Charges at community hospitals are lower than at acute hospitals

MOH's Reply

We refer to senior health correspondent Salma Khalik's commentary (Subsidies for different care hospitals need to be better aligned, April 11), and related letters (Address dilemma of higher out-of-pocket bills in hospital move by Mr Melvin Chan, and Standardise considerations for hospital subsidies by Mr Leong Kok Seng, both published on April 15).

The average daily bill at community hospitals is generally lower than at public acute hospitals.

The public acute hospitals list ward charges, which is only one component of the bill.

The charges posted by community hospitals reflect the overall daily cost, which includes all expenses that are likely to be incurred. The Ministry of Health (MOH) will work with our hospitals to review how information on the charges can be better presented to minimise confusion.

Government subsidies are available. To determine the level of healthcare subsidies to be provided, MOH generally uses per capita household income as it takes into account the means and size of the household.

However, we use an individual's income instead when assessing the eligibility for subsidies at acute hospitals to keep the processes simple, as acute hospital stays are typically relatively short.

We are reviewing whether the basis for subsidies for acute hospitals should be aligned with other healthcare subsidy schemes.

MediShield Life and MediSave can be used for both acute and community hospital stays.

The claim limits take into consideration bill sizes in the respective settings, and are therefore lower for community hospitals than acute hospitals.

Community hospitals are designed primarily to provide rehabilitation services for patients discharged from acute hospitals.

With greater experience in operating community hospitals and clearer care guidelines, MOH has assessed that selected patients can be safely admitted directly from emergency departments to community hospitals without first being admitted in acute hospitals. We extended MediShield Life coverage to this arrangement from July 15 last year.

On the whole, our objective is to ensure that care is accessible and affordable, regardless of setting.

We review the financing framework from time to time to achieve this objective, taking into account the diverse needs of patients while keeping the framework simple.

Lim Siok Peng
Director
Corporate Communications Division
Ministry of Health

Forum Letters

The Straits Times, 11 April 2019

Address dilemma of higher out-of-pocket bills in hospital move

Senior health correspondent Salma Khalik made some good points in her recent commentary (Subsidies for different care hospitals need to be better aligned, April 11).

It highlights the dilemma of having to pay more out-of-pocket because of less insurance coverage by MediShield Life, as well as possibly having fewer subsidies when a patient transfers from a general hospital to a community hospital for step-down care.

In addition to the points already mentioned, this may also have the unintended effect of stressing our general hospitals if patients are reluctant to move or delay their transfer to a community hospital because of the added financial strain to pay the extra out-of-pocket bill, as illustrated in the article.

Anecdotally, from some of my interactions with friends and relatives, it also seems that there is quite a long waiting time to get into a community hospital, especially if one is waiting for a subsidised ward.

I suppose, holistically, the situation of creating more capacity at both the general hospitals and community hospitals is already being considered.

I certainly hope that the subsidies alignment, as highlighted, is not a case of using prices or the lack of subsidies and lower insurance coverage to sway demand.

I hope the relevant review committee or government agency will comment on this, as part of the broader MediShield Life review and healthcare cost management for our greying population.

Melvin Chan

The Straits Times, 11 April 2019

Standardise considerations for hospital subsidies

I felt more confused when I read the recent articles on medical bills and insurance (Private stays at community hospitals: Patients pay cash deposits despite insurance cover; and Subsidies for different care hospitals need to be better aligned, both published on April 11).

First, I do not understand why whether a person can use his Medisave is dependent on the type of hospital and ward he is admitted to and not based on his medical condition. This adds to the confusion on the use of Medisave.

Second, why couldn't people who were referred to a community hospital directly from a public hospital's emergency department make claims before July 15 last year?

In this case, the question on my mind would have been where I should go to seek medical advice in order to make claims.

Third, why was the charge to be moved from Singapore General Hospital to Sengkang Community Hospital so high, as highlighted by patient Stephanie Kong?

Fourth, why is it that the consideration for subsidy for general hospitals is based on patients' income while that for community hospitals is based on one's household income? There would be less confusion if all subsidy rates were based on the same considerations.

Lastly, why are the insurance claim limits varied for the different types of hospitals? There would be less confusion if the limit for claims were the same for all hospitals.

Patients need simple and clear information on their claims and subsidy entitlements to make an informed decision.

More importantly, I hope the Ministry of Health will revise the subsidy rates to ensure people can afford good medical care.

Leong Kok Seng