June 1, 2007It can be seen that with the cost of medical treatment on the rise, patient becomes more aware that the money in the medisave account will not be enough for their future needs. Furthermore, the rules that once the patient opt for B2 or above, it is not possible for them to downgrade and they will be stuck with paying the higher class medical fees. By selecting the appropriate class, it shows that Singaporeans are becoming more prudent with medical expenses.
Demand for C-class beds at hospitals up sharply
Cost of subsidised care may go up again if trend continues
By Salma Khalik, Health Correspondent
MORE and more patients are opting for highly-subsidised care at public hospitals, resulting in a huge jump in demand for C-class beds over the past five years.
In 2001, only 27 per cent of all patients chose C-class beds, where the Government foots 80 per cent of the bill.
Last year, 40 per cent did so, and this has put a strain on hospital finances.
The demand for B2 class, where the Government pays about 65 per cent of the bill, remained at about 35 per cent.
But demand for the private A class fell by 8 per cent, while that for the B1 class dropped 25 per cent. Of the 5,000 public hospital beds, 29 per cent are C class and 41 per cent, B2.
The reason higher demand for C-class beds puts a strain on hospital finances has to do with the way Government subsidies are given out.
In the past, the money was given out based on the number of subsidised patients served.
But now, hospitals get a fixed sum and have to divide it among a greater number of patients.
The strain that has resulted is likely a major reason prices for both inpatient and outpatient subsidised care were increased recently. If the trend towards C-class beds continues, more price increases could result.
Industry watchers say the increased demand for highly-subsidised beds can be attributed to an ageing population requiring long- term care and the growing realisation that health care is expensive.
Health economist Phua Kai Hong says people are becoming more aware that their Medisave money may not be enough for their lifetime hospital needs.
Dr Lim Suet Wun, who heads the National Healthcare Group of hospitals and polyclinics, said better quality C-class care is another reason for demand - more people consider it 'value for money'.
In fact, some of the patients who opt for C-class wards can afford better quality beds, but choose otherwise because of the value for money factor.
Madam Halimah Yacob, head of the Government Parliamentary Committee for Health, said people with chronic illnesses who need long-term care are more likely to pick subsidised wards so they do not deplete their Medisave and personal savings.
She added: 'This, coupled with the general sense that it is difficult to downgrade once you are in a higher class ward, could lead many more people to opt for the C class.'
But she said this does not mean that these patients are 'abusing' the system.
Both Dr Lim and Madam Halimah also pointed out that many older people do not have much in their Medisave accounts. Only a third of those over 60 years old have Central Provident Fund accounts, Madam Halimah said.
Health Minister Khaw Boon Wan told The Straits Times that many factors are at play.
'It is partly caused by ageing of population as the elderly stay longer in hospitals and tend to opt for C or B2 classes to save on cost,' he said.
But Mr Khaw said that the shift towards C class is not the trigger for means testing, which is a 'standalone policy option'.
The minister had said in April that means testing - to ensure that subsidies go to those who need it most - is necessary to prevent abuse of public health services by the well-off.
Once means testing is introduced, possibly by next year, demand for C-class beds will likely ease.
Details are not out yet, but it is likely to start with patients who stay five days or more. Many of the older patients with multiple problems will fall into this category.
[email protected]
Good health care remains affordable
HEALTH Correspondent Salma Khalik ('Demand for C-class beds at hospitals up sharply'; ST, June 1) observed that Class C patients now formed 40 per cent of public-hospital admissions when it was 27 per cent five years ago. Perhaps alarmed by this observation, she concluded that this has 'put a strain on hospital finances' and speculated that this was the reason for (a) hospitals raising fees, and (b) the Ministry of Health (MOH) contemplating means-testing in hospitals.
Between 2001 and 2006, total admissions to public acute hospitals went up by 2.9 per cent because of two main reasons: our population had gone up by 8.5 per cent, and the elderly population (over 65) had increased by 25.8 per cent.
MOH has been actively managing the increased demand, by maximising our resources, cutting wastage and avoiding unnecessary hospitalisation.
The results are significant. Over the same period, our age-specific admission rates (i.e., number of admissions per 1,000 population) had gone down, bucking overseas trends, except for two age groups: those below five and those above 65. For all other age groups, admission rates have dropped, saving patients and our society unnecessary spending.
But there is a limit to such intensification efforts. Hence, we have been adding hospital beds and will continue to do so. As all the beds added were in the subsidised wards, not surprisingly the proportion of our patients in subsidised wards went up 'sharply', as observed by Ms Khalik.
Meanwhile, MOH's funding to hospitals to subsidise patients has kept up with the rising demand. Over the same period, it had gone up from $1.1 billion to $1.4 billion, and the Government has committed to increase its health-care budget from the current $2 billion a year to $3 billion a year in five years' time (Budget Statement 2007).
Our hospital subsidy policy has not changed. Class B2 and C remain subsidised at 65 and 80 per cent of our cost, respectively.
But as costs inevitably go up with rising wages and more costly medication and other supplies, fees have to be adjusted regularly. Hospitals have been mindful of the need to ensure that the increases do not pose an undue burden to our patients. Hence they go for small incremental adjustments, rather than less frequent but large changes.
Singaporeans are naturally worried about health-care costs. We have taken many active steps to ensure that they can afford good health care. With substantial government subsidies and the 3Ms framework (Medisave, MediShield, Medifund), medical fees are affordable to Singaporeans.
We hope that ST can do its part to help educate, inform and reassure Singaporeans. It is not helpful to alarm the public unnecessarily.
Julie Sim (Ms)
Assistant Director
Media Relations
Ministry of Health
Means testing already in practice
I NEEDED emergency medical attention during a long public-holiday weekend and could not seek a referral from a polyclinic. I was charged as a private, non-subsidised patient not just for the initial visit but also for follow-ups. I wanted a downgrade but was informed that I needed to undergo means testing.
I belong to the middle-income group who can neither receive social welfare nor pay consultation fees by the hundred.
What if I had been admitted then?
It is grossly unfair for a patient who walked into the A&E department because of an emergency to be given a non-subsidised status.
It was only after much hassle going through various authorities that I finally managed to downgrade my patient status, for which I am appreciative. However, patients who do not know how to seek redress have to suffer in silence.
Yeun Yik Kwong (Mrs)
Not the best time to raise hospital fees
I REFER to the article, 'New fee hikes at public hospitals and polyclinics' (ST, May 29).
During the Budget debate in April, members of the House were divided over whether to give those on public assistance an increase of $100. This came after the announcement of the increase in the Goods and Services Tax (GST) to 7 per cent from July during the Budget announcement.
Now there is a further increase in consultation fees at some public hospitals and polyclinics.
Despite the GST credits that have been given out, many people still feel the impact of rising costs. The perception unfortunately is that everything is increasing in price and nothing has been done to curb the increases.
Health-care costs are a worry for many Singaporeans. We have a good healthcare system and there are many schemes to help pay the medical bills. However, many still have problems paying their bills.
What I fear is that people, especially the old, poor and very sick, would delay seeking medical attention, resulting in their health problems becoming worse.
It does not matter that the increase is only a few dollars. To these groups of people, the few dollars would add up to a huge burden eventually.
No time is a good time, but is this the best time to raise the fees?
As some hospitals and polyclinics did not increase their fees, why did others do so?
Jason Chiam Chiah Sern