Leong Sze Hian recently wrote a letter to the Straits Times forum asking about the large jump in the size of class "C" hospital bills [Link]. In my blog, I've highlight numerous cases of families (that are not rich) shouldering enormous healthcare burden due to either cracks or inadequecies in the system. In the past 4 years, class "C" bills have nearly doubled and this escalating cost hit the sick and their family really hard. The latest case being that of Olympic hero Tan Howe Liang's wife who had breast cancer [see article below]- fortunately an anonymous donor came the family's rescue.
The MOH's reply to Leong Sze Hian generated by its PR (Corporate Communications) dept dismisses his concerns without addressing the real issue.
Class C wards are highly affordable
[Affordable? In the same sense that HDB flats are affordable?]
MR LEONG Sze Hian seemed to disbelieve that C-class patients would know to ask for non- subsidised drugs and implants ('Puzzled by spike in unsubsidised items for C-class patients'; last Wednesday).
[Mr. Leong wrote that he found it hard to believe the MOH explanation that the bill increase is caused by patients asking for unsubsidized medicine and implants]
There was a time when C-class patients were largely lowly educated and ignorant of treatment options. This has changed over the years.
Many subsidised patients are now well-read and often come with Internet printouts about alternative treatment options. We welcome this development as better informed patients can participate more actively in their treatment, especially where lifestyle changes can make a critical difference to their health outcome.
[This reply is really hard to believe. MOH is saying that doctors in class C ward do not offer patients the best treatment options and patients look it up themselves on the Internet? Even if what MOH said is true, why is so much of the better treatment unsubsidised? ]
With more than 42 per cent of all admissions to restructured hospitals opting for Class C wards, many are clearly not from low-income families.
[When I was hospitalised about a year ago, I also asked for class C because I was unsure what was wrong with myself and terrified of falling through the many cracks and getting hit by a enormous bill. Although class C does not ensure it will not happen, class B, B1 & A will be far worse. It is cause by fear of this system more than anything else and more people are now aware of the problems of our healthcare system. When I was in C ward, I was surrounded by people who appear to be from low-income families. No I did not look up the Internet to ask for unsubsidised treatment, I received very little subsidy anyway since I was means tested. Part of the reasons for the bill increase could be due to subsidy reduction due to means testing as the cost of healthcare escalatesm ]
To keep health-care costs low, our policy is to prescribe standard drugs and cost-effective implants for our subsidised patients. However, where the patients have expressed a strong preference for such non-standard items despite knowing that they will have to pay for them, we will meet their requests. [Trying to blame the sick for their healthcare financial burden is more than just a little inhumane. Why would patients ask for treatment and doctors willing to carry it out if it does not improve the quality of lives and odds of survival of these patients? Classifying treatment as standard and non-standard to exclude them from govt subsidy then blaming patients for high cost is an uncompassionate way to treat the sick.]
They assess that they can afford these non-subsidised drugs and implants as they are covered by both Medisave and MediShield, subject to certain limits.
[So those who cannot afford it don't get the better treatment?]
The reality is that Class C wards are highly affordable. Where is the evidence?
The average Class C hospital bill is about $1,600, equivalent to less than one week of the average household income. Eight out of 10 Class C hospital bills are fully covered by Medisave withdrawal limits. With MediShield, the vast majority of Class C patients do not have to pay anything out of pocket.
[I've pointed to the flaw of using average bills, 80 percentile bills as an indication of affordability. A typical hospital see numerous small cases of people warded for observation, minor surgeries etc. If you've stayed in hospital, you will know that severe cases such as ICU, major surgery etc form a small number of cases and for many people, it is a "once in a lifetime" illness. What is important is the size of these large bills - the top 5% or top 1% - how much they rise over time. Because it just take one case in a family to severely burden them. Looking at average bills then concluding that it is affordable is incorrect. Look at the previous case I posted in which standard Medishield which was designed for catastrophic illness is now inadequate because of the payment limits are too low given how much medical bills have escalated for serious cases.]
Mr Leong cited a $90,000 Class C bill. Such bills are rare and are usually the result of very long stays in the intensive care unit. The rational way to protect against such a catastrophic event is insurance. MediShield offers such coverage at very affordable prices.
[Enhance MediShield not MediShield may be sufficient for serious cases. Because of pre-conditions developed between the time MediShield was launched and Enhanced Medishield is introduced, many cannot upgrade because insurance companies won't accept them. Others can't do it because of much higher cost due to age...many have not done so because the MOH keep misinforming them that MediShield is sufficient when it is not. Otherwise, why was it necessary to introduce Enhanced MediShield? In this letter, MOH again misinforms by saying MediShield is sufficient. Even for MediShield, almost one in 5 (or 6) don't have it...so how many have sufficient Enhance MediShield coverage?]
Where patients have no or insufficient insurance coverage, we still have Medifund as a last resort.
[There is big gap between Medifund and your ability to get it. If you look at the strict criteria for Medifund, you would have to lose most of your assets due to illness before you can touch it.]
Our 3Ms (Medisave, Medi- Shield, Medifund) approach to financing health care is the correct answer to rising expectations for high-quality health care.
[Rising expectations? Oh come on. It is rising cost for the same expectations. Sometimes this type of PR people tactics is just to frustrate you with words. She again blames rising cost on rising expectations. What is really rising is the cost ...the same treatment cost far more today than it did 4 years ago]
Patients can do their part by staying within 3Ms and accepting their doctors' prescription of lower-cost alternatives. Most Singaporeans do.
[If most Singaporeans do, then how did it cause the near doubling of class C hospital bills. She shoots herself in the foot because she said many are asking for non-standard treatment earlier]
Karen Tan (Ms)
Director, Corporate Communications [We should make Minister Khaw answer for his policies. We should not accept this type of disingenous reply to genuine concerns of Mr Leong].
Ministry of Health
Help for Olympian Tan Howe Liang
By Patwant Singh Posted: 05 February 2011 2033 hrs
SINGAPORE: An anonymous donor has donated an undisclosed sum of money to Singapore's first Olympic medallist Tan Howe Liang.
In a MediaCorp exclusive last December, it was reported that Mr Tan's wife had undergone surgery for breast cancer and the subsequent treatment had set the family back by almost S$100,000.
Now an anonymous donor has come forward to present the former weightlifter with an undisclosed sum of money.
The contribution was facilitated by the Singapore National Olympic Council, which said the amount given was sufficient to meet Mr Tan's needs.
Other parties had earlier expressed interest in wanting to help the Olympic hero.
NTUC FairPrice is looking into an ambassador role for the 77-year-old to promote healthy living and active ageing. An announcement on this could be made soon, said the company's chairman Ng Ser Miang.
Mr Tan became Singapore's first Olympic medallist when he won a silver in weightlifting at the 1960 Rome Games. He currently works for the Singapore Sports Council as a gym supervisor.
The Olympians Singapore, an exclusive group of former and current athletes, also recently said they are planning to raise funds for the former athlete.