Monday, July 16, 2007

Will We Get Bankrupt with Mean Testing On Healthcare?

I raised my concern on the Mean Testing on Healthcare, at the Dialogue Session with Minister, Prime Minister Office, Mr Lim Swee Say, during his MCV to Mountbatten on 24th June 2007.

The people on the ground, were very concerned, when Minster of Health, Mr Khaw Boon Wan mooted the idea of Mean Testing for Healthcare, especially for the highly-subsidised 'C' Class wards. He also suggested implementing it within a year.

Whether the Mean Testing will be classified by our asset or by income, we found it to be non-justifiable or questionable. The worries lie with the defination of 'affordability'. To us it depends on our savings and the balance of our income after deducting our monthly expenditure.

Those badly affected are the 'sandwich' class, between the rich and poor, or between the aged parents and the dependant children. The rich can easily afford, and they will not go for C Class wards in public hospital, the poor would be taken care of by the government or welfare organisation.

We have to take care of our aged parents, who are no longer covered by any insurance scheme, and as they age, medical expenses will be higher or may become non-affordable.

Futhermore, quite a number of elderly are not used to the aircon in the better ward and some would like companionship in an open ward.

We cannot deplete our saving too, we also have to save for our children's future. They may not be able to continue their tertiary education in Singapore, due to the limited universities places available here. We have to save money, in order to send them abroad for further studies.

These middle income group already are the victim of mean testing as in housing, that is if their combined household income is above $8,000, they are not entitled to buy any public housing. If they want to own an asset, they have to get private housing. They have to pay higher housing loans and pay higher initial payment and thus deplete their saving. At the same time, they also contribute to income taxes, which are used for the subsidies.

Mean Testing for hospitalisation at public hospital, was mooted by a popular Minister who had done alot and still working on improvements to the healthcare system and lowering the cost. At the same time, he is faced with rising health costs, an ageing population and abuses, especially some families 'dumping' their parents to the care of the public hospitals.

I propose that Class C wards may still be accorded to patients of any income group, with reducing subsidies after a period of stay, for example 70% for first 7 days, 50% for the next 7 days and 30 % after 14 days stay etc.

The needy can apply for the normal subsidies. The medical doctor may certify that a patient require a longer stay, and providing the regular subsidies. Those not qualified under 'needy' may seek the Member of Parliament for recommendation of financial aids, if needed. Those who abuses the healthcare system gets the least or no subsidies.


oceanskies79 said...

A thoughtful post. I second your views on the sandwich class. I think we shouldn't be penalising people who have decided to opt for C class wards because they realised that it is more within their financial means. I hate to see basic healthcare out of reach to these sandwich class just because of means-testing.

Actually, means testing is not the best way to minimise healthcare costs, so that the "richer ones" pay more. I have done enough of means testing due to the nature of my work, and I seriously think that we shouldn't be putting everyone through it unless necessary (e.g. if patients need to apply for Medifund). Means-testing can be pretty time-consuming too, to do it properly.

Drawing from your idea, I think it will be more helpful to address the issue involved by substantially reducing the subsidies for people who have over-stayed in hospitals, longer than their condition require. This will also make step-down care seem more attractive, financially.

Christopher said...

Regrettably,those who have overstayed in hospital, are the elderly parents that were dumped by their children.

Hopfully the reduction in subsidies will deter them, and there is no need for Mean Testing to be introduced.

oceanskies79 said...

I am aware of the "social overstayers" who overstayed for some of the reasons you have mentioned. Hence if the subsidies decrease, then they may be encouraged to take up step-down care (e.g. community hospitals etc) which will adequately address their medical needs.

Perhaps the resolution to reduce unnecessary medical cost might be to make step-down care more accessible?

I have heard of people telling me that the cash amount that they pay for step-down medical care is roughly about the same as what they pay in cash for care in the hospital. And if they are in step-down care, they need to travel to the specialist clinic in the hospitals for outpatient appointments. In the end, people's mindset still thinks that they might as well overstay in hospitals.

Christopher said...

Thanks for the feedback. It will be good for me to get ready these costing on my next feedback to minister.

Yes, the step-down care must also be affordable too. It can be provided with no frills, to keep cost low.

This problem may developed further, and getting more serious, as the population is ageing and the family nucleus is getting smaller.

The burden on the one child, for the two aged parent medical expenses, is very heavy with no sibling to share with.

As the saying goes with the common folks it is cheaper to die than get sick.