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By Leong Sze Hian
I refer to Ian Sim’s letter “Right to redefine GPs’ role, free up Medisave use”and Francis Cheng’s letter “Proposals need careful analysis” (Straits Times Forum, Aug 15).
The former states that “While GPs are seen as an important public resource, patients referred by them to the public health-care system are considered private and do not enjoy subsidies. This leads to unnecessary polyclinic visits by patients seeking subsidisedtreatment at the restructured hospitals.
Therefore, the GPC report is timely and rightly advocates that patients referred by GPs to restructured hospitals should enjoy the same subsidies. This will ensure that polyclinic doctors can focus on treating the sick instead of reconfirming the medical needs of those requiring specialist referrals.”
The latter states that “The recommendation to allow patients referred to a hospital by a general practitioner to enjoy subsidies is excellent.”
Perpetual problem that may have caused hardship to patients?
The above once again highlight what in my view, may be one of the worse healthcare policies that we have had for decades – that patients referred by private GPs cannot opt for subsidised treatment (Class C and B2) in public hospitals. In our volunteer financial counseling over the last decade or so, we have had to suggest to patients to try to leave public hospitals to go to a polyclinic to get another fresh referral letter in order to go to the hospital again to gain admission to a subsidised ward treatment.
Did or didn’t MOH know when it replied to newspaper forum in 2009?
Given that the above is widely know, I would like to re-visit an exchange of newspaper forum letters between the MOH and me in 2009, whereby the MOH insisted that my information in this regard was wrong – “Mr Leong also claimed that patients referred from GPs cannot opt for Class B2 and C wards. This is also incorrect. All Singaporean patients who require admission are free to choose their ward class”.
Exchange of forum letters
I am reproducing the exchange of letters in full below, so that you, the readers can decide what the MOH was trying to do in 2009?
Was the MOH not aware of the subject common practice of eligibility to opt for subsidised treatment?
If indeed it was not aware of this common practice which has been going on for decades, why didn’t it ask to confirm – before replying to me in the negative?
Thousands of Singaporeans may consequently have been misled by the MOH’s reply, which may have prevented a lot of patients from ending up in the non-subsidised Class C and B2 wards.
Downgrading to subsidised ward success rate only 1%?
In this connection, the last time a reply was given in Parliament – the success rate of patients applying for downgrading from a non-subsidised ward (A and B1) to a subsidised ward (C and B2) was only about one per cent.
Please inform Singaporeans now?
In the interest of letting the public be aware of this “subsidised ward option” problem, may I suggest that the MOH clarify this now publicly – especially in the light of the above mentioned two forum letters.
Online Only — Make Medifund criteria public
Sep 29, 2009
**Letter from Leong Sze Hian**
I would like to highlight some possible gaps in the multi-tier system of Medisave, MediShield and Medifund, to ensure that healthcare remains affordable and accessible to all Singaporeans.I have tried to ask many medical social workers for the criteria to qualify for Medifund, but have been told that it is confidential. As I understand it, all family members’ Medisave, as well as the bulk of their savings, must be depleted, before one can qualify for Medifund. What this may mean is that by the time one qualifies for Medifund, the entire family may in essence be left with almost nothing already.Therefore, I would like to suggest that the Medifund criteria be made public, so that Singaporeans may not have a false sense of complacency, that if they cannot pay for medical costs, they can always rely on Medifund. For example, some important information that Singaporeans may need to be made aware of, are that as I understand it, about one out of five patients who apply may be rejected, Medifund generally cannot be used for polyclinic out-patient treatment and medicine, patients who are referred by a general practitioner cannot select subsidized Class C and B2 hospital wards and medical treatment and thus cannot qualify for Medifund, the maximum Medifund subsidy for B2 is 60 per cent, etc.
The last time the question was asked in Parliament, the success rate after means testing for patients who requested for down-grading to subsidized C and B2 ward and treatment, was only about one per cent. Recently, it was announced in Parliament that less than one per cent lapse their MediShield.
However, as I understand that there are about one million on MediShield, does it mean that about 10,000 every year lapse their cover because they cannot afford the premiums? How many Medisave accounts have zero or less than $500? The last statistic given by Madam Halimah Yacob, chairperson of the Government Parliamentary Committee on Health, was that about 750,000 do not have any form of medical insurance.
For those parents whose children were born with medical conditions which resulted in their MediShield being rejected, the stark reality may be that the entire family’s Medisave and savings may have to be almost exhausted, before they can rely on Medifund.
Our healthcare system may be one of the most cost-effective in the world with GDP spending of only about four per cent, and about 75 per cent by private individuals and 25 per cent by the state. But, for those who may fall in between the gaps in our multi-tier system, described above, is it any wonder that practically every study or survey have Singaporeans saying that the affordability of healthcare is one of their greatest concerns?
URL http://www.todayonline.com/Voices/EDC090929-0000290/Online-Only—-Make-Medifund-criteria-public
Online Only – MOH: “Medifund criteria are public”
Oct 07, 2009
Letter from Karen Tan, Director, Corporate Communications Division, Ministry of HealthMr Leong Sze Hian suggested that we “Make Medifund Criteria Public” (TODAY Online, Sep 29).We do. The general eligibility criteria are published on the Ministry of Health website at http://www.moh.gov.sg/
mohcorp/hcfinancing.aspx?id= 346 . In addition, the hospital Medifund committees assess each case very carefully and are free to exercise discretion in evaluating the merit of each case.
Mr Leong claimed that one out of five patients who apply for Medifund is rejected. This is incorrect. The approval rate is 99 per cent.
Mr Leong also claimed that patients referred from GPs cannot opt for Class B2 and C wards. This is also incorrect. All Singaporean patients who require admission are free to choose their ward class.
URL http://www.todayonline.
com/Voices/EDC091007-0000218/ Online-Only—MOH–Medifund- criteria-are-public
Online Only – Has policy been changed?
Oct 18, 2009
Letter from Leong Sze HianI refer to the Ministry of Health’s (MOH) reply “MOH : “Medifund criteria are public”” (Oct 7) to my letter “Make Medifund criteria public” (Sep 29).
It states that “We do. The general eligibility criteria are published on the Ministry of Health web site”.
The MOH web site merely says that the criteria is that any Singaporean who has received subsidised medical treatment and is unable to pay for the medical charges incurred, may approach the medical social workers at the relevant medical institution who will help to assess eligibility for Medifund, and can guide you in filing out the application form if required.
In other words, it is akin to saying that anyone who cannot pay can enquire.
There is no information as to what criteria is used to assess the eligibility for Medifund.
As to “The (Medifund) approval rate is 99 per cent”, with about 360,000 approved Medifund applications in a year, this refers to the approval of applications, and not the approval rate of patients who apply.
For example, a patient who has 12 medical treatments in a year may be counted as 12 approved applications. Whereas, the approval rate in terms of the number of patients who apply has never been disclosed. It was reported in 2008, that 301,126 approved applications were made by about 20,000 to 30,000 patients.
In this connection, the number of rejections increased dramatically by 2,900 per cent from 210 to 6,456 in 2006, and then declined dramatically by 79 per cent from 6,456 to 1,266 in 2007.
What about those who were told that they do not meet the basic criteria, which is not public information. In 2008, Madam Halimah Yacob, chairperson of the Government Parliamentary Committee for Health, expressed some concerns that the conditions for Medifund was too stringent, some procedures are excluded, and that for some ailments, B2 is the lowest class of ward available which only gives a maximum
Medifund subsidy of 60 per cent.
With regards to “All Singaporean patients who require admission are free to choose their ward class”, it has been the policy for many years that patients referred from GPs cannot opt for Class B2 and C wards. So, when was this policy changed?
Was this change ever announced to the media or the public?
URL http://www.todayonline.
com/Voices/EDC091018-0000093/ Online-Only—Has-policy-been- changed
