Fancy a 'lifelong income scam'?
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Insurance alone cannot pay the big bills
Salma Khalik
Wed, Feb 13, 2008
The Straits Times
MEDISHIELD premiums are set to rise again, just three years after an extensive overhaul of the Medisave-based insurance scheme.
Health Minister Khaw Boon Wan decided on this course to give subsidised patients some relief from having to fork out too much in cash. He wants patients with bills of $10,000 or more to pay less than the 40 per cent they now have to fork out.Only 'a small percentage' of subsidised patients are landed with such huge bills each year, said his ministry's spokesman. But the pain from such out-of-pocket payment can be crippling.
But how are such large bills accumulated in the first place?
The Health Ministry gives two main causes: days spent in intensive care units (ICU) and expensive, but better quality, implants.
How is it possible that, even with the generous medical financing in place, subsidised patients still need to make hefty out-of- pocket payments?The answer turns on the kinds of treatment a subsidised patient is eligible for. Such a patient, for example, cannot pick the more expensive drug eluting stent that keeps arteries open, if his doctor does not think it is necessary.
A patient who insists on the stent must switch to a private ward class. So subsidised patients, by definition, are given only treatments that doctors say they need.
For such treatments, the Government pays about 80 per cent of the bill for C class patients and 65 per cent for B2 class patients. On top of that, the Government also absorbs the 7 per cent Goods and Services Tax for them.
Granted, the above doesn't explain a $10,000 out-of-pocket payment, unless the total bill for a C Class patient is $50,000. But a closer look at the make-up of the bill will shed some light,
The subsidy for ICU ward fees for C class patients ranges from about 66 per cent to 85 per cent, with patients paying between $100 and $200 a day. They also need to pay for the medication and treatment they get in ICU.
Some may require medicines that are not on the subsidised list. For example, haemophiliacs who lack the coagulant that stops bleeding may need 10 to 12 vials of a non-subsidised medicine to stop them from bleeding to death following surgery. At $1,500 a vial, the total bill can be staggering.
Such medicine is not subsidised, since there are cheaper coagulants available. For the small number of patients for whom the cheaper drug is not effective, getting the expensive one is a matter of life and death.
MediShield insurance allows claims of up to a maximum of $500 daily for ICU stay and treatment. And at $1,500 a vial, the medicine alone would more than bust the limit.
Implants, too, can be very expensive. A spinal implant, for example, could set a patient back by up to $18,000.
The 1993 White Paper on Affordable Health Care called for basic medical care to be heavily subsidised. It defined basic medical care as 'essential and cost-effective medical treatment of proven value for illnesses, without which the patient's health and quality of life will be significantly compromised'.
This did not include 'artificial appliances other than the most basic models for the heart, hips, knees, etc'.
As a result, the subsidy on implants was capped at 50 per cent of the cost of the implant, up to a maximum of $500, for patients in both B2 and C class wards.
This means that if the implant costs $1,000, the Government will pay $500 or the full 50 per cent subsidy. But if the implant is more expensive, the percentage subsidised will be lower than half. A $2,000 implant will have only a 25 per cent subsidy, while a $5,000 implant will get only a 10 per cent subsidy.
Orthopaedic implants are no longer a rarity, with thousands of patients getting them every year - mainly for the knees, hips and spine. Singapore General Hospital alone carries out about 100 knee implants a month.
In the 15 years since the White Paper was drawn up, orthopaedic implants have become part and parcel of basic medical care - without which quality of life will be 'significantly compromised''. No one would want an artificial knee or vertebra unless it were medically necessary.
While only several hundred people may need spinal implants each year, the cost is high, between $2,500 and $18,000 each. At the higher end of the price range, the subsidy for a C class patient does not even come to 3 per cent. Those with MediShield can claim up to $2,500 for implants.
With such big bills, Mr Khaw's plans to tweak MediShield seems a perfectly rational way to help patients defray medical costs. The obvious solution is for the insurer to cover a bigger portion of the bill. But for them to be able to do so, premiums must go up.
Perhaps we should also ask other questions: Is the Government subsidy for C and B2 patients sufficient and equitable in the first place? Should the 15-year-old definition of what constitutes basic medical care be broadened?
If implants are considered part of basic health care, then a C Class patient's share of a $18,000 implant would be 20 per cent or $3,600. With MediShield insurance, his out-of-pocket payment will be just $1,100 - a sum that many patients can dip into their Medisave to pay for.
Expecting insurance - which means the 2.8 million people insured under MediShield - to make up for the shortfall in subsidy seems to be passing the burden of caring for the poor to people who have taken the precaution of buying insurance.
When Mr Khaw was pushing for means testing at public hospitals, he took the view that society should not begrudge poorer patients better quality health care.
He was referring to improvements in the quality of subsidised wards today, with the promise of more improvements in future.
Nicer surroundings would be welcome, of course. But better still would be if funds could be channelled to B2 and C class patients to give them the full 65 per cent and 80 per cent subsidies for needed treatments. Patients would then not have to face such enormous out-of-pocket payments.
Orthopaedic implants are generally needed by the elderly, many of whom do not have medical insurance. MediShield also stops covering patients once they reach the age of 85.
Raising the insurance payout is not going to help them, but increasing the subsidy will.
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Originally posted by HyperFocal:
Insurance alone cannot pay the big bills
Salma Khalik
Wed, Feb 13, 2008
The Straits Times
MEDISHIELD premiums are set to rise again, just three years after an extensive overhaul of the Medisave-based insurance scheme.
Health Minister Khaw Boon Wan decided on this course to give subsidised patients some relief from having to fork out too much in cash. He wants patients with bills of $10,000 or more to pay less than the 40 per cent they now have to fork out.Only 'a small percentage' of subsidised patients are landed with such huge bills each year, said his ministry's spokesman. But the pain from such out-of-pocket payment can be crippling.
But how are such large bills accumulated in the first place?
The Health Ministry gives two main causes: days spent in intensive care units (ICU) and expensive, but better quality, implants.
How is it possible that, even with the generous medical financing in place, subsidised patients still need to make hefty out-of- pocket payments?The answer turns on the kinds of treatment a subsidised patient is eligible for. Such a patient, for example, cannot pick the more expensive drug eluting stent that keeps arteries open, if his doctor does not think it is necessary.
A patient who insists on the stent must switch to a private ward class. So subsidised patients, by definition, are given only treatments that doctors say they need.
For such treatments, the Government pays about 80 per cent of the bill for C class patients and 65 per cent for B2 class patients. On top of that, the Government also absorbs the 7 per cent Goods and Services Tax for them.
Granted, the above doesn't explain a $10,000 out-of-pocket payment, unless the total bill for a C Class patient is $50,000. But a closer look at the make-up of the bill will shed some light,
The subsidy for ICU ward fees for C class patients ranges from about 66 per cent to 85 per cent, with patients paying between $100 and $200 a day. They also need to pay for the medication and treatment they get in ICU.
Some may require medicines that are not on the subsidised list. For example, haemophiliacs who lack the coagulant that stops bleeding may need 10 to 12 vials of a non-subsidised medicine to stop them from bleeding to death following surgery. At $1,500 a vial, the total bill can be staggering.
Such medicine is not subsidised, since there are cheaper coagulants available. For the small number of patients for whom the cheaper drug is not effective, getting the expensive one is a matter of life and death.
MediShield insurance allows claims of up to a maximum of $500 daily for ICU stay and treatment. And at $1,500 a vial, the medicine alone would more than bust the limit.
Implants, too, can be very expensive. A spinal implant, for example, could set a patient back by up to $18,000.
The 1993 White Paper on Affordable Health Care called for basic medical care to be heavily subsidised. It defined basic medical care as 'essential and cost-effective medical treatment of proven value for illnesses, without which the patient's health and quality of life will be significantly compromised'.
This did not include 'artificial appliances other than the most basic models for the heart, hips, knees, etc'.
As a result, the subsidy on implants was capped at 50 per cent of the cost of the implant, up to a maximum of $500, for patients in both B2 and C class wards.
This means that if the implant costs $1,000, the Government will pay $500 or the full 50 per cent subsidy. But if the implant is more expensive, the percentage subsidised will be lower than half. A $2,000 implant will have only a 25 per cent subsidy, while a $5,000 implant will get only a 10 per cent subsidy.
Orthopaedic implants are no longer a rarity, with thousands of patients getting them every year - mainly for the knees, hips and spine. Singapore General Hospital alone carries out about 100 knee implants a month.
In the 15 years since the White Paper was drawn up, orthopaedic implants have become part and parcel of basic medical care - without which quality of life will be 'significantly compromised''. No one would want an artificial knee or vertebra unless it were medically necessary.
While only several hundred people may need spinal implants each year, the cost is high, between $2,500 and $18,000 each. At the higher end of the price range, the subsidy for a C class patient does not even come to 3 per cent. Those with MediShield can claim up to $2,500 for implants.
With such big bills, Mr Khaw's plans to tweak MediShield seems a perfectly rational way to help patients defray medical costs. The obvious solution is for the insurer to cover a bigger portion of the bill. But for them to be able to do so, premiums must go up.
Perhaps we should also ask other questions: Is the Government subsidy for C and B2 patients sufficient and equitable in the first place? Should the 15-year-old definition of what constitutes basic medical care be broadened?
If implants are considered part of basic health care, then a C Class patient's share of a $18,000 implant would be 20 per cent or $3,600. With MediShield insurance, his out-of-pocket payment will be just $1,100 - a sum that many patients can dip into their Medisave to pay for.
Expecting insurance - which means the 2.8 million people insured under MediShield - to make up for the shortfall in subsidy seems to be passing the burden of caring for the poor to people who have taken the precaution of buying insurance.
When Mr Khaw was pushing for means testing at public hospitals, he took the view that society should not begrudge poorer patients better quality health care.
He was referring to improvements in the quality of subsidised wards today, with the promise of more improvements in future.
Nicer surroundings would be welcome, of course. But better still would be if funds could be channelled to B2 and C class patients to give them the full 65 per cent and 80 per cent subsidies for needed treatments. Patients would then not have to face such enormous out-of-pocket payments.
Orthopaedic implants are generally needed by the elderly, many of whom do not have medical insurance. MediShield also stops covering patients once they reach the age of 85.
Raising the insurance payout is not going to help them, but increasing the subsidy will.
PAP Propaganda press
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the dept of stats just released some figures yest.
average man and woman will live till 78 and 82 resp.
that means most of us will never get to see the $$$
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The same can be said about welfare states too. You pay so much tax when you are young thinking that you will benefit from free healthcare when you get old. What if you die before your retirement or without getting a chance to use the healthcare services?
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Originally posted by TCH05:
The same can be said about welfare states too. You pay so much tax when you are young thinking that you will benefit from free healthcare when you get old. What if you die before your retirement or without getting a chance to use the healthcare services?
... at least the welfares in Welfare States are tried & proven, and people have and are still being delivered the promises...... here, we're just being led on... pushing further retirement further and furether, offering us monetary incentives to postpone use of our monies... all kinds of outlandish excuses such as Living Longer...
... all these are BullCrap...
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Originally posted by HyperFocal:
... at least the welfares in Welfare States are tried & proven, and people have and are still being delivered the promises...... here, we're just being led on... pushing further retirement further and furether, offering us monetary incentives to postpone use of our monies... all kinds of outlandish excuses such as Living Longer...
... all these are BullCrap...
Yes, they are proven to be running on deficitI mean if you are capable to taking care of yourself, why do you need welfare in the first place. I think "welfare" should be given to people who really need them.
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Originally posted by TCH05:
Yes, they are proven to be running on deficitI mean if you are capable to taking care of yourself, why do you need welfare in the first place. I think "welfare" should be given to people who really need them.
... I mean look, if the bluddy government can say that they need to pay top dollars so that they can attract and keep top talents in their team, why can't they see the same way for the people who voted them? Especially the poor, low income, and needy...... yes, those who are gainfully employed need not rely on welfare, but hey, what benefits are there for local citizens in the needy category after paying decades of money to CPF??
... all I can see is that when it gets nearer to paying out to CPF members, they will come up with all kinds of cock & bull stories and stats to postpone paying out!
... STINKS to High Heavens!
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Originally posted by HyperFocal:
... I mean look, if the bluddy government can say that they need to pay top dollars so that they can attract and keep top talents in their team, why can't they see the same way for the people who voted them? Especially the poor, low income, and needy...... yes, those who are gainfully employed need not rely on welfare, but hey, what benefits are there for local citizens in the needy category after paying decades of money to CPF??
... all I can see is that when it gets nearer to paying out to CPF members, they will come up with all kinds of cock & bull stories and stats to postpone paying out!
... STINKS to High Heavens!
Suppose the CPF decide to release the CPF fund to the people at age of 65, what will you do to ensure that they will be able to takecare of themselves till the day they die and they will not be rotting on the streets.
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Originally posted by TCH05:
Suppose the CPF decide to release the CPF fund to the people at age of 65, what will you do to ensure that they will be able to takecare of themselves till the day they die and they will not be rotting on the streets.
... in the first place, this CPF thing is already fundamentally flawed, otherwise they wouldn't be trying to shove this Annuity thing down people's throats...... from one mistake to another, and it's just getting more and more rank...
... and why on earth would I want to try and dream up some solution for them after paying them millions in salaries? I'd rather kick back and watch them die trying to deliver their promises after I leave this place & claim back every cent of my CPF...
... hey, they are afterall Scholars... Creme de la Creme...
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Originally posted by HyperFocal:
... in the first place, this CPF thing is already fundamentally flawed, otherwise they wouldn't be trying to shove this Annuity thing down people's throats...... from one mistake to another, and it's just getting more and more rank...
... and why on earth would I want to try and dream up some solution for them after paying them millions in salaries? I'd rather kick back and watch them die trying to deliver their promises after I leave this place & claim back every cent of my CPF...
... hey, they are afterall Scholars... Creme de la Creme...
I for one dont think it is flawed. without CPF, I dont think I will be able to afford the downpayment for my first property because when you are young, you always tend to spend ahead of what you make. -
ironically all this shows only happen in sg ...
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Now they not only change the name of the plan, they also changed and used words to make the plan sounds better. Instead of 'mandatory', it is now 'automatically covered'. Whatever, as long as we don't have the freedom to opt-out, the govt is violating our fundamental ownership rights over our money.
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... here's more brain-washing propaganda...
... I think they'd be disappointed by public response, people have had it up to their ears with all their empty promises & scams...
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CPF Board to aggressively encourage CPF Life opt-ins
By S Ramesh, Channel NewsAsia | Posted: 13 February 2008 1640 hrsSINGAPORE: Manpower Minister Ng Eng Hen has said the CPF Board will over the next year aggressively encourage Singaporeans not automatically included in the new CPF Life, to opt in.
He was speaking a day after the National Longevity Insurance Committee released its recommendations on the lifelong income scheme.
Dr Ng also believes that the majority of Singaporeans, about 70 to 80 percent who qualify for CPF Life, will opt for annuity payouts to start at age 80, the default age.
This so-called "Refund 80" Plan is the option which strikes a balance between the amount of monthly payouts and the amount to be left behind for the beneficiaries when the member dies.
Dr Ng, who is 49 years old, would automatically qualify for CPF Life. So, which Refund Plan does he have in mind? Though he has not made his pick, he does have one regret.
"That we couldn't introduce it earlier. It is for all those aged 50 and below. But we want an opportunity for all those older than 50 years to opt in, in other words, for CPF Life to cover all those older than 50," said Dr Ng.
In devising the CPF Life scheme, he said, the government was concerned about the baby boomers - those in their late forties and early fifties now - when they retire.
Dr Ng said: "For those who are older, they have large families to depend on, most of them, anyway. But (not) for the baby boomers......With this piece, CPF Life, it's a great weight lifted off one's shoulder. Now, it's transferred to the other shoulder, the CPF Board, to shoulder this. The foundations are much stronger, we now have a tool to address longevity."
The CPF Life scheme gives Singaporeans about the same amount of monthly retirement income as the CPF Minimum Sum payout.
The difference is that the annuity income under the CPF Life scheme is for life whereas the payouts under the existing CPF Minimum Sum will last only for 20 years.
In fact, the National Longevity Insurance Committee had explored if the Minimum Sum payout period could be extended to 30 years.
Dr Ng said: "But that would have meant a reduction of what you got under the older system. Even at 30 years, you will still miss out those who live longer than 30 years from age 65, say, beyond 95. The committee came to the same conclusion that if we did that, it's not a sensible option and that annuities is a much (more) sensible option, and you get about the same payout, more or less compared to the old system, but for life."
The Manpower Minister revealed that the Prime Minister and his Cabinet colleagues had been discussing over the past three years the need for Singaporeans to have enough savings in their CPF to last their lifetime.
And CPF Life is the missing piece which will complete Singapore's CPF system.
Dr Ng said that the ball is now in the CPF Board's court.
It will soon embark on an extensive public education exercise, with simple handbooks and guides in the four languages to explain the CPF Life scheme to Singaporeans. - CNA/ir
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why this lifelong thingy operated by CPF and bring a 5% interest but the CPF can't?
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Originally posted by TCH05:
The same can be said about welfare states too. You pay so much tax when you are young thinking that you will benefit from free healthcare when you get old. What if you die before your retirement or without getting a chance to use the healthcare services?
You mean the citizen in the welfare state are only able to get their free heathcare when they are 85 also? Or most people in welfare state die immediately after retirement so they are unable to get a chance to enjoy the healthcare service?
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hahaaa quite true with sg ppl mindset.... not au... lol
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Originally posted by 333225520:
You mean the citizen in the welfare state are only able to get their free heathcare when they are 85 also? Or most people in welfare state die immediately after retirement so they are unable to get a chance to enjoy the healthcare service?
Do you own maths, how much money does an average citizen spend on healthcare every year when they are young and able.If your are earning 100K per year for 10 years, you would have already contributed $400,000 income tax. Will you get to use utilize them fully? I am sure most wont. Beside, if you can afford it, I am sure you will choose to seek healthcare in private hospital.
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Originally posted by TCH05:
Do you own maths, how much money does an average citizen spend on healthcare every year when they are young and able.If your are earning 100K per year for 10 years, you would have already contributed $400,000 income tax. Will you get to use utilize them fully? I am sure most wont. Beside, if you can afford it, I am sure you will choose to seek healthcare in private hospital.
Oh really? I guess you don't know how expensive the hospital bill can be if you suffer from some major illness (such as cancer, etc which is getting more and more common). It can easily drain your entire saving.
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Originally posted by TCH05:
Do you own maths, how much money does an average citizen spend on healthcare every year when they are young and able.If your are earning 100K per year for 10 years, you would have already contributed $400,000 income tax. Will you get to use utilize them fully? I am sure most wont. Beside, if you can afford it, I am sure you will choose to seek healthcare in private hospital.
A lot. Healthcare includes preventive measures. I rather have more money in my pocket to take preventive measures rather than save and spend all at one shot should I kenna a major illness because my preventive measures are not enough. Afterall, prevention is always better than cure. -
The scheme should help us.... .__.
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Originally posted by BangHong:
The scheme should help us.... .__.
It's just some sort of insurance scheme. But made mandatory by the govt, as the govt assume that you are still unable to take care of your own money when you reach retirement age regardless of your education level, that's all.
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when i read the straits times' coverage on the new scheme, I get the sense that the reporters themselves are trying to fudge things, or more likely, they don't really understand what they are writting either ...
if you read the thing closely, you'll notice that it's basically a rehash of the same old idea .... only difference is that instead of taking all your money when you die ... they let you have the option of getting back a little bitty sum back to your descendants to make you feel better (which ever that's left in the retirement account) ... while they siphon off the rest into the premiums pool ..... and unless you live to a hundred ... it's a good bet that that money will never ever benefit you ....
But I have to say, this scheme is brilliant .... worthy of all the scholars we have in power ... they conceived of a social welfare plan that's essentially self-funding ! ... what better idea than to get the peasants to help each other ? .... the goverment just solved the future problem of old, destitute peasants running out of money and sleeping on the roadside in a single stroke without having to fork out a cent, and now has another forever burgeoning pool of money with which to generate investments and profit from ...... this is just brillant ....
let's try to get them out before 2013 .... an election's due before that ... if this ever comes to pass .... I'll vote for anybody .... chee soon juan, a clown, a chimpanzee, a dog, whoever ! ...... I don't care ! ... I'm not going to spoil my vote .... put in a few clowns to make them sweat a bit .... for foisting this on us ...
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Eh how about suggesting this...
Everyone works for free and the common good of the country. But everything is free! Free transport, free meals, free healthcare, free housing, "FREE"!!
Oh wait.. thats communism.
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Originally posted by Shotgun:
Eh how about suggesting this...
Everyone works for free and the common good of the country. But everything is free! Free transport, free meals, free healthcare, free housing, "FREE"!!
Oh wait.. thats communism.
how about this ... you pay for everything, nothing is free, everything is expensive, and rises in costs every single year .... you pay for your own healthcare depending on your address and your paycheck, instead of subsidizing healthcare straight, they charge sky high and take it out of your CPF/Medisave to make you feel better .... you pay your taxes, you take public transport's that really private monopolies out to make a profit ... you even pay for your own and other people's welfare ! ...
what do you call it ? ... Singapore Inc ...
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<<I for one dont think it is flawed. without CPF, I dont think I will be able to afford the downpayment for my first property because when you are young, you always tend to spend ahead of what you make.>>
Its should rename itself as Central Housing Fund instead of Central Provident Fund. It misleads the Uncle and Aunties that they have something to hang on when they retire.
If CPF is such a good idea, we should recommend it to other countries..... especially the pre 1999 years where CPF is only allowed to be used for stocks and property and of course not to mentioned the strategy of having an "investment bank" thats uses the citizens funds for overseas investments and give short term interest rates for long term savings... i looked forward hearing our PAP recommending the CPF system to other developing countries. A mandatory fund thats passes off itself as a retirement fund , it is used primarily for housing, long term savings given short term interest rates, and the funds are used for investments but the returns are not returned to the citizens....Despite one of the highests savings rate in the world, it citizens cannot retire....CPF is something worth teaching other countries.