Saturday, January 08, 2011

30% jump in Class C hospital bills since 2006.

"The Ministry of Health (MOH) puts this down to multiple factors - including a greater number of more ill and older patients, and patients asking for non-subsidised drugs and implants." - Straits Times 8 Jan 2011.

Is the MOH blaming the rising cost on the old and sick? Didn't the govt implement means testing that would have caused the hospital bills to escalate? Didn't the govt plan to make Singapore a medical hub for rich foreigners causing a strain on our resources and cost to spiral up?

In an earlier posting, I pointed out that the Medisave Minimum Sum has been raised at an annual rate of roughly 7%[earlier posting here] - that translate to a rise of about 30% for 4 years. When I posted that, I speculated that the increase may be linked to rising cost of medical care in Singapore and this is a concern because it is rising much faster than wages. Based on the figures released by the MOH, class C bills have increased 30% in 4 years. If you look at the average bill across all ward classes and hospitals we see a jump of more than 50%. The bills at a few of the hospitals have doubled. Look at the table below:
When you read the table you have to be very careful not to misinterpret the data given which is average and 95 percentile bill figures. For those not familiar with what goes on in a hospital they might think that the figures still look okay because they are under $10k for 95 percentile. A typical hospital handles numerous small cases e.g day surgeries, short stay for a few tests, hospitalization for observation (chest tightness, shortness of breath, pain etc). These small cases overrun the statistics and the very big bills are concentrated on a small number of cases when a person has a serious illness so what they should publish is the average of the top 5% of the bills or average of, say, the top 1% of the bills. Showing the 95 percentile is misleading because it misses the very big serious cases - the type that we are afraid would hit us once in our lifetime. Deficient as it is, the numbers are useful in showing that cost has escalated sharply in the past 4 years.

Minister Khaw had this to say about the massive increase in medical cost:

"The bottom line : We have good high-standard public hospitals that are affordable because of the 3Ms" - Minister Khaw

Affordable? In the same sense as Minister Mah when he said housing is still affordable after prices jumped by 60% in 2 years As for the 3Ms, it is full of holes. Many self-employed individuals don't have Medisave, hundreds of thousands are not insured[Link] and for you to get Medi-fund you have to exhaust all your savings, live in a home and have kw enough income to pass the criteria for receiving Medifund. It is more dangerous for Minister Khaw to say that medical care is affordable than for Minister Mah to say that HDB flats is affordable. For HDB flats, everyone knows the truth but for medical care many don't know what is going on until they get seriously ill ....then it is too late. There many holes and gaps that people can fall through. Take Medishield, many people are still on Basic Medishield. Basic Medisheld has limited payout for hospitalization/surgery that is now insufficient for the 'catastrophic illnesses' it is designed for because hospitalization cost has escalated. In 2005, Enhanced Medishield was introduced. However, many people developed various pre-existing conditions or are not aware and didn't upgrade to the new insurance. The word "enhanced" is actually misleading because it gives people the impression that it is unnecessary. It is essential for you to move to Enhanced Medishield because Basic Medishield is inadequate and will expose you to great financial risk. In fact Basic Medishield no longer offered to new Medishield applicants. Please double check your Medishield policy to make sure you're on Enhance Medishield. Even Enhance Medishield has cracks you can fall through. Under Enhance Medishield there is co-payment amount that you have to exceed before Enhance Medishield will pay you. You may think that paying a few thousand from your pocket is okay, however, many patients, especially those with early cancer, found out the hard way that certain illnesses require many short hospital stays and you end up paying more than a few tens of thousands. To fix this you need to purchase a rider to cover the co-payment amount - which is another crack in the scheme that people are not aware of. Newborns with congenital illnesses are not covered [Link].

When Minister Khaw had a heart attack and needed surgery, he paid $8. Many poor people will pay much more than $8 when they get hospitalized. In our system, the richest in our society like Minister Khaw pay less than the poorer members because they can afford better insurance i.e. the less financially well-off have to shoulder heavier burdens when they get sick. Minister Khaw should make the medical coverage he has universal for all Singaporeans. We already have the biggest income gap among developed countries and our healthcare system further exacerbates the inequality in our society.
Jump in hospital bills over past four years[Link]

Most patients are able to pay, have MediShield and Medisave: Minister

THE average bill for a subsidised C-class patient in a public hospital has gone up by between a third on the low end and almost double on the high end, in the four years since 2006.

The Ministry of Health (MOH) puts this down to multiple factors - including a greater number of more ill and older patients, and patients asking for non-subsidised drugs and implants.


E said...

Thanks for highlighting.

However I'm still a bit skeptical about the need to purchase an additional rider for the co-payment besides the private-integrated H&S. The premium for the rider seems to be matching that of the H&S cover itself.

Is there something I haven't considered?

sgcynic said...

"The bottom line : We have good high-standard public hospitals that are affordable because of the 3Ms" - Minister Khaw

The PAP's undisclosed definition of affordability is indeed based on our ability to pay off the bill. However, as with many "good" salesmen, they neglect to tell us that after affording the item, we are likely practically broke.

Mah Bow Tan's flats are affordable though the COV wipes out young couple's cash savings and the affordable monthly CPF monthly installments mean that one would have little CPF retirement funds thirty years down the road.

Similarly Khaw Boon Wan's state l medical care may also wipe out one's savings. Not to forget afforable public transport fares that increases every year like an IV drip (recall Khaw's heart "bled" for the two public transport operators). Also afforable taxi rentals and commercial rents for hawker centres that result in the driver/hawker working longer hours just to cover the rent.

Anonymous said...

i am constantly astounded at the number of "affordable" schemes/things that singapore has -which i cannot afford!!!

what is even worse is that the list is growing. i expect it to cover food soon. i know i can't afford beef now.

certainly it looks like water is going to join the list in the next couple of years, seeing as how spore has signed a deal to buy it from indonesia - to meet an upcoming water shortage by 2015!

water from malaysia, reservoirs, newater, desalination, marina barrage and we still don't have enough. wonder if it has anything to do with the 2 million or so people we took in over the last 16 or so years.

to solve all these shortages, we should encourage more sporeans to emigrate. then there might be enough to go around.

Lucky Tan said...


You have to look at whether you have enough medisave or savings to self insure for the this co-payment issue. I just brought it up for awareness because one of my friends encountered this and was highly disappointed the sysetm. If you get a chronic problem it will just drain your CPF. Remember also, the govt is trying always and means to shorten hospital stay for older patients to free capacity...the artifact of this more people going below co-payment.

Anonymous said...

"30% jump in Class C hospital bills since 2006."

This is not as much as the "how many % jump?" in property prices since 2006.

And with so many other jumps, one must feel exhausted at jumping up everytime to complain. And lagi worse, some more no use.

Lucky Tan, I admire your inexhaustible energy. And if only it helps to reverse things. said...

We can use all the 7% GST to fund universal health care.

PM Lee has promised that GST is to "help" the poor, but currently no one knows how the monies are being spent. Lee Hsien Loong seems to be a fraudster and criminal, robbing our monies.

Any "Joe Singaporean" doing the same thing as Lee Hsien Loong did in business dealings, would land up in jail in 2 weeks.

I suggest creating a openly audited "GST Expenditure Ministry", to provide free healthcare for every Singaporean except the Top 10%. I believe 7% GST would be more than enough. said...


Doctor per 1000 people. We need to thank PAP for that tied Syria with Singapore ranking 82. Cuba ranked 2.



I estimate from MOH data that hosiptal bed per 1000 is around 2.4, again we are the bottom among the league of 1st world countries. We are even below some 3rd world countries like Turkey.

The main reason is that until very recently, medical profession is a one of few professions that cadet branch of elites chose, if they are not interested in politics or business.

(Recently, those elite doctors chance occupation to become hospital manager and thus medical profession now see lots of FT)

The medical profession is the most unionized here. This is first to keep the number of medical students low. Next is to keep the poor out of medical school even if they scored 4As -- and give the rich a back door. This is done through corrupted entrance interview.

The working class has to pay high medical cost to make sure those elite look like talent.

sgcynic said...

"PM Lee has promised that GST is to "help" the poor, but currently no one knows how the monies are being spent. Lee Hsien Loong seems to be a fraudster and criminal, robbing our monies."

To get a sense of how part of the money has been spent, read

So, plently left to go into Singapore's reserves and election sweeteners.

As for the poor,"How much do you want? Do you want three meals in a hawker centre, food court or restaurant?"

Anonymous said...

Sin is prospering and progressing by leaps and bounds. Everything rises and values increased. Only one thing and A VERY MINOR ONE, pay did not or regressed.

Singapoorerians have to be thankful and grateful to their rulers.

Anonymous said...

Mr Lucky

For the 1000th time ... if you get anything worse than a bad cold ... Class C of a public hospital is the LAST place you want to be ... unless u have a death wish. Then it wont be expensive any more!!!

Anonymous said...

To the Elites, affordable means you can afford to repay with your whole life.

They have got pea brain i guess.
"affordable" home + "affordable" transport + "affordable" medical + whatever "affordable" scheme they cook up = Unaffordable

Each area made their policy looks affordable but overall, singaporeans gotta work will death to afford and forget about retiring.

Rich always get richer.
That's why the rich is able to pay the least to get the best medical service.

I dont understand how M Khaw got the cheek to brag that he paid only $8 for his medical expenses when he is clearly able to afford to pay for his medical bills even without insurance.

Ghost said...

It's always expensive if you fall ill in Singapore. Nothing new here.

Anonymous said...

everything is affordable in the eyes of papaya since they are paid very well by the people who vote for them.

Anonymous said...

that the doctor: patient ratio on the chart suggested by vonhayek is a 2001 figure is scary. it was before the Big Flood (of foreigners). the reality today could be far far worse.

can anon (21:23) - or anyone else -plse explain why going to a class c ward sucks unless one has a death wish? why is it so bad?

generalpervaizmusharraf said...

Really effective material, thanks so much for the post.