MediShield: Deductibles increased by 5 times historically for elderly?

l refer to the report “MediShield deductibles up from next March” (Channel NewsAsia, Nov 12).

Deductible up to $2,000

It states that “Class B2 and C patients will have to pay MediShield deductibles of S$1,500 and S$2,000 respectively from 1 March 2013”.

Deductibles up by 3 times historically?

When MediShield was first launched, the deductibles were $500 and $1,000 for Class C and B2 respectively.

So, the deductible for Class C has gone up by three times, historically.

Implications for lower-income

What does this mean for lower-income Singaporeans?

1st $1,500 cannot claim

Well, you will have to pay the first $1,500 of your hospitalisation bill in Class C, before you can claim anything under MediShield.

Use Medisave and cash to pay?

So, it may increase the financial burden of lower-income Singaporeans.

In this regard, the Health Minister said, “In the meantime, smaller bills can be covered by Medisave or cash”.

If you are a lower-income Singaporean, it may be less likely that you have the cash savings to pay, or sufficient Medisave because it may be consumed by out-patient and medical fees and/or higher MediShield premiums that will increase from 1 March, 2013.

Medisave top-ups help you?

So, how is the Government helping you in this regard? – “$50 to $400 one-off Medisave top-ups” and “eligible elderly will also receive annual Medisave top-ups of up to $450 under the GST Voucher Scheme”.

The problem with this may be that top-ups may end up being consumed by increasing medical costs, leaving perhaps nothing in the Medisave account to pay the deductible or premiums.

Everybody suffer to focus on a few larger bills?

The reasons given for increasing the deductibles and premiums is to “keep premiums affordable and to help MediShield focus on larger bills”.

As I understand there has been very few claimants who exceed the current policy year and lifetime limits, why make everyone suffer through higher deductibles and premiums?

Catastrophic large bills should be borne by Govt?

After all, how much would it cost the Government, if it absorbs the amount in excess of the limits?

So, why have Medifund?

After all, shouldn’t Medifund kick-in in theory to pay, when lower-income patients in Class C and B2 can’t pay?

The fact as reported in Parliament last month, that more than 90 people had annual claims exceeding $50,000 (after the deductibles and co-insurance) in both 2009 and 2010, shows how expensive healthcare is in Singapore, even in the two lowest class wards of Class C and B2 which are supposed to be subsidised at up to 80 per cent.

Less cash for WIS?

As to “He added that low-wage workers who qualify for the Workfare Income Supplement (WIS) Scheme would receive part of their WIS payouts in their Medisave account”, it may leave even less cash which is what older low-wage workers need to make ends meet.

Left to right pocket healthcare funding?

In respect of “On top of these, Mr Gan said the government provides ad-hoc Medisave top-ups when the budget situation permits, which have totalled S$2.2 billion since 2005”, all these money may simply have gone back indirectly to the Government by way of increased medical fees, deductibles, premiums, etc, which reduces the Government’s public spending on healthcare.

Age 81 and above deductibles is $2,500!

The deductibles for Members aged 81 and above is $1,000 and $1,500 more in Class C and B2 respectively, compared to Members below age 81.

Elderly deductibles increase 5 times historically?

Does this mean that historically, the Class C deductible has increased by five times to $2,500 for those aged 81 and above, from the original $500?

Greater burden for elderly?

What is the rationale for the above, when aged 81 and above members may be less likely to be able to afford the higher deductibles in the first place?

Help Govt spend less?

The only conceivable reason that I can think of, may be that it simply enables the Government to spend less when the probability of being hospitalised and incur larger bills, are higher for the elderly.

Pay more when you can least afford and need it?

Shouldn’t we be helping the elderly more when they are less likely to be able to afford it, and more likely to be ill?

Let the numbers do the talking?

In the final analysis, perhaps we should just let the healthcare statistics speak for themselves:-

MediShield: Premiums, surpluses up?

MediShield premiums will increase by 450, 511 and 309 per cent compared to 2005, for age 30, 50 and 70 respectively

This is an annualised increase of 24, 25 and 19 per cent per annum, over the eight years.
despite accumulated MediShield reserves growing from $205 to $530 million, from 2008 to 2010, an increase of 158 per cent

Hospitals owed $110 million

The last available statistic was that public hospitals were owed about $110 million, after writing off about $90 million in FY 2008, FY 2009 and FY 2010

21% in debt due to healthcare?

The last available statistic was that about 21 per cent of Singaporeans who sought help from Credit Counseling Singapore cited healthcare costs as one of the reasons for getting into debt

Lowest public healthcare spending in the world?

Last year’s public spending on healthcare at about 1.6 percent of GDP is one of the lowest in the world

Public sector spending declined to 40%?

Public sector spending on healthcare, as a percentage of total healthcare spending, has declined from about 75 percent to about 40 percent now

Medifund 99% successful?

MOH discloses the number of successful Medifund applications (480,000 in 2010), but not the number of patients rejected. What is the percentage of Medifund patients (not total applications) that are rejected when they can not pay their medical bills?

0 increase in hospital beds in a decade

According to the Department of Statistics’ Yearbook of Statistics 2012, the total number of hospital beds in Singapore declined from 11,936 in 2001 to 11,394 in 2011, against an  increase in the number of hospital admissions from 384,054 to 469,445 a year, increase  in medical tourists to about 850,000 a year and a population increase of about 1.1 million

Down-grading 99% unsuccessful?

The last time a reply was given in Parliament, about 99 per cent of down-grading requests to a lower ward class in hospitals were unsuccessful due to means testing

Leong Sze Hian

About the Author

Leong Sze Hian has served as the president of 4 professional bodies, honorary consul of 2 countries, an alumnus of Harvard University, authored 4 books, quoted over 1500 times in the media , has been a radio talkshow host, a newspaper daily columnist, Wharton Fellow, SEACeM Fellow, columnist for theonlinecitizen and Malaysiakini, executive producer of Ilo Ilo (40 international awards), Hotel Mumbai (associate producer), invited to speak more than 200 times in about 40 countries, CIFA advisory board member, founding advisor to the Financial Planning Associations of 2 countries. He has 3 Masters, 2 Bachelors degrees and 13 professional  qualifications.