Why I am not hopeful about Govt’s healthcare proposal

August 26, 2013
Singapore Democrats

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Eveline HowAfter the initial excitement at PM Lee Hsien Loong’s announcement of “universal healthcare” in his National Day Rally speech last week, realism is beginning to creep in.

The proposed mandatory MediShield Life insurance scheme also includes plans to increase Medisave contributions, meaning that the co-pay component will likely remain high.

The Community Health Assistance Scheme (CHAS) will also remain. CHAS is a scheme where patients can apply for subsidies for outpatient medical treatments for chronic and/or acute conditions at participating CHAS clinics.

CHAS subsidies are, however, extremely low (maximum of $480 per year). Means testing for qualification still remains for primary care (upper-lower and middle classes are left out).

MediShield Life, being primarily a hospital and surgical policy, will presumably not cover intermediate and long term care (ILTC), which we expect will increase in importance as the proportion of the aged increases. The current discussion on the healthcare financing revamp needs to incorporate ILTC services such as home care, day care, and hospices to more fully address the concerns of family members who are and will be caring for elderly family members.

Under the SDP National Healthcare Plan, Singaporeans pay the following rates to the National Healthcare Investment Fund (NHIF) compared to the current rates that we are paying to Medisave:

 

 

 

Total family income

SDP National Healthcare Investment Fund

Current Medisave

Annual Contribution

Monthly Contribution

% of Earnings

Annual Contribution

Monthly Contribution

% of Earnings

>$4000

$1800

$150

≤3.750%

>$3360

>$280

7% – 9.5%

$4000 – >$3500

$1500

$125

≤3.571%

>$2940

>$245

7% – 9.5%

$3500 – >$3000

$900

$75

≤2.500%

>$2520

>$210

7% – 9.5%

$3000 – >$2000

$600

$50

≤2.500%

>$1680

>$140

7% – 9.5%

≤$2000

$0

$0

0.000%

$1680

≤$140

7% – 9.5%

 

Table: Monthly Contribution Rates for a Family of 4

 

As is clear, our NHIF rates are a fraction of the Medisave rates.

In return, the NHIF will pay for the following:

  • $10 of the doctor’s bill whenever we visit the GP (the patient takes care of the remainder),
  • 90% of the hospital bill whenever we are hospitalised (the patient pays only 10%),
  • outpatient costs for chronic diseases.

Minister Vivian Balakrishnan says in his FB says that the Government’s expenditure on healthcare will double over the decade. But given that medical expenses is set to increase, how much is this as a proportion of the nation’s total healthcare expenditure in 10 years?

Read also The SDP National Healthcare Plan: Facts & figure

Also, a large chunk of the increased Government expenditure will probably go towards building the two new hospitals (Sengkang and Jurong) and a couple of new polyclinics, meaning that expenses for the average Singaporean will not go down substantially.

How much do patients have to pay out-of-pocket? Currently, it is more than 50%. The SDP’s plan will reduce this to a more manageable 20%. Will the Government match this rate to make healthcare truly affordable for Singaporeans, especially the lower-income groups?

I’m really not comforted with the announcement of MediShield Life. The devil is in the details but given the little that has been announced, I have a feeling the out-of-pocket portion will remain high. In other words, Singaporeans will continue to feel the pain when it comes to medical care.


Eveline How is a member of the SDP’s Healthcare Advisory Panel.