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     FrontPage Edition: Sun 20 January 2008

 Means-testing in public hospitals


Quality Healthcare for the Low-Income Group

An Excerpt

My job at the Ministry of Health is to continuously push and raise the quality of healthcare to benefit all patients, rich or poor.
My particular concern is for the lower half of the population, for unlike the higher-income group, they have no viable alternative. They look to the Government for their basic medical services. This is the context behind the current public discussion on means-testing in public hospitals.
I have by now met more than 1,000 Singaporeans from all walks of life. We have had very lively and candid discussions. I thank them for their participation and their ideas. They help me shape the proposed scheme so that it can achieve its objective of helping the poor by keeping healthcare affordable, and yet be fair to the middle-income group.
While a range of views have been expressed, there is a clear consensus among the vast majority of the participants:
a. First, everyone agrees that all patients, rich or poor, should be free to choose Class C or B2, if they wish;

b. Second, all support the principle that high-income patients in subsidised wards should co-pay more than lower-income patients, but remain subsidised.  There is good support for a reduced subsidy of 50% in Class B2 and 65% in Class C.  In other words, high-income patients, from the top 20% earner bracket, will remain heavily subsidised if they choose Class B2 or C;

c. Third, there is support for a more generous approach in defining the “low-income” group who will continue to enjoy the full subsidy.  Instead of the traditional definition of the bottom 20% as the low-income group, we can extend full subsidy to the lower middle-income group as well.  This way, the current subsidy of 80% in Class C and 65% in Class B2 will remain available to the bottom half of workers;

d. Fourth, there is strong support for a gradual sliding scale of subsidy, with subsidy reduction in 1%-points from 80% to 65% for the upper middle-income in C wards, and from 65% to 50% in B2 wards;

e. Fifth, all agree with my proposed approach that we keep the scheme simple for easy implementation.  If the patient is working, we will use his average monthly income, as declared to CPF Board or IRAS, as the sole criterion.  If he is no longer working, we will rely on his housing type.  As a special concession to retirees and those not working, we will allow them to enjoy the current full subsidy, except for those living in the top 20% of properties; and

f. Finally, I agree with the consensus that implementation must be flexible to allow for those with special deserving circumstances.  For example those with a large number of dependents or who are suffering from frequent and prolonged hospitalisation will be fully reviewed by hospital Medical Social Workers.
We are continuing the public consultation on the basis of this consensus package. Meanwhile, we will also begin technical discussions with the CPF Board and IRAS to work out a simple, automated assessment process that will not cause undue hardship at the margins.
We are introducing means-testing now, not to tackle a current problem but to avoid a future problem.
We want to keep the standard of Class C and B2 wards high, so that they can meet the higher expectation of the low-income Singaporeans come year 2020.
As we raise the standard of Class B2 and C, and narrow the gap with, say, Class B1 which costs 2 to 4 times more, we need a mechanism to minimise subsidised wards from being inundated with patients who can actually afford unsubsidised rates. Hence the case for means-testing today.

Full Text of Speech

Source: News 17 Jan 2008

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