berthahenson

A healthcare begging bowl

In Money, News Reports, Society on February 25, 2013 at 2:02 am

We’re all talking about healthcare these days and whether we can afford to get sick in our silver years. Economists are wondering if the healthcare system should be reformed – why save so much money in Medisave when some of us need it now? Can’t the G share of the bill be higher? And my own favourite question: Has anyone ever been bankrupted by a medical bill?

So I read with interest The Sunday Times story on Medifund, that last safety net in our 3M system. I gather that this is for those who have depleted their Medisave (and those of their immediate family members?) and who didn’t sign up for Medishield. At least, that’s what I think the criteria is since it hasn’t been publicised with the G seeming to prefer a “case-by-case’’ basis.

I have friends who have been helped by Medifund, for which they are grateful to the G. It’s good that people are “grateful’’ but should it be the case that they look to G largesse to foot medical bills. I mean, no one intentionally gets sick. So I read about Health Minister Gan Kim Yong vowing that no one will be denied healthcare because they can’t afford it. He’s said it before, probably more than twice, and so has every Health minister before him. The ST led with this assurance – again, although the news should really be how many people have been helped by Medifund. I can’t help but think that the problem can be fixed at the root, but I will leave that to health economists.

Anyway, Medifund disbursements have increased from$78.7 m in 2011 to $90.8 m last year. Number of applications approved shot up from 480,869 to 518,389. The rise is attributed to greater flexibility to medical social workers to say yes to applications, although I still don’t know what is “flexible’’. As compared to what?

I tempted to say “wah, so generous now…’’ but I won’t. Because the figures are troubling. So many people need help with their medical bills, so much so that there is a “shortfall’’ – Medifund, an endowment fund, paid out more than its income for the first time. There is one more figure which appals me: That 96 per cent of the applications were for out-patient bills. I mean, so many people cannot afford out-patient bills? Something is wrong somewhere no? Especially since an in-patient received $1,295 while an outpatient get $103. So many people cannot pay $100 or so? How come? Is it because the medical problems aren’t covered by Medisave in the first place? Or they really, really are destitute?

I really think we need to look hard at the figures..

Then I read today in ST about medical centres in the Orchard Road belt. It’s an exclusive by ST I believe, so I’ll just sum it up here: Basically, the Raffles Medical Group wants to convert seven podium floors of Thong Sia building into a medical centre and applied to the URA to do so. As usual, there was a bureaucratic gobblededook response: “We evaluated the new proposed use taking into consideration specific site context, the impact of the proposed use on the amenity and surrounding uses, and the local road infrastructure capacity in that area, and decided to turn down the proposal.” In other words, the URA said no.

The ST has an interesting graphic on all the medical centres in the Orchard Road belt. Go buy ST. Did you know Pacific Plaza is converting the top seven floors of its 12-storey building into 22 medical “suites’’? The private medical centres are everywhere in the shopping district. Raffles wants to use Thong Sia to serve the “significant number of patients who live in District 9, 10 and 11’’ and foreign visitors, its spokesman said.

I don’t know why the URA said no. Apparently no parking space and complaints of residents have something to do with it. I don’t want to be envious, but I am. Nor do I want to say that private sector initiative should be stifled given Singapore’s bid to be a medical hub. But this story coming after the Medifund story really makes you think about the healthcare system in Singapore. Can we look after our needy sick in a better way than have them go with a begging bowl to the G?

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  1. 1. It doesn’t do the government any good to publish the criteria for Medifund approval. Some will view it as too stringent & others too generous……so better use the vague “case-by-case” statement so that the criteria can be changed without arousing more attention.

    2. I hope there were multiple applications made on behalf of some citizens – cos 518,389 applications on a “1 application per needy citizen” would imply a very high percentage of citizens requiring Medifund assistance.
    It would be good if Minister Gan can share more details about the Singaporeans who needed help from Medifund.
    Example
    Do their living conditions or lifestyles contribute to them falling ill more often?
    If so, let’s work on improving these so that they can spend less time at the polyclinics and thereby reduce the workload on our social workers & our public medical staff.

    3. I think Medisave & Medishield do not cover out-patient treatments – which might explain why 96% of the Medifund applications were for out-patient bills.

    4. It’s kind of ironical that some Singaporeans can’t afford even their out-patient bills while others and many foreigners are coming to Singapore for the more costly but perceived better quality of private medical care.
    I sense the private-public healthcare divide will widen with private medical chains offering top dollar to entice the healthcare professionals to crossover……which puts more emphasis on getting last week’s announcement of retirement villages in Danga Bay.

    5. Reading your articles in succession, I worry if these moves will have the unintended consequences of widening the Gini coefficient even more?
    My logic:
    – Malaysia will only be interested in allowing foreigners who can support themselves into the country…i.e. contribute to Malaysia’s GDP
    – Middle-class Singaporeans would most likely be the ones who find the Iskandar projects appealing.
    – Really rich Singaporeans & foreigners will still find Singapore more attractive (no 1hour wait to cross the Causeway, big name foreign chefs aren’t going to open in Johor anytime soon and you won’t be seen dead shopping at Factory Outlets)

    6. So, come 2020 & beyond, will there be a hollowing out of the middle-class and thereby have a higher percentage of lower-income and upper-income within the population that remains?

  2. ‘Can we look after our needy sick in a better way than have them go with a begging bowl to the G?’

    I don’t get what you mean. As it is currently, we don’t have many chances to beg until our medisave, medishield, children’s medisave etc are exhausted.

    Begging or not, if the G doesn’t want to pay more, who can pay? Insurance? But that’s Medishield already, right? Or look for corporate donors? Or pray that one strikes Toto?

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