Class C wards are highly affordable

02 Feb 2011, The Straits Times

Question

Name of the Person: Leong Sze Hian

Puzzled by spike in unsubsidised items for C-class patients

I AM puzzled by the Ministry of Health's (MOH) remarks that the almost doubling on the high end of the average bill for a subsidised C-class patient in a public hospital in the four years since 2006 is partly due to patients asking for non-subsidised drugs and implants ('Jump in hospital bills over past four years'; Jan 8).

How would patients know to ask for non-subsidised drugs and implants? Aren't these in the treatment guidelines of the hospital, which doctors are duty-bound to inform their patients?

Has the number and proportion of non-subsidised items in C-class been increasing over the years?

The MOH statistics provided show that average surgical bills have increased by at least 50 per cent at six out of the seven public hospitals.

In my volunteer work doing financial counselling for the needy, I have come across C-class bills of around $90,000, for just over a month's stay in public hospitals. Since C-class is already the cheapest hospitalisation option for Singaporeans, and non-subsidised items are also generally not covered by CPF-approved medical insurance, the trend of increasing health-care costs and non-subsidised items may pose an increasing financial strain on patients and their family members.

What are MOH's plans to address this problem?

Reply

Name of the Person: Karen Tan (Ms)

Director, Corporate Communications

Ministry of Health 

Mr Leong Sze Hian was “puzzled by spike in unsubsidised items for C-class patients” (ST Jan 26).  He seemed to disbelieve that C-class patients would know to ask for non-subsidised drugs and implants.

There was a time when C-class patients were largely lowly educated and ignorant of treatment options.  This has changed over the years. 

Many subsidised patients are now well-read and often came with Internet printouts about alternative treatment options. We welcome this development as better informed patients can participate more actively in their treatment, especially where lifestyle changes can make critical difference to their health outcome.  With more than 42% of all admissions to restructured hospitals opting for Class C wards, many are clearly not from low-income families.

To keep healthcare costs low, our policy is to prescribe standard drugs and cost-effective implants for our subsidised patients.  However, where the patients have expressed a strong preference for such non-standard items despite knowing that they will have to pay for them, we will meet their requests.  They assess that they can afford these non-subsidised drugs and implants as they are covered by both Medisave and MediShield, subject to certain limits.

The reality is that Class C wards are highly affordable.  Where is the evidence?

The average Class C hospital bill is about $1,600, equivalent to less than one week of the average household income.  Eight out of ten Class C hospital bills are fully covered by Medisave withdrawal limits. With MediShield, the vast majority of Class C patients do not have to pay anything out of pocket.

Mr Leong cited a $90,000 Class C bill. Such bills are rare and are usually the result of very long stays in the ICU. The rational way to protect against such a catastrophic event is insurance.  MediShield offers such coverage at very affordable prices.

Where patients have no or insufficient insurance coverage, we still have Medifund as a last resort.

Our 3Ms (Medisave, MediShield, Medifund) approach to financing healthcare is the correct answer to rising expectations for high quality healthcare.  Patients can do their part by staying within 3Ms and to accept their doctors’ prescription of lower-cost alternatives.  Most Singaporeans do.