Means testing a minefield
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Means testing a minefield
ST: April 19, 2007 Thu
MEANS testing to allocate subsidy for using the public hospital system appears imminent. Health Minister Khaw Boon Wan has gone so far as to suggest that, for a start, a limited form of sorting to steer more aid towards low-income patients could be the five-day threshold. Patients who have stayed longer than five days in B and C class wards will have their finances checked to determine how much or how little support they should receive, based on their means. It is important that the basis of evaluation is understood. There is no quarrel with the thinking that rationing of state-funded health-care resources is necessary since these are limited by the Government's fiscal priorities. An unequal shareout among patients can be defended if done with fairness. It is unlike subsidised education, which is not means-tested as it is an inalienable right of citizens. There is a political dimension to the issue as well, in that the Government has to demonstrate its seriousness in minimising the bad effects of the wealth gap.
Implementation is the tricky part. Devising the yardsticks to make the means test least objectionable is going to challenge the most imaginative of ministry bureaucrats. Should it be the income or assets test or something else? On income, the ministry can expect to run into a thicket of exceptions and objections. Patients of the middle-income bracket and upwards will reasonably expect undiscounted subsidised care, if they choose to, as they pay tax. Two-thirds of the workforce do not pay tax but receive the most state benefits. The middle-income group will not begrudge non-taxpayers receiving the full subsidy, but will resent the means test as discriminatory of them. There are other inherent weaknesses. People of 'means' could be supporting aged or ailing parents. Assets test then? Assets can be hidden in trusts or are simply undeclared. Statutory declarations are intrusive, which will invite more resentment. Retirees living in private housing but on limited savings would be most fearful of the cost of falling ill. They are a large group of health-care consumers. The assets test will probably penalise them.
In the end, the Government will come under pressure to increase its Budget allocation for health. Careful thought must go into the means exercise so that the system does not end up alienating one segment of the citizenry while helping another. The best neutral advice: Those who can afford it should consider taking out private medical insurance. It is the soundest bet against an inexorable trend of ever costlier treatment and husbanded resources.
http://www.straitstimes.com/portal/site/STI/menuitem.c2aef3d65baca16abb31f610a06310a0/?vgnextoid=6fadbe120b93a010VgnVCM1000000a35010aRCRD&vgnextfmt=vgnartid:a617862cf1502110VgnVCM100000430a0a0aRCRD:vgnpdate:1177019940000 -
MY EYES
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As usual, and in all likelihood, this is going to be another imminent screw-up waiting to happen...
..nothing more...
I hope however, that they will pleasantly prove me wrong about this.... -
..........
at least paragraph that article
OH MY EYES. THERE ARE GOING BLIND -
HOLY WALL OF TEXT!
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X2Originally posted by the.owl:HOLY WALL OF TEXT!
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ST 21 April 2007
WHILE I agree fully with the intention of means testing to bring about a more equitable health-care system, the operationalisation of the aim should not be to make the better-off pay more but to allow the less well-off to pay less.
The Health Ministry's decision to stick with the former indicates that health care is a zero-sum game.
All indicators point towards economic prosperity, so why the need to cut costs now instead of just boosting subsidies from the bottom?
Means testing for long stayers in hospital seems to be based on the following assumptions:
Patients with more money are not spending as they should on health care.
They are able to spend but they choose not to for reasons which the ministry feels are invalid.
These patients deprive the more needy of their subsidies.
Patients' ability to pay for health care correlates positively to their family income.
Although affordability is an important consideration when deciding on nursing homes versus hospitals or A-class versus C-class wards, I find it rather presumptuous to assume that elderly patients who can afford much better would choose a hospital over a nursing home with a better environment. For the elderly who have lived out a large portion of their lives, costs would probably be a lesser factor over environment and comfort, especially if they can well afford it.
Another debatable assumption in means testing seems to be definite familial support for the patient. Family income alone is not a good indicator of how well a patient is able to afford his hospital bill. A family that willingly supports an elderly patient would necessarily give him the best health care and comfort within its means. However, immediate family members have their own family units to take care of.
Furthermore, not all families follow the 'seniors first' rule. In the event of having to choose between paying for one's child and one's parent, many would choose to support the child.
Health care is an essentiality which no one should be deprived of, regardless of the patient's supposed ability to afford higher fees. Policies should not be made based on assumptions of familial support or dubious claims that high-income patients choose to stay in a poor man's ward.
Fang Shihan (Ms)
does anyone knows wtf is this means testing and how does it applys or benfits the people? -
mean test my as s
test water to lower cost and increase pay, that is what they are trying to do... -
Whoa, you suffering from verbal diarrhoea izzit? You want to show you are writing a thesis or wad? KNN!! Be clear and concise!!
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Why are all of you bombarding TS? Paragraphing may not be up to par but it's the content that matters.
I'm myself am not too sure about the benefits of means testing. This is S'pore, whatever the minister says must be for our good yeh.
They are using our money to help the poor, so rejoice. -
ST Forum 1 May 2007
I WENT to the Travellers' Health and Vaccination Clinic at Tan Tock Seng Hospital for a Yellow Fever vaccination recently. The charge was $130.20, compared to just $15 for the same vaccination I had at the same clinic 10 years ago. This is an increase of 768 per cent or a 24 per cent compounded increase per annum.
Another help the poor scheme?
The clinic was furnished lavishly with leather sofas, leather chairs, paintings on the walls, flowers in vases, etc, like a five-star hotel.
The same vaccination costs about HK$200 (S$39), A$50 (S$63) and 35 euros (S$72) in Hong Kong, Australia and Ireland, respectively. Why has the cost of vaccination increased by so much over the last 10 years, when inflation in Singapore was less than 2 per cent per annum?
When I paid the $130.20 fee, the staff gave me a brochure and said that if I had a platinum credit card, I would receive a 12 per cent discount for health screening.
Why do the more affluent who qualify for a platinum card get a discount of 12 per cent, whereas the lower income has to pay 13.6 per cent more, in a government restructured hospital?
Is this not, in a way, like reverse means testing - the rich pay less, the poor pay more?
Leong Sze Hian -
I can summarise this whole means testing issue in two words.
Pay More -
Hey, compared to ministers, these platinum card holders are poor.Originally posted by LinYu:ST Forum 1 May 2007
Another help the poor scheme?