Targeted subsidy approach ensures help reaches those who really needs it (ST)

30 Aug 2011, The Straits Times

Letters on Healthcare affordability

1. Health care: Key problem is paying cash upfront

THE crux of the problem for patients regarding the use of Medisave and MediShield is the cash outlay.

Despite government subsidy and Medisave/MediShield claimables, patients still find paying cash upfront prohibitive, especially when insurers cite pre-existing illnesses to deny them coverage.

The household income benchmark should reflect actual reality than hypothetical assumptions, like stating that the $10,000 collective income of a family of four should be enough when it isn't.

Young adults today have their own obligations other than filial duty. While they may give their parents some money monthly, the filial tithe isn't ironclad. In fact, many parents are thankful if their working children do not ask them for money instead.
So the basis of having a combined family income, as if in a pool for expenditure within the family, is not quite accurate. Instead of measuring household income, the Government should measure individual income and parcel out subsidies accordingly.

Arthur Lim

2. Decouple patient's subsidy eligibility from ward status

DRUG subsidies post-hospitalisation for patients with chronic conditions should be based on the status of a patient (subsidised or private) at the point of referral for hospitalisation ('MOH to spend $45m more a year on drug subsidies'; yesterday).
While the Government move to enhance its drug subsidy schemes is commendable, it should also delink the eligibility for chronic drug subsidies from the patient's choice of hospital ward.

For example, my retired father currently gets his medical treatment through the polyclinic system as a subsidised patient.

If he is admitted to the hospital for a one-off procedure, I can use my Medisave to upgrade his stay to a B-class ward. But if I did so, he would lose all subsidies for his future medication for his chronic condition, which is quite substantial.

Losing the drug subsidy would significantly increase the cost of his prescriptions, and in the long run, would cost more than the bill for his one-off hospital stay.

If the Government delinks the hospital ward class from future chronic medical subsidies, this would likely reduce the demand/waiting time for C-class beds for those who really cannot afford to stay in a higher ward.

It would also reduce subsidy costs for the Ministry of Health, as a key disincentive to upgrade to a non-C-class bed is removed.

Dr Christopher Wong

3. How more of the needy can get health subsidies

I AGREE with Mr Arthur Lim ('Health care: Key problem is paying cash upfront'; last Wednesday), that the Government should measure individual income and parcel out subsidies accordingly.

Giving subsidies based on household income inevitably excludes many citizens from health-care subsidies when they need them most. Take for example a household of two siblings where one has a chronic illness, no income and needs the subsidies badly for long-term health-care management. The other sibling earns, say, $4,000 per month.

The household income is now averaged to $2,000, which exceeds the Primary Care Partnership Scheme's household income limit of $1,500. This effectively excludes the sibling who needs the subsidies most. One may argue that the healthy sibling should help, but his $4,000 monthly income is hardly enough for himself in the high-inflation environment today.

My 78-year-old mother, who has suffered strokes, is unable to access the subsidies because my household income exceeds the limit. If individual income is used as a measure, many more needy Singaporeans will be able to enjoy the benefits under the scheme.

John Lok

Reply From MOH

We refer to the letters (“Decouple patient's subsidy eligibility from ward status”, “Healthcare: key problem is paying cash upfront”, 17 Aug; and “How more of the needy can get health subsidies”, 24 Aug) published in the ST’s Forum pages and would like to thank readers for sharing their feedback on how we could better address the issue of healthcare affordability.

The Ministry of Health (MOH) regularly reviews and updates our healthcare policies to ensure their relevance and sustainability. Healthcare is a shared responsibility between the government and the individual. In formulating our subsidy policies, we adopt a targeted approach to ensure that help is given to Singaporeans with greater needs, while taking care to ensure basic healthcare remains generally affordable and avoid excessive consumption. Such a philosophy ensures the long-term financial sustainability of our healthcare system. 

In this regard, MOH’s recent initiatives seek to make healthcare more affordable for more Singaporeans. By raising the Primary Care Partnership Scheme (PCPS) income ceiling from $800 to $1,500 per capita monthly household income and lowering the age criterion from 65 to 40, more Singaporeans can now benefit from the PCPS. This is a very significant expansion of the scheme’s coverage. 

In ensuring that the additional subsidies reach those who need them, we have adopted the per capita monthly household income assessment model. This is a fair gauge of a family’s economic means as it takes into account, the number of dependents (e.g. children, retired elderly etc) that income-earners have to support in each family. Nevertheless, MOH will exercise some flexibility when assessing applications from those who may fall just outside the qualifying income bracket but whose unique circumstances may warrant some level of assistance.

In addition to extending the PCPS, we will also be increasing our subsidies to selected high cost drugs and expand the use of Medisave for outpatient treatments. As for Dr Christopher Wong’s suggestion that MOH should de-link a patient’s subsidy eligibility from ward status, this is being studied as part of ongoing efforts to better align subsidies across the healthcare sector for eligible patients.

Bey Mui Leng
Director, Corporate Communications
Ministry of Health