Sunday, October 03, 2010

Cover all newborns for congenital illnesses....

UPDATE : A commenter wrote:

In Malaysia the liver transplant would have cost significantly less at their public hospitals..just RM500!!

The hospitals there may not be perfect and the waiting list long but they'd never say no to their patients! Some Malaysians even say that after undergoing surgery the public hospitals would sometimes even forget to collect the bill...if that is is inefficnency..I'd prefer that anytime over Singapore's world class facilties

I found it hard to believe that with govt help Malaysian hospitals only charge RM$500 (S$217) for a liver transplant for patients vs more than S$100,000 in Singapore. I did a check and it turned out to be true : the Malaysians put this in place because they felt that those who have suffered liver failure should not be financially burdened . Quite amazing.

I've written about this several times[Link][Link]. I want to bring this issue up again because of recent news report about a child born liver problems. About 4-5% of children are born with congenital conditions and 1% are serious & life threatening. Many of these cases are tough not just because of the financial burden that parents have to bear but the time, energy and dedication needed to care for these children. One of our patriots and most famous blogger Mr. Brown (Lee Kin Mun) has a child who is autistic [Link]and he writes about the challenges of bringing up his child who needs special care[Link]. Mr. Brown's struggle was made harder when means testing was implemented and he described his disappointment:

This is because of this thing called "Means Testing", where they test your means, then if you are not poor enough, you lose some or all of the subsidy you've been getting for your special child's therapy.

I think I am looking at about a $100 increase, which is a more than a 100 per cent increase, but who's counting, right? We can afford it, but we do know many families who cannot, even those that are making more money than we are, on paper. - Mr. Brown, 2006.[Link]

While Mr. Brown can afford it, the small helping hand in the form of subsidy he received from the govt represented the govt's willingness to share a small bit of the burden and help with his family's challenges of bringing up a special child. With means testing, that was eliminated for middle class families and the message is loud and clear : you shoulder all the financial burden yourself. The govt argument for means testing was so that it can "can devote more resources to families who need more help"[Link]. This is not true. With means testing, poor families get the same level of subsidy as before while middleclass families are squeezed to pay more. The purpose of means testing is to keep govt expediture on healthcare low so that cuts in tax rate for the corporations and rich can be maintained. The govt often tells us that the 3Ms - Medisave, Medishield and Medifund are adequate. It is not. Healthcare burden for the sick and their families is higher here than in Taiwan, S. Korea and Japan and the system is full of cracks and stories of severe hardship for those who get sick. The lack of universal coverage for newborn with congenital illness in itself affects 4-5% of children and severely affects 1% of them - you throw in the large number of uninsured adults, uninsurable old folks and the cases not covered by restrictive conditions of insurance policies, you conclude that many Singaporeans will face heavy healthcare burdens.

I just want to show you this example to illustrate how our healthcare policies result in severe burden for the poorer families and how the lack of coverage for newborn can plunge families into a lifetime of struggle and the oft-advertised "sufficient help for the poor" is overrated. I'm sure no family in any other developed countries in Asia or Europe has to go through what this family has to go through. The healthcare system exacerbates the effects of the wide income inequality which is already the largest among developed countries.....covering all newborn Singaporeans to take away the financial burden of congenital illnesses is something the PAP can easily afford to do ($387M for YOG is okay? But caring for sick babies is not?) to take away some of the pain families have to endure but they refuse to do so, it is unconscionable not to do it - medical social workers who are at the frontline of providing support for these families are probably fedup with the situation and it has been such a long time since the need to fix this was recognised...the frustration is building.

Asked if she was tired from having two jobs, Madam Lim replied: "If there's money to be made, there's nothing to complain about.

"Which mother will sit idly by when they see their child suffering? If there is a need to, I would even be a prostitute to get my daughter the help she needs."

Avril's transplant operation - scheduled for Oct 9 at the National University Hospital (NUH) - will cost an estimated $80,000 to $100,000. Her post-operation medical bills could come to more than $1,000 a month

Her 'little monster' is a feisty fighter [Link]

Mum had considered ending her baby's life when the infant was diagnosed with biliary atresia, a condition due to the absence of bile ducts. -TNP

Sat, Oct 02, 2010
The New Paper

By Geraldine Yeo

WHEN her daughter was diagnosed with a rare liver condition two weeks after birth, Madam Lim Hooi Yan was so devastated that she even considered ending the baby's life. She did not want to see her child suffer.

But when she saw how hard little Avril Tan fought her illness, she changed her mind.

Since then, she has been desperately fighting to save her daughter's life - even taking on two jobs to raise money for a liver transplant. Avril, now three, needs a new liver. Otherwise, she won't live past the age of five.

On Avril's birthday on Oct 9, Madam Lim, 35, will be giving her daughter the best birthday gift - part of her liver.

Avril was diagnosed with biliary atresia, which affects one in 14,000 newborns.

Infants with this condition are born without bile ducts. This prevents bile from being transported to the intestines.

When Avril was born, she had jaundice, during which increased levels of bilirubin in the blood gives the skin a yellowish tint.

The condition is common among newborns whose livers have yet to function properly but usually clears without treatment.

After noticing Avril's prolonged jaundice, her paediatrician did some tests and found that she had biliary atresia.

Thoughts of ending her daughter's life started crossing Madam Lim's mind.

"Once, I was very stressed and even wanted to carry my daughter up to the 13th floor of my block," she recalled.

When Avril was a little more than a month old, she underwent a procedure known as a Kasai operation, in which a duct is constructed by using a part of the intestine to drain bile from the liver into the intestines.

Madam Lim, who also has a seven-year-old daughter, recalled: "I was sitting outside the operating theatre. I felt so scared, I broke down. I did not want my daughter to suffer."

Bad news
Six hours later, the doctors emerged with bad news - the operation had failed.

They told her that Avril needed a liver transplant if she wanted a long-term cure.

Madam Lim said she was informed that the transplant could go ahead last December.

Avril takes seven types of medication twice a day. She goes to the hospital for monthly check-ups and is cared for by a maid when her parents are at work.

Madam Lim said Avril's doctors had urged her not to give up hope.

"As I watched my 'little monster' grow, I started to realise that she was quite a fighter and that I should do all I can for her to lead a normal life."

"Little monster" is Madam Lim's pet name for Avril because of her playful nature.

When The New Paper visited the family's four-room flat in Ang Mo Kio on Sunday afternoon, Avril was cheerful despite her illness.

Her skin was distinctively yellow against the sunlight (see photo above, right), and her stomach was bloated from water retention.

While Madam Lim was being interviewed, the tomboyish girl played "masak masak" (cooking in Malay) with her sister and posed readily for pictures.

Then it was time for her to take her medication. Avril put her toys down and promptly emptied the medicine syringe into her mouth.

She then resumed playing.

Madam Lim said: "She doesn't complain or ask why she has to take so many types of medication a day."

The girl later took out her dolls to play "doctor" - complete with toy injections.

"She is very brave and so used to getting injections and everything, while I am the one who is scared by the sight of blood," her mother said.

Avril's medical bills total almost $1,000 a month.

She also needs a special milk formula as she has brittle bones. Each 400g tin costs $45 and lasts for only 1½ days .

Her parents pay for the bills and expenses through Medifund and get financial help from the Singapore Children's Society.

They also care for Madam Lim's mother-in-law, who is in her 70s and has diabetes, high blood pressure and leg problems.

Madam Lim has been juggling two jobs since Avril was diagnosed with biliary atresia.

From 6am to 8am on weekdays, she works as an office cleaner before starting her job as an administrator in a private hospital at 9am.

She and her technician husband earn about $3,500 a month.

Asked if she was tired from having two jobs, Madam Lim replied: "If there's money to be made, there's nothing to complain about.

"Which mother will sit idly by when they see their child suffering? If there is a need to, I would even be a prostitute to get my daughter the help she needs."

Avril's transplant operation - scheduled for Oct 9 at the National University Hospital (NUH) - will cost an estimated $80,000 to $100,000. Her post-operation medical bills could come to more than $1,000 a month.


Anonymous said...

I feel very sad. But as this is a selfish and greedy country (created by LKY in his own image!), I am sure that PAP is not going to lose any votes. We have come to this state be because most Singaporeans (66.6%) couldn't care less about other Singaporeans. Simple as that.

sgcynic said...

The PAP is an anachronism with its hard-headed policies and little or no heart. It may be necessary during our country's early days where we have little or no reserves and infrastructure. However, this is not the case now.

It is simply distasteful to see GST raised and Means-testing introduced in the guise of helping the poor and less-fortunate while income and corporate taxes are reduced for the well-off, and miltary spending increased readily.

Priorities are skewed - economic growth is pursued as THE goal over than betterment of lives of the citizens. The PAP is good for Singapore Inc and not Singapore the Nation.

Why is the PAP against Minimum Wage and in favour of Workfare? Is it because it is pro-status-quo and adverse to any changes that may be beneficial but carries some risk as it disrupts current "equilibrium"? This is why we see laws such as the one-man-assembly fast-tracked and state and quasi-governmental institutions politicised to preserve the party's rule. Any "changes" is likely to preserve status quo to benefit the party over the country.

Anonymous said...

This a a good proposal.

And we know around this critical time in PAP's calender,they happen to be the most generous!

So lets's all make efforts to help those unfortunate fellow citizens of ours.

I hope all Singapoere citizens would support this proposal to help those helpless people.

Thanks to forth coming general election!

bw said...

"it is unconscionable not to do it"

I fully agree.

Thks for the post Lucky.

Anonymous said...

It saddens me that while we have no money to help poor Singaporeans pay their sky-high medical bills, we have the money to give a foreign YOG volunteer free treatment for heart attack.

I am glad that the YOG volunteer was treated, yet at the same time, saddened that we deliberately treat our own citizens so shabbily. And the worst part is, no CEO will drop by with chocolate cake to visit our sick kids who need surgery.

The only people who will drop by are the debt-collectors from the hospital.

This is the sort of system we are protecting with our 2 years of National Service.

Anonymous said...

Well ... Tat is our priviledge to be a Singaporean. 1st to pay everything, with d exorbitant medical fee which a commoner struggled to make ends meet ... Sadly tis is same scenario day-in day-out. There is nothing we can do except tat is a substantial of voices in our parliament or else we r dead meat ... More will jus jump down to end their life in order not to be a burden to their children or family members. It is negative but it is d truth on ground. Those highly paid MP better open their eyes n see for yrself cos I do believe karma ...

Anonymous said...

The cost of insurance will go is cheaper to focus on antepartum screening and abort the fetus with abnormalities

Anonymous said...

but 66.6% prefers not to share the burden hor

Anonymous said...

In Malaysia the liver transplant would have cost significantly less at their public hospitals..just RM500!!

The hospitals there may not be perfect and the waiting list long but they'd never say no to their patients! Some Malaysians even say that after undergoing surgery the public hospitals would sometimes even forget to collect the bill...if that is is inefficnency..I'd prefer that anytime over Singapore's world class facilties!!

Anonymous said...

mp pay should be tagged to the poor of sg citizen. this system created by a selfish old guy ignore the poor, the pysical challenged, the mentally challenged and the under privileged.

Anonymous said...

If Singaporeans don't have to pay top dollar for their surgeries, then I worry. said...

A little social service to citizen actually needs a big shakeup of our whole system, which not many people are aware.

Currently we are running into deficit during years of low economic performance, even though government is providing no social service. And the whole public service and GLCs are the best paid in the world. Clearly, our government employee prosper on canibalising those unfortunate singaporean.

So how are we going to get the monies?

So we have to cut down the wage of public service and GLCs fat cat. That would not be easy because

1) These parasite is already a formidable interest group.

2) It affects another pillar of Lee's system, (our scholarship system). Lee is able to entice scholar to come onboard the scholarship because scholars are able to see how well paid those civil servants and GLCs are.

If those parasite got hit in pocket, we should experience more brain drain.

And there are many more severe consequence....etc

In short, system are so screwed by Lee that it will take a long time to undo the damage.

Divali said...

"Chemicals Can Affect Unborn Babies, Too"

Anonymous said...

Please do not burden the state.
We are not a welfare country.

If everyone ask for subsidy, this country will be bankrupt soon.

People have to be responsible.
If you are rich, bear more kids.
If you are poor, please do not get marry and have children.

You can't even support yourself, cannot lead a good life, why have kids and burden them instead?

See the news last week?
The father murdered his sickly 19yr old son and he went back home commit suicide.

In the past, the father spa owner helped alot of ppl...donate generously. But when he had troubles, who help him?


This lesson taught us, do good things have retribution.
Better be selfish, greedy & cunning to have a better life.

See NKF Durai, Renci, etc have early release and enjoying life now. said...

Re Annon 4/10/10 11:15

Please do not burden the state.
We are not a welfare country.

If everyone ask for subsidy, this country will be bankrupt soon.

First, we need to ask ourselves are we burdening the state or is the state burdening us.

If Singapore requires us to pay $500 000 for 99 years HDB and 2 years NS...etc without giving anything in return, the people must ask for their rightful share of wealth.

Next we need to ask ourselves, why Singapore may bankrupt if she provide her due social service.

The citizen has so far ask little of the state and why it keep on running deficit.

Reason is simple, our GLCs and civil servant are too greedy. They have taken all the monies that is suppose to be for the citizen.

Next, our sovereign fund is too incompetent losing their pants.

From what I see, Singapore, is a quintessential tyranny. said...

The fact that civil service is so well paid is absolutely ridiculous. Civil servant produce nothing- absolutely nothing, that can be translate directly into monies.

Singapore earn its monies when hardworking engineers, operators or banking executive toil and produce product we can sell.

But our civil servant is greedy enough to take a whole significant share out of the whole economic pie, bragging they are talent.

Hard working Ah Ma need to wash bowl wipe table in food court until she drop dead, because PAP say she is not talent.

Anyone think its fair?

lim said...

Nothing will change if pap remains in power..

I am willing to let the oppositions have a chance to govt, they cannot do worst than pap. At least they will listen to citizens' concerns..

Look at pap policies..
- Flatly refusing cpf members to use their cpf $ to tide over when they lose their jobs.. Why need to hold it for their "retirement" when they need it NOW?
- Refusing to refund parf in cash, citing reason that it is difficult to budget for it. But somehow it is not difficult now, when it suits their purpose..

Anyway, I have long realised that pap == hypocrites

Anonymous said...

I too am angry that 'ill' less than 'perfect' children born to this govt are not coveredby medishield. You have to put your money where your mouth is - what is 'no one left behind' if you refuse to cover these children of Singapore??

cleodux said...

I also have a newborn son who has congenital disorder called Hirschsprung's disease.

@anonymous 3/10/10 14:26
Not all congenital disorder can be detected on scan/blood test.

Well anyway my son spend his first few weeks at hospital and cost us a bomb (test and all) and now he need a surgery when he got a bit older. I think the author of the blog is not talking about insurance coverage, but rather as a subsidy from goverment.

Let alone subsidy now.. i even scared we can not buy health insurance for him. And whether his medishield got approved.

I think if our newborn have auto cover from his parents medishield would be good enough.

Lucky Tan said...


I'm talking about a combination of coverage and subsidy. Many illnesses cannot be detected fully through screening - cerebral palsy, many heart defects, autism, pre-mature birth etc.

The insurance should care the major cost such as surgery and hospital stay. Subsidy for special care and followup treatment.

Right now if you fail means testing, heart problems & pre-mature births can cost upwards of $50K sometimes going up to $200K. Even if the family is poor such as the example I gave the cost can run up to $40-50K and the special care cost that is needed can crush a poor family financially.

I'm sorry to hear about your child. It must be very tough as parents to go through what you've been through. The financial part just add to the severe stress that parents already have to go through. The absence of state help and financial at that point in time when it is badly needed really calls to question how much we share responsibilities. Singapore men are expected to be willing to die for their country if war breaks out. No where else do they demand so much of their citizens and share so little of their burden in their time of need.

Anonymous said...

My son was born 6 weeks pre-mature, and AIA rejected my application for insurance until he was 12 months old... We are on our own if anything happens within that 12 months...

Lucky Tan said...

anon 22:31,

Sorry to hear your child is pre-maturely born. Hopefully he did not need incubator or ICU. That would have been really expensive. My friend paid about $45K for his child who was in ICU for 3 months due to premature birth.

For-profit insurance companies are cold and calculated in their underwriting. Many countries like Germany solve this by legislating that insurance companies cannot cherry pick their customers. The solution here may be to have govt insurance to cover newborns and for govt to pay for the poor who cannot afford.

Anonymous said...

We all know the system in Singapore has been gerrymandered to such an extent that it can no longer be defended as fair. The excuses they have given and continue to give is becoming lame day by day. The ultimate is the excuses for not holding the bye-election and claiming that the other MPs can cover the job, given that one member is the PM and has bigger things to worry about then go on meet-the-people session. Well if this excuse is valid than the contituency certainly has too many MPs in the first place. So much for productivity, when the government itself is a lame excuse. But do they care, heck they don;lt give a shit cause we are all dogs that have been trained by the old master to obey. Woof Woof

Anonymous said...


We were fortunate that our baby was more than 2kg though 6 weeks premature. He was in ICU for 3 days for observation. Prior to giving birth, my wife spent 2 weeks in the labour ward in a bid to delay giving birth. And the total bill was about 10k.

With decent jobs, we are able to afford such hiccups, but we know that 10k will be very challenging for low income families. So in Singapore, one should not marry and have babies without the financial means.

i support universal healthcare, even if it means that i have to pay more taxes or insurance premiums. This is basic human rights to me.

Anonymous said...

The Malaysian Government actualy have a small expenditure on healthcare at RM2 billion per year but most additional costs are absorbed by the government.

Government clinics, which is much disdained by Malaysian Middle Class charges only RM2. A broken arm only RM1000(RM10 000 private), cataract removal RM1500(RM15000 private), baby delivery only RM500.As for liver transplant, only Hospital Selayang offers RM500 transplant but the waiting list is long with priorities on fatal cases hence many on the waiting list will try to raise money via charity and appeals.No matter rich or poor, the public health service is open to both rich and poor. Even foreigners only need pay RM50 for government clinics/hospitals so they pay RM550 to deliver a baby at the government hospitals.

The downside is that Malaysian doctors, whether sponsored or stidied on parents money are forced to serve these government hospitals. Interestingly, there not enough hospitals to cater to the large numbers of graduate doctors in Malaysia with 4000 Malaysian students currently doing medicine inside and outside the country.

The lesson here is that poorer countries like Malaysia and even Cuba(best public healthcare in the world_ could even beat first world countries when they know their priorities.

Perhaps affirmative action is prefereable to protect native Singaporeans who are now marginalized!!

The Bull said...

How come issues like this are not brought up in parliament by LTK and Sylvia Lim and the otber NMP?

Or Was this issue brought up by someone but ignored? said...

Well, I don't really think it may have success.

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Ashleywlrz said...

The cost of insurance will go is cheaper to focus on antepartum screening and abort the fetus with abnormalities

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Asked if she was tired from having two jobs, Madam Lim replied: "If there's money to be made, there's nothing to complain about.
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