Sunday, February 06, 2011

High Cost of Medical Care in Singapore....

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 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.

- CNA/ir


Anonymous said...

Singaporeans here think that they can reason with the bosses of the land and winning their hearts.

For sure one has heart problem and the Rest with strong hearts have got no conscience.

Dealing with the wolves will only land Singapoorerians in deeper shits.

Buy their hearts with your votes, vote the PAP.

Anonymous said...

"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."
-Lucky Tan

I would think large bills, like 5 or even 6 digits, are rare or exceptional cases, maybe only 1% or less of all C Class bills.

Just like extreme poverty, like almost starving, although possible, are also exceptional and rare cases.

So it may be best to handle it on a case by case basis and "See your (PAP)MP" if need be, for help.

To be realistic, you can't have policies to suit everybody and every type of case but they must cover the vast majority(at least 66% or more). Then the government and society will be super stable and peaceful.

If the government is very repressive and also doesn't properly take care of the vast majority and for a long time, then they may end up like what happened in Tunisia and Egypt.

hayek said...

Healthcare has long been a tools to fleece the peasants. I have always question is there any "true" subsidy in our healthcare system.

It is already rotton and corrupt to the core.

The only way to solve our problem is for Malaysians to open 100 budget hospital in Johor.

Anonymous said...

"If the government is very repressive and also doesn't properly take care of the vast majority and for a long time, then they may end up like what happened in Tunisia and Egypt."

By then, it would be too late because the rot / charade was left to fester for too long until beyond hope & rectification.

Anonymous said...

Income from the taxes from the casinos, cigarettes, alcohol, cars and income from the singapore pools could easily be around a few billion. Btw, is singapore household income that high, more than 1600 per week?

Anonymous said...

We have to 2 choices:
pay high hospital bill in restructured hospitals and tax at 7% GST
pay slightly lower but still high hospital bill in restructured hospitals and tax at 10% GST.

If we ask for help, this help will be used as an excuse to increase GST.
It is better not to ask for any more help. We should help ourselves.
Are they of any use to you since they are not willing, do not want and cannot help you?

hayek said...

If the link do not work google

Wikileaks Thailand Crown Prince Maha Vajiralongkorn dog's birthday with naked Princess Srirasmi

Anonymous said...

the medical system in sg is a huge ponzi scheme to enrich the pockets of you know who. the pap never set up proper systems (eg housing, medical, transport, infrastructure) but only systems to enrich their own pockets.

Anonymous said...

Why is there not enough subsidise for Singapore citizens who opt to stay in Class C ward?

Why there is enough money to subsidise permanent residents for hospital bills when permanent residents are foreigners who are citizens of foreign countries and hold foreign passports?

By not taking up Singapore Citizenship, these permanent residents will leave Singapore and go back to their foreign countries in the future. These permanent residents want to enjoy both the benefits from Singapore and the benefits from the foreign countries they are from.

Anonymous said...

Median household income is $4800, I don't understand why MOH prefer to use average household income as argument for affordability. I agree with Lucky's definition of affordability. Due to the high Gini coefficient in Singapore contributed in part by the million dollar salary of our Ministers, average and median income is far far apart. For our readers info, add another $2000 to the median household income and you get the average.

Anonymous said...

Thanks for the fantastic piece. Once again it confirms that our civil servant have become a bunch of heartless bastards!

Anonymous said...

Income from the taxes from the casinos, cigarettes, alcohol, cars and income from the singapore pools could easily be around a few billion.

Do you know why casino entry fee will remain as $100 per day and not raised to more than $300 to deter more people from going to the casino?

Unlike the case for ERP where there are more cars, the ERP rate is increase and will continue to increase.

Because they have already calculated, to give an extreme scenario. If the entry fee is raised to $1000, Singaporeans and PR may as well go to Genting Highlands. So instead of having more revenue like ERP, Income from the taxes and entry levies from the casinos will become zero.

This is what I call cunning bastards.

Anonymous said...

My ex-boss visits the polyclinic regularly. He told me that some of the medicine which were regularly prescribed were re-classified as "non-standard medicine" over the years, and hence are no longer subsidised.On my part, I find that doctors sometimes prescribed these "non-standard medicine" which costs more. Could the same thing been happening in hospitals?

Anonymous said...

Civil Servants are paid so high income that they have no problem to stay in Class 'A' ward or private hospitals. To them, class 'C' ward is invisible. We, common people, have no choice and have to suffer.

Anonymous said...

To those who say GST must increase in order for the govt to subsidize more, pls note that the budget surplus is in the Billions annually!

If the govt is serious abt taking care of the ppl, the MoH budget shld get a bigger share! Instead of getting another squadron of F15s , Apaches or submarines..

Anonymous said...

Singapore is the only country that quotes household income frequently, most other countries quote income per person not household. Quoting household income just makes income look better than it is. I don't believe Singapore's household income is as high as this gal quote is too.

Anonymous said...

high household income is useless if you also have to bear high housing, transport, food, necessity costs. should use net income per person. most will end up negative after taking in all necessary and basic costs.

Anonymous said...

Anon 7/2/11 08:59

There is a name for that. Not net income but purchasing power.

In fact, on purchasing power for SIngapore, it is unflattering compared to other developed countries. Read this link for the story:

Our purchasing power is comparable to the Malaysians, although their income is much lower.

hayek said...

Singapore is the only country that quotes household income frequently, most other countries quote income per person not household.

The reason is PAP is able to tell big lies using household income. Household income rises especially on occasion where everyone is much more poorer than before.

When that happened, people will not be able to move out. Everyone will squeeze within a small living space.

Our government is so debase and corrupt that it is not able to survive until tomorrow without perpetuating their lies.

Anonymous said...

After the CNY, everythings the prices increases.
It seems that it is going to be a permanent feature.

How to tahan?
Sufer & more sufferring.....
what to do??

Anonymous said...

TR is manipulating " hard truths" by commenters.

Anonymous said...

There are no "informed" consumers of healthcare - most of us are dependent on our medical advice and choices made by our doctors on our behalf.

In the USA big pharma and diagnostic equipment manufacturers use conference junkets and other perks to influence doctors decision.

The FDA and NIH have had little effect on this trend. Clinical test and modern imaging drive up cost due to CYA and litigation concerns. Some suggested solutions

1. The only way not to be affected by rising cost is to increase supply of doctors and hospitals whilst limiting salaries. This may turn some of the talented and pragmatic wise from entering the medical profession.

2. Lower administrative cost by reducing all the cost center management services.

3. Pray for great genes and be responsible for your own health by self education - reduce number of "sick" people.

4. Price medical services appropriately to prevent misuse and abuse.

5. Ration medical services by various premiums, classification of services.

6. Reject or limit adoption of new technologies that do not deliver on a diagnostic or therapeutic basis until proven by irrefutable clinical evidence.

7. Limit proliferation of the new "specialities" until efficacy is proven clinically.

8. Evaluate medical outcomes with a better metric that includes quality of life, productive capability, cost and time. Maybe even naming facility and doctor. Metrics should be published regularly to enable "consumers" to make informed and educated choices.

9. Accept that death as inevitable in the process of life - problem is drawing the line and defining the the objective measure. The last 10% of one's life consumes 90% of personal healthcare cost during a person's lifetime.

Everybody wants choices real or imagined in most things we do.

Imagine nobody would disagree "a faster, cheaper better philosophy," could be interested if could be applied to the provision of health and education services.

Anonymous said...

As permanent residents (PRs) are foreigners from foreign countries and these PRs are already receiving medical healthcare subsidy from their foreign countries,
PRs must not be receiving any medical healthcare subsidy from Singapore.

There are four advantages from removing the PR medical healthcare subsidy.

First, the saving from removing the PR medical healthcare subsidy can be used to subsidize Singapore citizens medical bills in class C and B2 wards.

Second, the health budget need not be increased.

Third, GST need not be raised.

Fourth, as said above, PR are citizens of foreign countries, they must not receive medical healthcare subsidy from Singapore. If PRs want to receive medical healthcare subsidy, they should take up Singapore citizenship and become Singapore citizens.

Anonymous said...

Singapore needs Work Permits and PRs. And lots of them.

That's why have to give them health care subsidy, can buy HDB flats, etc, etc.

Or else they won't come. And our GDP will not grow. And PAP will not look good.

Locals suffer as a result? Can't be helped lah. Because majority (maybe those who don't suffer)will still vote PAP.

DareToAct said...

I wonder what is the proportion of higher healthcare cost is directly attributable to hospital's real estate cost.

hayek said...

Comparing cost of surgery such as liposuction, lasik...etc, the price of doing it in SG can be 3x more than Thailand.

Besides, doctors in Thailand are in many way superior in surgical experience than SG.

We have to ask ourselves, what is the reason of such hugh price difference. Are we overpaying hospital CEO's, real-estate, utilities...etc.

Or is PAP using phoney accounting to justify the exorbitant cost?

Anonymous said...

"Besides, doctors in Thailand are in many way superior in surgical experience than SG."
Hayek 7/2/11 16:56

Then how come Singaporeans don't go there for treatment? Or better still emigrate there?

Some more why the foreigners also want to come here, and not go to Thailand?

Anonymous said...

Prices of Coffee & Teas increase again!!
They hv so many "reasons" why they MUST increase the prices.

But the wages & slaary remain low or even very low.
Many still cannot find a proper job.
Who will talk on their behalf??
Who will "pity" them??

Anonymous said...

To annon 7/2/11 19:13
It is because they don't know. They have been fooled by the government for many years thinking Singapore excel in many areas. Plastic surgery in Thailand is well-known but the news won't report it. Foreigners came here for work, not surgery.

Anonymous said...


If future doctors decided to prescribe drug base on affordability, I will not be surprise.


Doctor: I have prescribed 3 different types of combination of medicines.

Sick: Which one is better?

Doctor: Well, the most expensive one is the best for you but there will be no subsidy given.

Sick:... but I cannot afford.

Doctor: Then take the combination which you can afford.

Sick: What would happen to me if I choose the cheapest?

Doctor: The effect will not be as good. It is your choice.

Anonymous said...

Dear Mr Lucky

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.

Even if the insurance company accepts, the likes of Tan Howe Liang would not be able to afford it!

Just cut to the chase. Fact: Government has to pay for the exceptional cases. Scrap means-testing and all the demeaning obstacles. Cut defense spending to pay for it. or increase income taxes. *sufficient* Personal insurance is prohibitive except to the likes of millionaires like mini-stars and lucky tans.

Anonymous said...

@Anon 7/2/11 20:29

For a few years!

Anonymous said...

It is imperative to live a healthy lifestyle. I've been avoiding eating rice so as to keep my BMI index on the go. Also, there is a need to be prepared for old age and potential illnesses. There are many Singaporeans who are sick but not going to the hospitals for treatment as they can't afford it. They are patiently bearing the pain and waiting to die. There is a need to be prepared and be insured. Don't expect this bastard government to care let alone take care of its citizens. Take care and trust yourself, rather than the government. Their track record has been falling since the advent of the casinos and their multi-million dollar lifestyles.

Anonymous said...

Anonymous said...7/2/11 20:29

hahahahahaha. very good one.

Anonymous said...

the ruler here is very good in preying on the ignorance of the citizens. luckily, there is internet to expose all the wrongdoings of the ruler.

Anonymous said...

I'm not surprise. They are only interested in net happiness and in theirs, in particular.

If Goh Chok Tong could put an equation for happiness, he would do the same for love.

I wonder if he stays in his marriage because of net happiness.

When you have a government who does not respect the rights of EVERY citizen to universal healthcare 'cos they they believe in net happiness, what do you expect? Don't just get apathetic and defeated, get even!

Anonymous said...

I am 67 years old Singaporean, I went for heart stenting at "C" class, the first time was unsuccessful to implant, two weeks later, stenting was carried out successfully. I had to pay for both days the operation was carried out.

Next I was given one of the medication which was not subsidized.
I did not know that it is not subsidized, till I pay for my medication.

Why did the doctor recommended non subsidized medication?

Anonymous said...

Do something. Make Singapore better. And make the difference today. I'd donated $150.

The Pariah said...

These days, you are "lucky" if the restructured/govt hospitals admit you. You are second-time "lucky" if you get a bed in a ward (as opposed to a corridor).

If you compare the list of "standard" medication between 1991 and 2011, do you think the 2010 list will be shorter, longer or the same (bearing in mind medical advances over the past 20 years)?

Let's hope that Singaporeans will send Khaw Boon Wan packing in the upcoming GENERAL ELECTION before he packs us off to JB nursing homes or Malacca hospitals or New Delhi operating theatres!

The Pariah

Anonymous said...


so grateful to be able to find a "CLEANER's job" after retirement after working 34 years in the CS.


Anonymous said...

"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."

This is very true. They will only stick to their standard procedure of treatment even though there are other better ones as long as you are on subsidized costings.

I've heard directly from a critically ill patient that he was given morphine painkiller shots and told to go home as "There is no other medication left to treat him". He has since transferred to private hospital and received treatment.
It is not that there is no medication to treat him but rather it is too high costing for the subsidized scheme!

Anonymous said...

Standard outpatient A & E charges are now $85. Other tests and diagnostic procedures are subject to additional surcharges.

I shudder to think how a family with 2 kids with monthly income of $2k or so afford to seek urgent medical attention should the unfortunate arises. $85 most definitely eats into their household budget. I reckon they'll rather ride through the pain/discomfort or self-medicate.

In comparison, Khaw Boon Wan mentioned he paid only $8 for a heart bypass? That is either another atrocious wild spin by the complaint media, or Khaw self-administered his own heart bypass with assorted scissors, funnels, bandages, and plastic bags costing $8.

Yes, healthcare is affordable, if you so choose to look at one side of the equation and dismiss the rest.

Anonymous said...

i just came across your post and yea i do agree. Medical bills can take a huge chunk off our life savings. Im a financial planner so would you be interested to know how you can protect yourself financially in event of hospitilisation?

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Anonymous said...

Hi All,

I just went to the A&E after the car accident.

And they took ECG and pain test before the consultation alone in SGH and it costed $108 exclusive of GST(GST absorbed by Government as per the letter) after subsidary. Before subsidary is $214, so government absorbs $106 including the GST.

The $108 was before any other medicine or further check up costs factored in.

I am just amused and yet shocked as the medical cost could be so high and hectic for Singapore Citizen. As the saying goes, can die cannot get sick or ill.

The way the authorities and the hospital probably do together is mark up as high as possible and gives rebate which is really strange and questionable.

Hope our authorities really treat hospital as hospital and not a place to make as much money as possible.

It is vicious cycle and things will back fire eventually.

Anonymous said...

It's probably the best to pay for a health insurance instead of relying on government when the system is like this.

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