No Respite from Rising Medical Costs
by singaporearmchaircritic
Before Budget 2013 was announced, many of us would have learned about the spike in our health insurance premiums either through the media or the letter from CPF.
Come March, Medishield premiums and integrated shield plan premiums will see a hefty increase. Because the Medisave withdrawal limit for each premium is up to $800 per insured person per policy year, any sum above $800 would have to be paid out-of-pocket.
Sigh.
If you are a Singaporean, you would be familiar with the saying that one can die but cannot fall sick in Singapore. Some of us might have said it in jest and our foreign friends might think it was an exaggeration.
Yet increasingly, high medical costs in Singapore is making this more of a painful reality than a joke. According to the Mindshare survey 2012, 72% of Singaporeans believe that “we cannot afford to get sick these days due to high medical costs.”
Has the Budget 2013 addressed this very real concern of Singaporeans?
In DPM’s budget announcement, he said the government would look into lowering Singaporeans’ out-of-pocket health spending (report).
Singaporeans’ out-of-pocket medical spending is the highest among the East Asian developed economies. Fifty-four percent of our total health expenditure is paid out-of-pocket, compared to around 30-35% in Hong Kong, Taiwan and South Korea. Citizens of the Nordics pay less than 20% of their medical expenses out-of-pocket.
Our public health expenditure as a percentage of GDP is also the lowest among these economies (see Figures below).
(Data sources: WHO Data Observatory, Taiwan & Hong Kong). Note that Medisave is not counted as out-of-pocket spending in the Singapore figure.
(Data sources: World Bank & others). Note that private health expenditure in this chart includes out-of-pocket expenditure borne by individuals.
Although DPM said that the government will “study” how it may broaden the usage of Medisave and Medifund, the Budget statement provides no further detail.
Instead, the key initiative drawn up in the Budget is to channel more money to three funds: the Medifund, the Eldercare Fund, and the Senior’s Mobility and Enabling Fund. The government top-ups amount to $1 billion, $250 million and $40 million respectively.
Before you applaud these seemingly generous injections of capital, do know that only the interest income from these funds may be used.
Elderfund subsidized the operating costs of nursing homes run by voluntary welfare organizations; Medifund is only for those who cannot afford to pay the charges at restructured hospitals even with Medisave and Medishield.
To be eligible for the Senior Mobility and Enabling Fund, you must be a senior citizen with a per capita household monthly income of $1,500 and below, or live in a residence with an annual value (estimated rental value) of not more than $13,000 if your household has no income.
Given the stringent eligibility conditions, how may these initiatives benefit most Singaporeans and reduce the medical expenses we pay out-of-pocket?
Singaporeans have every reason to be skeptical.
Despite repeated calls by experts and ordinary Singaporeans to reform the use of Medisave, the government is slow and reluctant to lift the restrictions, leaving us to fork out what little cash we have to pay for our medical expenses.
As recently as in late January, the Health Minister had dismissed Lee Li Lian’s suggestion to lift Medisave restrictions for senior citizens above 75 years old, saying that “elderly Singaporeans may face greater financial difficulties down the road if they are allowed to use up their Medisave fund without restrictions” (source).
This sort of preposterous argument, coming from the Health Minister himself, only goes to confirm our suspicion that the government couldn’t care less about our wellbeing.
Fine then. Many Singaporeans also couldn’t care less about the government’s promise to take up a larger portion of medical costs.
Just give us the right to use our own Medisave money for essential healthcare needs.
As this reader asks in a letter to Today:
“What is the purpose of having so much in Medisave while having to pay for high medical expenses out of pocket? What is the purpose of getting citizens to top up their parents’ Medisave accounts?”
Public/govt hospitals must not benchmark their charges and fees against private sector which is out to make substantial profits (it’s their prerogative). Govt should come up with a more comprehensive and clearer scheme of medical subsidies instead of the 3M crap which even doctors find difficult to understand.
SDP has a very detailed healthcare plan formulated by a panel of medical experts and practitioners. For readers’ interest: http://yoursdp.org/_ld/0/5_sdp-national-he.pdf
http://www.fivestarsandamoon.com/budget-2013-reinventing-healthcare-in-singapore/ the writer of this article made a few good points
The answer to the readers question is simple. All the money in the CPF accounts is theirs to give, not ours to take when needed.
The “3Ms” – Medisave, Medishield and Medifund – are of no help if you are caught in certain situations, like this reader:
“Just went for a MRI this morning and realised that I can only use up to $600 of my Medisave for it. And I can only do this every 12 months. If I need another MRI within this period, I will have to pay the full cost by cash. So it’s true. You literally cannot afford to be sick in Singapore. And because of my pre-condition, no insurer will approve my application for Enhanced Medishield. Even if they do, there will be exclusions – which becomes useless anyway. I just have to learn how to become cash-rich on a salaried income. Maybe I can acquire some advanced meditation techniques that will enable me to survive without eating or drinking and be at different work places as avatars but not in physical form. Wish me luck!”
Technically, using Medisave to pay for medical expenses should also be counted as out-of-pocket spending since Medisave is a compulsory deduction from our salary. So while Diagram 1 above shows that 54% (excluding Medisave) of our health expenditure are paid out of pocket, the figure is far higher if we include Medisave payments.
And don’t be misled by those who equates expanding Medisave usage to “welfarism”. Singaporeans are not asking for handouts from the government, for goodness sake. We just want the right to use our own hard-earned money in Medisave to pay for necessary medical expenses such as preventive care (health screening), MRI etc.
[…] Before Budget 2013 was announced, many of us would have learned about the spike in our health insurance premiums either through the media or the letter from CPF… Despite repeated calls by experts and ordinary Singaporeans to reform the use of Medisave, the government is slow and reluctant to lift the restrictions, leaving us to fork out what little cash we have to pay for our medical expenses.As recently as in late January, the Health Minister had dismissed Lee Li Lian’s suggestion to lift Medisave restrictions for senior citizens above 75 years old, saying that “elderly Singaporeans may face greater financial difficulties down the road if they are allowed to use up their Medisave fund without restrictions” (source).This sort of preposterous argument, coming from the Health Minister himself, only goes to confirm our suspicion that the government couldn’t care less about our wellbeing.Fine then. Many Singaporeans also couldn’t care less about the government’s promise to take up a larger portion of medical costs.Just give us the right to use our own Medisave money for essential healthcare needs. […]
It’s a catch-22 situation: You can’t use your Medisave for a lot of medical expenses, or you will deplete them. But you can’t get help from Medfiund because you still have Medisave, so you are not destitute. Use out of pockets expenses.
As long as you have funds in your Medisave, you can’t tap into Medifund. Smells like a clever trick to play on us. So how many people don’t have any Medisave funds at all? Those who didn’t work in their younger days and no-top ups from their spouses and children. My advice to all. Don’t top up your parents’ Medisave. Let it run to zero? But then you may be fined for neglecting your parents…hmmm.
You’re right about the catch-22 situation. And I agree it’s pointless to top up any Medisave account because of the numerous restrictions on usage. Now that the insurance premiums have gone up, the Medisave withdrawal limits should go up accordingly too. And we should also be allowed to use Medisave to pay the premium for rider plans.
A Chinese blogpost on Singapore’s healthcare policy that is worth a read:
http://www.sginsight.com/xjp/index.php?id=9602
“为何会出现‘患者使用了保健储蓄、健保双全医疗保险,仍然不敷之后,用来支付所剩的全额医药费’?也就是说,什么情况导致人们无法支付全额医药费?解答这一个问题之前,不妨先看看一些已知的事实,因为答案就在其中。
新加坡确实是有着林林总总的堂堂皇皇的社会援助计划,也就是说,政府行政上,新加坡并不缺乏各种各样的应对方案,但是,这些往往都是纸上谈兵,只是作为墙纸的美观视觉效用,目的是展现政府关心民生的假象。能够成功执行的计划却是成效少见,因为要成功取得援助的门槛太高,求援人士很难满足附带条件的要求。就是因为政策的脱离现实,所以才会出现了求救无门,而唯有走上绝路的社会悲剧。
新加坡的医疗保健储蓄、健保双全医疗保险,等等计划令人眼花缭乱,可是,能够动用这些资源的条件非常苛刻,实际上,由于无法动用足够的保健储蓄,所以才会发生支付困难的问题。水中捞月只能蒙骗无知,而不是实质性的解决问题。”
My sister passed away from cancer last year. Although she was lucky that her employer had insurance in place that helped cover most of the bills, the cost was still very frightening.
On many occasions, my family had to come up with the money first for urgent operations and could not wait for the haggling between the hospital, and insurance. The hospitals were very unwilling to deal with the insurance company.
I can assure you that it was a strain to the entire family. My sister wished for death rather than watch herself be a burden to us.
I am so sorry for your loss and the ordeal you and your family had gone through. The haggling you mentioned is unacceptable and so inconsiderate of both the hospital and the insurance company. But it’s still fortunate that you had insurance to help cover the cost. I strongly believe that the full cost of the insurance premiums (including the rider plan) should be paid through medisave. That would encourage more people, especially those who may not be able to fork out the cash, to take up insurance.
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