparison. By doing that he, appeared to be introducing a whole new set of topic altogether.
Worst when he brought in statistics that does not seemed to chime with what his original viewpoint, it only brought confusion as to what his original message was.
What Singaporeans want to hear is healthcare reforms like that mentioned by some of the readers here of the UK healthcare system and Taiwan Healthcare system.
I do know there is limitations to a single person effort to propose any comprehensive or holistic approach to healthcare reform.
This should be the focus of the government as they are able and have always gone overseas on “Study trips” to world-class countries to study the various aspect of operations.
Not sure what you are trying to say here. If you are suggesting looking for overseas model, than my opinion is don’t bother.
At end of the day, attitude towards how much people want to spend on health care and what to spend on, is largely culturally different. So you really can’t compare.
Take the case of UK health care, the attitude, on the whole, is that health care is viewed as a right so they are prepared to pay for it. In other words, the attitude is this is a right so we must defend it and earn the money to pay for it.
In Singapore where attitude is more, let’s say, more money oriented. We don’t see health care as a right. We have this attitude that if we are sick, in danger or dying, and can’t pay for it; too bad we have to die. Unlike the Brits with this attitude that if you are sick, let’s try to cure you first and than find the money for it.
I am not saying the UK or Singapore is the right or wrong way to go but if you have two different “cultural” attitudes than you are NOT going to get a like-with-like comparison. In which case the point of any study trip is going to be a waste of time because the very basis for comparison is wrong.
Just like when I queried TKL as to what his basis for what he meant by adequacy. Now, if his criteria for adequacy is different from others than where is the basis for comparison?
My take in the Singapore context is basically, don’t bother with International comparison. The upshot is to simply set a target as to what as the national spending on health care should be and what level of care is expected from that spending. Of course, the question of what to spend and what to standard to be expected is a matter or debate. And what ever outcome will be the consensus. It may or may not look good by International comparison but if you that is what you want then go for it. But then we don’t do it for the sake of international comparison.
On the other hand, I do think teams in the alternative camps need to show people that they are capable of proposing world-class solutions.
Show people that you are able to propose “new’ systems that can compete with the current healthcare system.
Show people that they truly have a choice between current and new systems, not choices within the current system.
Is your statement here targeted to TKL or other commentators?
First you are defending TKL message which is limited in scope to choice between current system. Then you are saying that the argument of choice within a current system is to narrow and now you want TKL to expand his argument?
As for other commentators, are they not bringing up alternatives and arguing what they are getting for alternative system? So are they not making the kind of arguments they want more so than TKL?
Dear ISA, I think that is your common understanding of communism bulid on the basis of past communist country. I strongly suggest you study the concept of founding father Karl Marx. Word communism come from “community”, it was never on one individual. It is people power, with no status, no differences and no bias.
If you use history to guage communism, then it seem have deem as evil as many had stated in the past. Hum….. Take a look now, we see capitalism seem to be falling and communism seem to be on the rise. Deng Xiao Ping once asked by people, has he abundant communism. His answer was, No. China has to go thru capitalism in order to fully embrace and appreciate the system of the communism. I say he is a wise man and had realized the truth concept of communism.
Make no mistake, China growth is no coincidence! And I suspect they will be over the top very soon. Greedy? China people? Well, as far as I remember. Singapore people in the 70′s was equally greedy for success when our nation slowly become rich. As a matter of fact, Singapore in the past had been a success because we are also in communism system. Disagree? Look back in the 80′s you will see that wealth is very much evenly distributed among majority of Singapore. Everyone can afford house, a job, education and colour tv. That’s the reason why Singapore success in the past but failed badly now. The gap had become wider and wider. That’s the full blown of capitalism and heading for self destruct!
Read Karl Marx and you will find that the concept of communism is to address the weakness of capitalism. You want fair and equality in a country? Then better start demolish the bad fruits of capitalism and relook on how to let the other that was left behind to catch up! And start having more people contribute to the country! Instead of abundant them and forget that they ever exist. If not, the nation will one day be very much well divided! Worst scenarios, fighting one another!
Like Deng Xiao Ping, I now ask. How can a country not believe in communism can fully embrace the finest of capitalism system at the same time realize it’s bad? Buddhism believe in the middle path. And if there is any? I say there must be a
Balance between 2 system.
Capitalism help productive while communism bring people together to achieve a common cause! A country need both advantages to be consistent. You want fair medical welfare? Strong growth? Good and affordable housing? Start thinking what I say. Anyway, like I mentioned. The world will eventually go to this path. Because there is no other way.
If one day, TKL do succeed in getting a place in history. I do hope he can work towards this direction in every decision our country made.
For now, there is very little he can do to change the system. But to advice you how to go around it. Thus, I will take it as long as it is a sound one. Until Singapore people can stop dreaming and see the truth! Please be fair and don’t go after TKL as if he is the ruling party now!
You want him to initiate changes, how about starting to sign on the petition now? Merry Christmas and a happy new to you all.
53) Tang Li on December 16th, 2008 2.35 am
Mr Tan is correct here. A sane person would think, why don’t you take advantage of a government subsidy as long as the care is of a decent standard. Of course if you feel that you can afford to go private and should not use that subsidy so that someone else who can’t afford it can use, that is also admirable too.
And you need an ex-ceo and a so-called financial expert to state the obvious?
And you need an ex-ceo and a so-called financial expert to state the obvious? – Tan Ah Kow,
What TKL is actually saying is to insist for Class B2 or C despite that the PAP government will do its best to compel Singaporeans against their will to use B2 or higher wards. If the PAP government isn’t forcing Singaporeans to accept the more expensive hospital wards in the first place, would there be a need for TKL to say that?
well, ah kow. Common sense is not so common recently you know? That’s why there are still 66% Singapore still voted for PAP mah. Any better suggestion btw?
Don’t have to compare UK medical system. I was recently updated by a PRC engineer and was shocked that even their medical coverage is better. Being working in Singapore many years, he told me that Singapore medical cover is lame. With all CPF funding going into housing. He ask if it is even enough for medical not to mention retirement.
In China, terminal illness are heavily subsided by the country accumlated from the monthly contribution from the young generation. Normal medical, will be given a medical card when retired.
However, due to size of the country. This system is currently out of reach for the less developed parts of china. However, their government is working to bridge the gap.
#65) Redman,
what you have mentioned is the original ideology. I’m sure Capitalism, Communism, Socialism, Democracy etc etc, all wanted the end goal of equitable rights and benefits to all.
However, what I have emphasized is that it is human nature to distinguish oneself. So, no matter what system you implement, it ultimately will deviate from the original goal and skewed towards the power-to-be (depending on the system).
So, it does not matter what my understanding of the ORIGINAL system is, all that matters is I know I have to adapt and excel at the top-end of the food chain in the system.
Hi I am ok with the current health facilities in our country.
You choose where you want to go and determine your affordability.
If you are poor go to C or B2 ward and if you can afford it go to B1 ward or even private hospitals.
There is no barrier to anyone getting proper reasonable healthcare in our system now.
The only bugbear I feel is the intorduction of means testing. This will keep the subsidy low so middle income earners will probably have to pay more than before. More headache for them.
My mum was hospitalised for stroke last year and it was fortunate that we put her in a B2 ward (8 bedded non aircon) and she was upgraded to a B1 aircon 4 bedder! We were thankful as she benefitted from the aircon condition and lesser patients together in the room. She stayed there for 2 months in total. She also was warded in a rehab hospital for recovery for another two months.
The unsubsidised bill was close to $50K! However due to the B2 heavy subsidy, we only paid less than $8,000 all from my medisave account. There was not a cent we paid in cash.
The rehab hospital was already using means testing approach and we failed their test. So we have to pay about $1000 per month for the rehab services. Two months of rehab there cost us around $2000 which is acceptable.
The aftercare services are more sticky as we need to get a maid to care for her plus all the medication. So far, we have no complaints but only fear that the implementation of means testing will take a toil on us soon if she ever get hospitalise again in future.
“Don’t save face, go to C-class wards,” says Tan Kin Lian
Yes, this is true. In fact, there is nothing wrong and there is no disgrace in staying in a C-class ward.
The biggest concern for Mr Tan, in fact, is that people are not educated about making the right choices when it comes to accessing and funding healthcare.
On a sidenote, I sometimes wonder what the reaction will be if the PAP makes such a statement.
Is it possible to do away with the class system?
Can we let SG health system evolve into 50% public and 50% private structure?
Let public hospitals have airconditioned open wards only. For the rest of the ppl whom feels the need for whatsoever reason, they can go to private setups. We can have private hospitals like the size of the former Balestier hospital in addition to the “big ones” like Mt E and Gleneagles, etc…
The private healthcare sector injects entrepreneural know how into our healthcare system and the public hospitals caters to the “heart-landers” at heart with a heart.
Just as important to the patients, healthcare workers (doctors and admin) know very clearly where they stand. The SG health system caters to the “socialistically inclined” and also caters to the “free market spirited”, while upholding the “hippocratic oath” (i almost wan to laugh when writing this…but let’s not get cynical, for if we give up even on our ideals then there is not much hope). This will inject vibrancy into Singapore.
Of course certain things will not change like long waiting time at public hospitals, that is to be expected worldwide. Our hope is to maintain a reasonable waiting time and with the slightly well off moving into smaller private hosptals spreading across the island, will bring the problem to a managable level…like real..hahaha…(sigh, why am i so cynical?)
and of course public hospitals will forever be the training ground for our young doctors and other healthcare students. The public must accept this and have no illusions. By then, I believe there will still be public spirited senior doctors whom are passionate about teaching like now will still remain in public setup.
Means testing will still be applicable at the public hospitals. Not to deter the well off from using public facility but more to present the real cost to them whom are more afluent. Then they can compare the pricing bet. public and private and make an informed choice.
Is it possible to look into some form of subsidy for private pts in private setup who “lapse” into ICU? Main reason why ppl like public hospital is because a C-class ICU pt is heavily subsidise! Even though the ICU ward facility is class blind. PPl like to put their elderlies into public C-class “just in case” they lapse into ICU.
and why am i writing all this rubbish!? hahaha…
thanks anyway.
Disclaimer:
The above will only work in a “two-party system”.
???
Balance.
#71) ISA
Totally agreed, that is why original concept must be sticked to at all time.
#75)
Yes, one of the solution to address ISA concern on one party domination.
See http://tkl100kpetition.blogspot.com/
Hi radlife66,
50-50 is no good. Walk into any restructured hospitals and you will see the ratio of subsidised against private patients is like 85% to15% respectively. Making it 50-50 would mean forcing the mid-level class of patients to become private class.
Air-con wards are also not good for certain illness especially respiratory and cardiac related ones. That’s why the non-aircon policy. It also means that some private class patients have to forego air-con even as they are housed in private wards. No discount though. Even people like LKY who felt that Singapore is colder than Winterland, will have to live in a non-aircon ward if he sneezes too much.
You do have a novel idea though on segregating private class from subsidised class into different physical institutions. A good start is for all restructured hospitals to be re-classified subsidised class. Private patients can go straight to private hospitals like those you mentioned. If need to, more can be built to accommodate demand.
Institutions like the Neuroscience Institute must be self reliant. It cannot continue to tap on restructured hospitals like Tan Tock Seng and add to its bed crunch problem. Neither should it be using TTSH’s ICU facilities to house and treat its patients. NNI’s director, Lee Wei Ling, the daughter of LKY and sister of LHL, the same one who wrote to ST championing better treatment of the foreign workers, cannot be bossing these restructured hospitals to give into her demands while she continues to save cost and be stingy in making the needed investments on good and up-to-date medical equipment and facilities for the Neuroscience Institute she manages. She cannot be the devil in her workplace and try to play angel outside of it. (ok, I side tracked, cannot help it).
The patient, healthcare worker and doctor do know exactly where they stand. In the service sector, the customer is always right. In the hospital industry, the doctor is king. The rest just have to nod their heads and go along with them. Some patients have tried to be smarter than the doctors but most of these ended up having to face more unnecessary pain than are normally necessary.
Trick is, if you are the bossy type of patient, go for subsidised class. Here you can play doctor to the houseman and medical officers, something you cannot do to the senior consultant at private class wards.
Public hospitals will continue to be the training ground and will be expanded to include trainings for Shatec students, logistics companies and courier services. See the latest NUH mortuary case in the ST? Even porters have to be trained how to open lockers and doors and how to unwrap dead bodies.
How to cut short waiting time? Issue outpatients with electronic queuing device. Device will keep track of the patients being seen before you, and you will be prompted 15 minutes before you can be seen. So, with device in hand, you can go about doing your own things until your hear the beep, after which you have 15 minutes to return to the clinic.
We do not need means testing. Nothing to talk about here.
i just received a call from a friend, his kidney stone is back…his case is w/ TTSH…the ealiest appt w/ uro is Jan 2009!… he’s having on and off fever. He was shivering in the office when he called me asking wat to do…?
i told him if his fever persist go to A+E and they will/may admit you or else i gave him a uro contact at a private hosp in SG… but he will have to go thru the whole shebang again, x-rays, etc…$$$ but almost guarantee very fast, no need to wait.
he has been to the A+E and 1 trip cost $80+…i told him to call the uro clinic at TTSH and explain to them, he did…but same reply…fully book and if persist goto A+E…
i think no system in this world can give you your cake and eat it.
Looks like he has to spend those $$$ and get it over and done with and transfer his case to this private urologist…peace of mind VS $$$…
no easy solution.
Means testing will hopefully divert cases from public hosp to these private clinics/hosp, but the devil is in the details…
A doctor no matter how helpful he is will still have to contend w/ rental. Rental is so steep, this cost is pass on to patients and the whole healthcare cost increase, same with your kopi-0 and roti prata.
Who ever controls the land wins. Once go up all up! (read this in hokkian it sounds funnier…)
i don’t understand enough, will somebody come in here and conduct a SG healthcare cost structure 101 for me…
all we know is from the PAP side of the story, really appreciate a no-holds-bar, no BS understanding…
thanks…need to check on my friend now…
Hi it’s me again…
just remembered another experience i had….years back my grandmom-in-law was down w/ stroke and was warded in a private (small hosp) in KL, Malaysia…we went to visit her there….their so called ICU is no bigger than our HDB 5 room flat. The hosp bulding looks like it needed a paint job overhaul… there was this little “back door” exit in the ICU…i walked over to look see look see…the entrance leads to a spiral staircase (pre-war houses type) and when i look up, the aircon unit was filled w/ cotton like dust! blowing away, doing its job…and all along i have this picture of the patients breathing in dust and eating dust!
grandma got well and discharge…she’s still around man!
in SG i think we are all very pampered….one dust particle we scream but our neighbour up north they eat and breath dust…and get well… of cos they got no ISO, ppl developer, GEMS, etc…
i don’t know lah…
From Day One, about three years ago, when the NTUC took over ‘Medisave” from CPF I already got fed-up with the way it spread the “gospel”. An ordinary letter printed without any NTUC letterhead arrived to inform me that my future top-up for my medicsave will go to NTUC.
I read the content which was confusingly written and instructed me to pay up cash at Singapore Post. I went to a post office near at a small lane near Victoria Street to cough up the money which I had to withdraw from nearby POSB at Bras Basah Rd.
I handed the NTUC letter to the post office girl who exclaimed that I must pay the full amount. But I read the letter and it stated that my top-up was half. Luckily, the post office manager came out from his room and I approached him and he made me happy by saying, “No ! You pay much lesser….about a quarter of the amiount “whichn his stall insisted.
Then the matter was processed by the staff and she gace me a receipt which resembled Receipts issued by Fair OPrice Super Market with very information what the payment was for.
Next day, I called NTUC to check but no staff could help and it seemed that nobody knows who is handling this new business. for Days I called and called and even screaming that NTUC has taken over the CPF Medisave business but
nobody there is incharge. The staff just passed me from jane to Jil and still no
proper answer. Finally, out of the blue, a NTUC Insurance Expert visited me and eaplained the fiasco to cool my outburst. The expert told me she just had been assigned to handly this job without any commission.
Only another few days later, more related policy documents arrived and at least
I felt easy but up to today, I hate the whole Mediave transfer which wants more and more money because of my aging. What bloody nonsense that I must pay cash for Day Care Treatment. With the recession on and no income at age 78, where to get more money to pay cash. The savings is for daily expenses and any left to buy a decent funeral lah.
Give up. Can NTUC keep increasing our premium for the benefits of others..like Day Care Cancer Patients…but the rest of us have to cough up more money from our daily expenses. Please Mr.Tan Kim Lian…ex CEO of NTUC, stop telling us we are paying lesser than those living in other countries. Balooney !
Obamaosama
On a sidenote, I sometimes wonder what the reaction will be if the PAP makes such a statement. – cjc (#73)
People will be cursing PAP instead because PAP holds the power to reduce consumers’ healthcare cost in Singapore.
Hi radlife66,
Hope you friend is much better. Please extend my well wishes to him/her.
If your friend plans to go to a private hospital, he need not have to go through the whole shebang again. He can walk in to TTSH’s Medical Records Office and ask for some of the relevant documents to his case.
a. for old xray films – S15
b. digitalized diagnostic images (cd) – $30
c. Blood test report – $5.35 (Histopathology report needs doctor’s approval for release and takes up to 5 days).
d. If there is a need to get hold of a discharge medical summary, it will also need doctor’s approval for release and can take up to 4 weeks. The cost is $80.25. It’s not worth it, if you ask me.
I would recommend, a or b, and c.
he has been to the A+E and 1 trip cost $80+…i told him to call the uro clinic at TTSH and explain to them, he did…but same reply…fully book and if persist goto A+E…
I do not understand this part of our health system. How can one working behind a counter, without any medical knowledge, be able to fix appointments for patients who are in need of medical attention, based on a system of availability of appointment slots? This is not only wrong but very dangerous. What if a patient is denied immediate treatment because an appointment slot is not available immediately.
How many of us here really dun know Class C wards are more affordable?
And how do we define the word “AFFORDABLE”?
I used to send my late father to CGH frequently and it appears that sometimes he has to wait to be admitted as there are shortage of C wards .
Cheapest ward had always been our choice and its worth waiting..
But I don’t understand why must there be a class A, B1,B2 or C etc.Must we also divide among the rich and the poor even they are hospitalised?They are wearing the same uniform anyway.
Has anyone in the Healthcare or any smart million dollar businessman thought of the idea of adopting a Standard class for everyone and a standard fee?.
Patient who really feel uncomfortable sleeping next to another patient or for any reason and want a room by himself should be given an option to take up a special ward with a additional special fees.,like aircon at S$X.00 per day, pepper chicken chop at XX dollars per meal ,attended by stewardess like nurses at S$XXX per day and Specialist Doctors at S$XXX per visit etc.etc
Another way doctors can help patient cut cost is to know what medicine patient is still taking now and not to prescribe the same medicine again unless the medicine is finishing etc.Some medicine are mean to be taken for a period of 1 month or more and it is a waste to buy again ,as you may not be able to finish it before doctor prescribe another type of medicine.
I have many good experiences with CGH C class ward .My late father is always happy when he was attended by the Hokkien speaking Lor Koon.The nurses know his name well as he is in and out at that ward.
If I got a chance to be warded , I will first look for my propose Standard Ward ,pay only on what I use.If BoPian they still want to divide me from the rich ,then I will go for the Class C ward.
Let me remind you hor,I actually want to keep it to myself but for the benefit of those about to be warded,I will reveal to you this lobang that almost all the Class C medical staff like nurses etc at CGH can serve you better than the Class A airline stewardess .But…Shhhhh.dun tell this to Foreigner…let them stay in private hospital because shortage of class C ward.
Stay healthy! Unless you end up in an accident. Don’t ever go to the hospital.
agongkia#84;
You have brought up a good common sense arrangement that the Health Ministry should look into.
A common class hospitalization system is a most equitable arrangement for patients, it will also do away with all the complicated administratie procedures.
In short, it simplifies the whole process of providing healthcare services efficiently with cost savings.
It is also posssible to have separate higher class hospital(s) to cater to patients/customers who want/need more privacies, better services and facilities. Again this can be made common class, such as all ‘A Class and all ‘B’ Class etc.
Patients that need special cares or who want better facilities, services/environments and amenities may like to seek treatments in Private(not privatized public) Hospitals.
puppy.
Thank you Gemani [55] and alky [51]for your advice.
My sister-in-law has liver cancer in early/mid stage. The drug cocktail is the chemo drug that she is taking. I understand the drug is mixed in the hospital and she received the medication from a drip so buying drug from neighboring country is not possible.
The suggestion of moving her to a neighboring country hospital is also not feasible because she needs to stay at least 1/2 days to 3/4 day in the hospital for this treatment. Putting her through custom jam etc would take about a day and would put additional stress to her physically and mentally. Financially the cash outlay would be more since currently she can pay the $1500 per treatment from her husband and her medisave account. If she move to say a malaysia hospital, the medical bill would be in cash immediately.
Here again is a case where the middle class Singapore is in a fix with no recouse from MediFund and no subsidised medication because the drug is not in the subsidized list.
Any suggestion is welcome!
Hi Enlightened,
I do not know if you have already tried these approaches.
1. Ask to speak to a Medical Social Worker; who might be able to assess your sister-in-law’s situation. Be prepared for detailed scrutiny of family income and all financial matters. When it is ascertained that financial help can be extended, your SIL will be given special subsidy for further treatment. Talk to a MSW for further and more accurate details.
2. Approach the CDC of your zone. Again, means testing will be carried out to assess if your SIL meets the requirement for help to be extended. A letter will be issued for use when your SIL visits the hospital for futher treatments. Some patients are able to get free outpatient consultations or heavily subsidised treatments.
Hope you can try out these approaches and see if they help. All the best to your SIL and her family and I’ll be keeping her in my prayers for a speedy recovery.
Hi Gemami,
#83. Really appreciate your concern and fine suggestions :-)) I will convey this to my friend.
cheers.
ps: do i know you… ;-)
Gemami (#83),
Why do I have to pay for copies of my medical record which I had already paid for when I pay for medical testing and medical consultation?
what are you all mubbling here?
just received a wonderFOOL letter
from the health ministry
who tell you/me
those with cronic diseases
to go for a sunbsidised $8checkup
you know some sort of scanning/updating on your chronic illness?
best part
mother of all mothers
doctor consultations fees is NOT included in the $8 scanning deals/scam
best of all
our government polyclinics is not involved in this excerside
the lists contained
all the
private practised doctors on all the private clinics around your nearest neighbourhood
dr khaw ole dr khaw
is this what you called mean testings?
you want every private clinics to have private consultations fees/business
EXCEPT
government subsidised polyclinics?
kaninia…
medical social worker?
ahem ahem
what a joke
donkeys years ago
when i was suffering/still sufferin
the same chronic sickness
my good kindhearted indian local doctor from changi south general
asked me
according to my experiences
you should be dead
but you are not
why didnt you go for treatment?
i says
when you are unemployed
where do you get your funds to be treated in a semigovernment hospital
who would charged you $70 under the emergency treatment rules
when you don’t have an appointment
no appoinment
no subsidised $17 consultation
the kindhearted doctor says
oic
perhaps you should consult our medical social worker on this financial issue
the staff nurse who is his assistant
start coughin
AHEM
AHEM
and start whispering
doc….
eer……
there is no such thing as a medical social worker
they can only listened
they will write down what you are sayings
thats ALL you gonna get
and if any of you peasants here think
wow
halleluja
a miracle is born
don’t even think
dr khaw
will act
blind/dumb and stupid as well
last year
our government annouced
you citizens will get subsidairy for outpatient treatment
for those listed chronic diseases
i went
i was told
you think your father run this hospital?
i replied
eer
ugmm
but i have a medical records/files in this hospital what
the staff replied
aha
you don’t know the correct procedure
let me assist you
first
you make an appointment again
$70 bucks flushed
than you goe for all the neccesarry bloodtest/checkups
more $$$ flushed
p.s.
for those who have never visit all this government aided hospital
let me show/guide you
every room you enter
there will be a net/cash card machine
they will zapped your ATM card first before you are even tested
by the time you leave the hospital
your bills should average above
$150
yes
ONE HUNDRED FIFTY DOLLARS
and do you know how much are you qualified to be on subsidise treatment/year?
unlimited?
in your dream
$300 nia
(this will be deducted from YOUR medicsave…not FREE hor)
above $300
you will pay every single $ extra in CA$H….
now you see our wayang show?
i asked the staff concerned
who implement this smartarsh ideas?
she said
refer to the doctor in charge of ministry of health
guess who he is?
nabei
CATCH22
again
Hi radlife66,
You’re welcome. Cannot answer you last question though, not without a face ;).
Hi smallvice585 #90),
Now where do I start? OK, medical records. There is a misconception that since I paid my medical fees, I am entitled to everything that goes into the provision of my healthcare during my stay in the hospital. This is not so, because the fees are for consultations, treatments and medications during your stay.
All the other items that does not directly go into your healthcare are not covered in the bill. Examples are medical records and post-discharge medications and theraphies.
They do not belong to you. Yes, you paid for your medical treatments, consultations and all other forms of tests but the notes, which later form part of your medical records, are written by doctors for their own perusals. These are notes written by the doctors who treated you during your visits and for which will be used by other doctors for your subsequent visits.
So, they do not belong to the patient. They are however, available to the patient should he require them but this is subject to a re-read by the doctor and thereafter a summarized one will be offered, not in any way a replicate set of original scribbled notes. Therein lies the extra effort required by the doctor to review your notes and to write up a summary and therefore the added fees.
This topic has generated a lot of discussion. Many people having different points of views and personal experiences of the health care system. Each person has a different idea of what is a good system. It is all right.
I am also entitled to my opinion. I believe that our current health care system does deliver fairly satisfactory health care at an affordable cost. It is a good balance. This is seen by the international comparison and study quoted in my paper. I believe with these independent findings.
Some people think that the health care system in UK and Taiwan is better. I also agree. But it does cost more to the country (to be funded by taxation) and is subject to wastage and abuse. I personally prefer this type of system, but this is a separate matter.
I accept that the Singapore system still has its drawbacks, as pointed out by some readers, including the high cost of medication and the high cost of post hospitalisation care (which cannot be paid by Medisave). No health care system in any country is perfect.
In my paper I suggest that the public can save money by making the right choice under the current system. Let me address some of the points that have been brought up:
1. If you have been warded in a subsidised ward previously, you are entitled to buy the post-hospitalisation medication at a subsidised rate (which is much cheaper than the non-subsided rate). However, it is restricted to the generic drugs, and does not cover your choice of branded drugs. One has to accept any benefit with its limitations.
2. After means testing is implemented, you are still entitled to be treated in a subsidised ward, but the level of subsidy is lower (ie 65% instead of 80% for C and 50% instead of 65% for B2). Some people argue that the cost in C has increased from 20% to 35%, a 75% increase. I do not agree with this way of seeing things.
3. People who prefers private Shield coverage and is aware that the estimated lifetime cost is $100,000 (compared to $43,000 for Medishield) are entitled to their views, They do not need to justify their decision and does not have to attack my view.
I do not have the time (due to many other commitments) to debate with readers who hold a different view. Each person is entitled to his own opinion, and it does not matter to me that it is different from my view.
There are some insurance agents who does not like my advice to consumers to avoid spending premiums on unnecessary and duplicative coverage/ They find any opportunity to attack me, using quite unfair arguments. I have learned to ignore these malicious attacks.
94) Tan Kin Lian on December 19th, 2008 8.23 am:
Firstly, I want to point out that if you read any of my comments, I have in no way suggests that you are not entitle to your opinion. Having said that, it is worth noting that when people start debating with you about your argument it does not mean nor even imply that you are NOT entitle to your opinion.
A debate is basically where different people come and give their view points and in some cases, give counter points, and even point out discrepancies. Again I hope you DON’T take this to mean that your are not entitle to your opinion.
Secondly, as I may have in my eluded to in my previous comments about your statistics, I am getting the impression that you have been misinterpreting my argument. Here I am going to say what I said again.
(a) My impression of your statistical presentation of “cost” is, as part of your argument, may be flawed. In other words, you may have inadvertently brought in evidence to suggest that health care cost by taxation, especially, may be NOT be worst than Singapore’s case. In fact, on face value, the UK systems seemed for efficient than Singapore. And in Singapore’s case there seemed to be more wastage. Here again I want to emphasise that the argument I raised about the UK is NOT whether it is better or worst than Singapore. I was merely pointing out that the statistics you provided show a case that was at odds with your argument.
That is why when I queried your use of the statistics, I DON’T mean to say that your argument is wrong. What I was saying is that you might want to read the statistic again make sure you are aware what they mean. Otherwise, the statistics you presented have a danger of undermining rather than strengthening your argument.
(b) Also you have used a lot of anecdotal (Personal experience) evidence to support your argument. In particular, the issue about “acceptability” or otherwise about the ward. Again, I am NOT suggesting that you are not, entitled based on your personal experience, to come to your own conclusion about the Wards.
But if you want people to appreciate why you found something to be “acceptable”, it would be helpful to explain with more detail why you came to the conclusion you did. You don’t have to write a thesis about your decision making process but take the reply you gave to me on that issue:
The issue is both affordability and satisfactory standard. Some people say that the subsidised ward is not satisfactory, so they are forced to pay for the more expensive treatment. This is not the case here, as the subsidised wards are of a good standard. – 13) Tan Kin Lian on December 14th, 2008 11.01 pm
As you can see there was not attempt to explain why you found something to satisfactory. So basically, you have open the way for people to guess what you are trying to say.
You could have pointed out with some EXAMPLES, like you found the nursing care to be responsive, or that the doctors did not act differently in C class as they would in A class, etc. At the very least, then there is clear measures of acceptability that one can debate on WITHOUT getting personal.
94) Tan Kin Lian on December 19th, 2008 8.23 am :
Some people think that the health care system in UK and Taiwan is better. I also agree. But it does cost more to the country (to be funded by taxation) and is subject to wastage and abuse. I personally prefer this type of system, but this is a separate matter.
This is a general philosophical case made to everyone who is reading this comment not just TKL.
TKL alluded to this notion of “wastage” in the healthcare systems.
What is wastage in this context?
(a) If there is no cure for some disease, let’s say Cancer, would it be a waste to give treatment?
(b) Doctors can make wrong diagnosis. So if the doctor say, wrongly, that a person cannot be cured, so no point giving treatment. Is the doctor avoiding wastage?
(c) Using in order to avoid people abusing something, you have to put in place system to check. Now if the cost of having a system the check abuse is more than what could be lost by abuses, is that avoiding wastage?
(d) In the case of means testing, there is cost involved in administering means testing. If the cost of administering means testing is more than saving one gets from means testing, is means testing a wastage?
(e) If a patient that could be cure but is not given treatment because the patient can’t pay or can only pay for less effective drug, is that avoiding wastage?
(f) Insurance-based healthcare system typically expects to persons to be responsible for their own health. But insurance have to be administered and in some cases profit goes to insurance providers. So is giving profit to insurance providers a waste?
This list can go on-and-on-and-on.
Anyone has any definition of what is waste? Personally, I don’t.
Hi Tan Ah Kow (#96)
The argument about wastage is made by economists and by our Government. A national health insurance scheme which if given “free” is likely to lead to abuse by consumers in getting more than is necessary … i.e. described as the “buffet syndrome”. It also extends to insistence on expensive treatment beyond economic justification, e.g organ transplant.
I am personally in support of a national health care system, available to all, but will provide the medical care to a certain level which I shall describe as “necessary”. We need competent people to decide on what is “necesary” and the issue of cost and wastage will have to be considered. I don’t think that it is “all” or “nothing” and it is not possible to fix all the rules in advance.
I am not a medical expert, so I can only lay out the broad principles. I will let the experts work out the details.
20/12/08
Dear Gilbert Goh & Tan Kin Lian
I have been very busy with my work and hardly have time to read the articles on TOC till now and I am happy to write that we have one of the best health care in Singpore including CPF-Medishield and Medisave, and there are rooms for fine tuning especially helping the genuine very poor who does not have enough CPF-Medishield and Medisave, it is only a very minute drop in the ocean if we can take this from our GDP, and these genuine very poor need not have to die and can seek the best treatment and get well. As I said, we don’t need to just simply dismantly everything the PAP government has established and what we just need is to fine tune these policies and institutions established by the PAP government since Singapore independence, ie should one day the Singapore Opposition forms the government of the day. We Singaporeans have been so dependent on these policies and institutions which now have flaws and this which we must recognise and hope that they can be fine tune for better for all Singporeans.
Regards
Andrew Chuah
Before going to the airport now and off to Oz for a month let me have a few words on this subject. TKL is right. Go for B2 or C class wards. Nothing to be ashame of. At most cx into B1 class. The trouble with most people is tend to buy the min. ie “C” class/costs type health insurance but when hospitalised, cx into A class or private hospitals and the subsequent high billigs & blame game ensued. Always buy and spend on things w/i your means, it will never go wrong and get into credit payment problems. People with BIG heads and BIG mouths but small pockets and small/weak brains are the fall guys.
One more thing, because many bloody idiot consumers tend to cx into A class and private hospitals it create a false demand, the government also in response “tutup” more lower class wards/beds and open up more A class wards(macham like HDB, build more executive flats in the 80s). If the situation is in reverse, more people cx into C class wards in hospital, then the government has to response accordingly.
I agree with Mr Andrew that S’pore’s healthcare system is one of the best. And yes, there’re definitely room for improvement, especially on Medifund and means-testing.
Some of the commentators have extreme opinions regarding the state of S’pore’s healthcare system. Perhaps they can view from the economics perspective, and they will realise that S’pore’s healthcare system is not that terrible. In comparison to other countries such as the USA, Singapore’s healthcare system can be said as efficient and covering most of the population from cradle to grave, albeit with major individual responsibility.
I am very disappointed with the service provided by NTUC Income. I had a day sugery for my trigger finger. One week before the sugery, I requested for the letter of guarantee, required by the hospital. I was told that the letter will be sent to the hospital. On the day of my sugery, no letter was forthcoming. I was told to pay the bill. I did not have money or credit card or medisave to settle the bill. Why cant the insurance company give a simple letter of guarantee to the hospital to make things easier for us.. What happens to people who cannot afford to pay? Do they have to postphone their sugery. To add insult, when I wrote to the company regarding this matter, their reply was it is an additional service of NTUC to give policy holders a letter of guarantee and this is given when a deposit is required by the hospital. I feel I have been rip off now especially when I bought the policy, I was told that everything will be taken care of when the need arises. Why tell us to buy health insurance when it is so difficult to get assistance from the insurance company.