Singapore Government Press Release

Media Division, Ministry of Information & The Arts, #36-00, PSA Building, 460 Alexandra Road, Singapore 119963, Tel: 3757794/5

THE REPORT OF THE COST REVIEW COMMITTEE - RESPONSE OF THE MINISTRY OF HEALTH

The Cost Review Committee (CRC), after its review, concluded that government subsidies have helped to keep good health care affordable for all Singaporeans. C and B2 class wards are subsidised heavily to provide health care to low-income Singaporeans. Together with the comprehensive three-tier safety net system of Medisave, Medishield and Medifund, Singaporeans are well provided for.

The CRC made recommendations to improve the provision of health care. The Ministry welcomes the recommendations. Some of the recommendations have already been implemented by the Ministry. Some will be implemented soon. The recommendations with policy implications are being carefully considered by the Ministry.

Administrative Procedures

The CRC referred to administrative red tape in public hospitals. In particular, the CRC cited the requirement in hospitals for documentary proof of relationships before use of Medisave. The Ministry has stopped the requirement with effect from 1 November. Instead, the claimant will make a declaration. To prevent abuse, sampling checks will be made.

The CRC had also expressed concern over the lack of knowledge of the 3Ms (Medisave, Medishield, Medifund). Publicity on the 3Ms is an ongoing process. Very often, people do not remember the details of how the schemes work, until they need to use them. This is where financial counselling before hospital admission is useful. During financial counselling before hospitalisation, the patient and his family are told the estimated medical bill and based on their financial circumstances, and whether they have coverage under Medisave and Medshield/Medishield Plus. They can then choose the type of ward that is most appropriate for their own circumstances. Those with financial difficulty will be referred to the Medical Social Workers for Medifund assistance. Financial counselling procedures, already in existence now, will be made more comprehensive and will be systematically done. The new procedures will take effect from January next year in all government and restructured hospitals.

The Ministry will continue and sustain the general publicity on the 3Ms. At the ground level, joint MOH-CPF talks to unionists, grassroots members and to participants in Feedback Unit dialogues, will go on. This is another important part of the publicity. Through the community leaders, the Ministry hopes to reach out to a wider spectrum of the population. Information on the 3Ms will continue to be freely available through various communication channels: the CPF hotlines, CPF publicity materials, the MOH Home Page, MOH publicity materials. The Ministry will also examine the possibility of using Health Beat (the health programmes over cable TV).

The CRC has also called for publicity on revenue caps to allay public concern over rapid rise in health care charges. The Ministry will bear this in mind. In the publicity programmes, the Ministry will explain the reasons why revenue caps are imposed by the Ministry on restructured hospitals. This will assure the public that the increase in hospital charges each year is constrained by the revenue caps.

On encouraging elderly Singaporeans (in their 50s and 60s) who had opted out of Medishield, to rejoin the system, the Ministry will work with the CPF Board to review administrative procedures so that these Singaporeans receive periodic reminders and offers to rejoin the system. But the individual must play his part to ensure that he and his family members are adequately covered. The Ministry will also put across to Singaporeans that in any catastrophic health insurance, it is better to participate when healthy, otherwise, once struck with a serious illness, no insurer would accept him.

On Medishield for dependants of Medisave members, the Ministry had launched a media campaign last year to encourage parents to cover their dependant children with Medishield with payments from their Medisave accounts. A second prong approach was also done by sending forms to the children in the schools to take home to their parents. Unfortunately, the response was not encouraging. The feedback from the CRC has given the Ministry fresh impetus to re-examine an opting out system for dependants. Those who already have insurance for their dependants will have the choice of opting out of the system.

Policy Recommendations

Other recommendations from the CRC require policy consideration. The CRC has suggested extending Medishield coverage beyond 75 years after more experience with the recent extension of coverage to 75 years, up from 70 years. Beyond 75 years, the premiums will shoot up. The concern here is with inter-generational subsidies and how such an extension of the coverage will affect the premiums younger Singaporeans will have to pay. While we want to insure the old, we do not want the younger generation to be left with the burden of paying for the aged through very high premiums. The Ministry will have to study the impact of the recent extension of Medishield coverage to 75 years before reviewing the possibility of another extension.

The CRC has also recommended extending the use of Medisave funds to certain outpatient tests. The concern of the Ministry is that the rates of Medisave contribution, as originally structured, were based on using Medisave to meet the needs of hospitalisation. We will have to study how such an extension will affect this original purpose. We are also concerned that unnecessary tests may be ordered when Medisave is allowed to be more freely used.

For the existing 5 specialities which are not available in C class wards, Medifund is already available to the needy who require such treatments. The Ministry agrees in principle to the proposal to extend new and costly treatments/equipment to C class wards as the treatments/equipment become more widely used and when such wards are cost effective. The Ministry is also considering the use of a means test to determine eligibility for C-class rates when C class wards are not available.

We will study the proposal for contributions into a personal Medishield endowment account fund during working years, using Medisave funds, to cater for the payment of Medishield premium after retirement. A variation of this was introduced this year with the extension of Medishield to 75 years. Those who join Medishield when they are young pay a little more. When they are over 70 years old, they then get a rebate on their insurance premium.

MINISTRY OF HEALTH

8 NOV 96