Means testing - Why simpler guidelines works better for deserving cases - The Straits Times

10 Mar 2008, The Straits Times

Question

Name of the Person: Jason Chaim Chiah Sern

Means testing: Spell out rules for special case

I REFER to Tuesday's report, '60% of workers will get full subsidy', on means testing in public hospitals.

Means testing is a necessary evil to ensure that health-care subsidies go to Singaporeans who deserve them most. I am pleased to note that under the guidelines, about 60 per cent of workers will receive the full subsidy when they choose to stay in a B2- or C-class ward in public hospitals.

In most countries, health care remains a touchy and emotional issue which does not go down well with the public. I am happy that the policy in Singapore will benefit 60 per cent of Singaporeans, based on the data released by the Ministry of Health.

My concern relates to Singaporeans who fall within the grey zone mentioned by Health Minister Khaw Boon Wan. This refers to the group of people who have high incomes, but are saddled with exceptional financial difficulties. Means testing may not capture the true financial position in such cases.

While Minister Khaw has given an assurance that he would be flexible on the matter, I am less sanguine. Similar guidelines often cause frustration and delay because of the lack of clarity. I would rather have clearly spelt out guidelines so that hospital administrators and patients are fully aware of what they mean.

Reply

Reply from MOH 

In "Means testing: Spell out rules for special case" (ST, 6 March), Mr Jason Chiam Chiah Sern asked for guidelines to be spelt out specifically  for special cases.

As assured by the Health Minister, means-testing will not affect a large majority of patients.  For patients earning significantly more than average Singaporeans, they will co-pay more but the reduced subsidy will still result in largely affordable bills given their healthy Medisave balances.   We do know that there may be some with special circumstances who may need additional assistance.  For instance, they may have many dependents or are looking after family members who may have complicated congenital illnesses, rendering them uninsurable.  Given the wide range of possibilities, rigid guidelines will not be practical and will likely miss out other unanticipated circumstances which deserve help.

In fact, a simple guideline that "all those with genuine financial difficulty paying essential treatment should be assisted" works much better and offers our hospitals wider leeway.  This is not a theoretical formulation.  For example, the Hospital Medifund Committees have been performing such tasks for years.  They are assisted by our Medical Social Workers and the approach has served their objective well. We are therefore confident that this can be done.

Meanwhile, middle and upper-income Singaporeans should remember to subscribe to MediShield and top that up with a private MediShield Rider, if they have not already done so.  Premiums are affordable and with such insurance protection, they will not need to worry about means-testing at all.