Medishield is too complicated for its own good, and a Health Minister with no relevant experience makes it worse

Medishield started in 1990 to provide insurance for catastrophic medical expenses. The co-payment was supposed to be covered by money in the CPF Medisave account.

The problem is that the medical expenses were too high. There were caps placed on the use of Medisave, to prevent too much money being siphoned out.

This result in the patient having to pay a large sum of money out of pocket.

In a recent case, a senior who opted for subsidised treatment for a cataract operation was able to claim for only $4.50 from Medishield.

He had to pay the balance of the post-subsidy bill of $4,477 out of Medisave and from his pocket. Medisave only paid $3,000, so the remaining sum of over $1,400 was paid out of pocket.

This is a complicated arrangement. l call it the “bits and pieces” payment system – some part paid here, some paid there. No wonder the people are confused with this system.

The govt thinks that this is necessary to make the patients responsible to help to control the medical expenses. In reality, most patients are so confused that they are not able to play a part to “control” the expenses. The actual expenses are outside their control.

The only control that they have is to choose the medical facility to go to. After that, they have to face the charges and add-ons for various kinds of treatment.

In the example of the cataract operation, the patient went to a govt facility to enjoy the subsidy.

The minister should, by now, realize the problem. Medisave and Medishield has been going on for almost four decades. He is not a new minister, as he has been in office since 2011.

Anyway, it was a bad practice to appoint him as the minister for health when he had no prior experience in this complicated ministry (pardon me, if I am wrong on this matter).

So, what is the solution?

The govt should take the responsibility to set the charges for various types of treatment, if Medisave and Medishield are to be used.

The public hospitals and clinics, which also have access to the subsidy, should be the expected to take the lead to provide services based on these approved rates. These rates will still yield profit to the restructured hospitals, but not the big margins that they enjoy now.

The approved rates should be an all-in rate for the treatment. The hospitals should be expected to absorb any variation in the treatment, and not allowed to charge for every item of service.

The restructured hospitals that are not profitable should look into the control of their expenses. We are currently spending too much for infrastructure, management salaries and expensive systems.

With proper rates in place, many private hospitals will probably join the scheme. They should be able to operate profitably on these approved rates.

If the rates are too low, the public and private hospitals will not provide the service. This will give the signal for the govt to revise the rates.

The deductible under Medishield scheme is too high. It should be reduced to $500 or even lower.

All the caps on Medisave should be removed. After all, the patient is going to an approved hospital for an approved treatment.

In Japan, they carry out the negotiations every year. It seemed to work well generally.

It is naive for the govt to think that the patients can control the expenses. They are leaving the patients to the mercy of the mercenary medical system.

Hospitals can be allowed to charge higher rates to local or foreign patients who do not wish to have access to Medisave or Medishield.

My suggestion is to set the approved charges for various types of treatments. I do not claim that this will solve all the problems. I am sure that other problems have to be dealt with prior to the launch or within a few years after that. But I am sure that it will be a better basis to deal with the problem than the current confusing and messy system.

 

Tan Kin Lian

 

 

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21 Responses to “Medishield is too complicated for its own good, and a Health Minister with no relevant experience makes it worse”

  • reeee:

    The actual aim of medishield and save is not to help patients but to limit the claims to bare minimal, in lay man term is to help the govt make money! The actual claim is only 3% of what the citizens paid, so the profit goes back to Temasek.

    If you ask the govt to simplify, you are asking them to be transparent, transparency means we will know the nett nett and how the system rip us off.

    You expect them to be transparent?

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  • N.Jungne:

    What a mess, yet he has made it more messier

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  • patriot of TUMASIK:

    Compulsory Medishield or whatever its called is deducted from your Medisave…ya, after whatever discount rebate or what shit they call it PG still pays about $400+ per annum…

    CONfusing CONvincing or whatever it is still a damn CON job…remember “no free lunch” so said the bast**d now dead

    The CONpulsory Medishield cover roped in Billions yearly and payout??? chicken SHIT most likely…

    Mr Tan…as an ex Insurance Expert…please enlighten us what the SHIT Medishield and whatever the Old Folks are CONNed into in your Next Contribution and help the PG to SUE them for wrongful deduction

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  • Singapore Fooled Again n Again:

    It’s really shocking our Medishield that we pay for from working days for decades can only cover a tiny fraction of the bill, so tiny that the administration cost is not enough to cover the cost of payment. To add wound to injury, the remaining is paid for using Medisave (which is our own money) and out of pocket money.

    So effectively Medishield is not covering any or much as it should have to be

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  • LIONS:

    It is clear to this simple simon that MEDICAL COSTS especially in govt hospitals have been schemingly allowed to e$calate uncea$ingLEE.

    IT IS TIME FOR SGS to BE MORE CONCERNED WITH THE PROFITEERING WAY$ of the MOST GREEDY PAPigs running,or rather,ruining,our NATION.

    With MORE N MORE SGS GETTING INTO JOBLESSNESS(chronic jobless n under-employed including graduate-taxi uncles),it will mean MORE OF THEIR OWN SAVINGS(PLUS CPF) would be used up for HIGH MEDICAL FEES as JOBLESSNESS ALSO MEAN 0 INCOME N ZERO COMPANY MEDICAL BENEFITS,which now the FTs enjoy at our expense.

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  • SGs being shortchanged:

    Just imagine this..gov bodies profiteering from citizens’sufferings.
    You can afford to die but cannot afford to get sick in our 1st world country!
    How shameful, after sucking our hard earned money thro cpf to medisave to medishield etc..
    Sgs getting shortchanged in broad daylight!

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  • mike:

    The whole medical system is going towards bankrupt, bankrupt of personal savings.

    Fundamental problem is actually very simple – Income of people did not catch up with medical cost inflation. And the end result is breaking the piggy bank by high medical cost when goverment is not performing its role in securing the quality of life of its people.

    Who does not fall sick and who does not need more medical care when turn old?

    Old folks are liabilities to the nation. They can only be useful if their account have enough money to support a broken medical care system which had turn into a political tool.

    We deserve it

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  • MOH's money mind:

    Well, hasn’t anyone noticed that the Ministry of Health has been corporatized under Temasek Holdings? And that many over-the-counter prescriptions and pills are cheaper at Mustafa Center than at MOH pharmacies? Be wary of government “subsidized” medicine!

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  • Bapak:

    Todays situation is 1G generation has already tapped into 2G generation’s accounts. If Sinkies still dont wake up & let PAP run rampant, cost to medicine & medical care will go further up. By the time 2G generation fall sick their account is already koso long before. Then what? 2G tap into 3G account? And for many, their 3G is not borned yet. You better wake up to throw PAP out before they destroy SG.

    mike:
    The whole medical system is going towards bankrupt, bankrupt of personal savings.

    Fundamental problem is actually very simple – Income of people did not catch up with medical cost inflation. And the end result is breaking the piggy bank by high medical cost when goverment is not performing its role in securing the quality of life of its people.

    Who does not fall sick and who does not need more medical care when turn old?

    Old folks are liabilities to the nation. They can only be useful if their account have enough money to support a broken medical care system which had turn into a political tool.

    We deserve it

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  • Boh Leong Sim PartnersInCrime:

    @ mike

    Aiyoyo, mike ah mike, the system IS already broken and bankrupt, you haven’t, hadn’t, noticed??

    Your warning, alas, has come too late, way too late. Off by about fifteen years (around SARS).

    Never mind, the planet’s still spinning, you’re still alive and kicking, just sit back, relax and treat yourself to a cold SARSi carbonated fizzy drink, cheers!

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  • David Neo - King Kong Ass:

    The article says the senior is a subsidised patient. It is not true. He opted for the private patient choice. That’s why the bill is $4477 and he paid $3000 by Medisave. Pay by Medisave is out of your own CPF pocket, not a subsidy. I myself went for cataract surgery at eye center as private patient. Actual cost $3000++. Medisave paid $2500 max.The balance pay cash before operation. The consultations at clinic separate charge.

    I then tried the subsidized option for the other eye. I had to get a polyclinic referal and opt out as a private patient. The operation was done at eye center Balestier branch. You can’t choose your doctor like a private patient can. Entire operation cost $1200 was full paid by Medisave excluding doctor consultations.

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  • Billy:

    People voted.is what count.

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  • LHL: don't be foolish like me:

    The govt thinks that this is necessary to make the patients responsible to help to control the medical expenses.

    That reflects the level of intelligence of those who pay themselves the highest salaries in the world (to make the wrong decisions).

    The effect of such thinking will be that many citizens will end up not getting the medical care they need because they either cannot afford the medical bills or feel the pain of the medical bills and so would either forego or procrastinate or delay the medical attention they need until it beaomes too late, and often, more costly.

    Of course, all PAP Civil Servant decision makers have the cushion of millions received from the tax payers. So such heartless policies do not hurt them, only your ordinary Singaporeans.

    Nobody wants to be sick. People end up becoming ill because they did not know how to prevent it, because they are not informed enough.

    However, those scholars making decisions think that if you hand out free or cheap healthcare, people will fall for it and will not mind falling sick for, after all, healthcare is free. Or, because it’s free, we want to take advantage of it.

    Or conversely, if you raise the price of medical care, people will control their lifestyle or their craving to be sick.

    Smokers continue to smoke because they can’t kick the habit, even if you make healthcare costs prohibitive for them. Certainly not because healthcare is free. That’s the logic of the self-proclaimed intelligent people (mis)running our country

    LHL and GCT succumbed to cancer and HSK had a stroke not because they could afford the medical care and so could afford to live a more reckless life.

    Or maybe I am wrong. Maybe it was because they could afford the medical care. So their reasoning for making healthcare unaffordable for Singaporeans so Singaporeans will not be as foolish as they were for getting themselves the cancer and the stroke.

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  • those who care for themselves:

    The govt thinks that this is necessary to make the patients responsible to help to control the medical expenses.

    LHL: don't be foolish like me:
    The effect of such thinking will be that many citizens will end up not getting the medical care they need because they either cannot afford the medical bills or feel the pain of the medical bills and so would either forego or procrastinate or delay the medical attention they need until it becomes too late, and often, more costly.

    Of course, all PAP Civil Servant decision makers have the cushion of millions received from the tax payers. So such heartless policies do not hurt them, only your ordinary Singaporeans.

    We have a PAP sanctioned system where only a certain non-selfless kind of people are allowed to flourish and become leaders in Singapore.

    Those who have empathy for the people or those who feel for the people will not join the PAP. These will also be the kind of leaders harassed by the PAP and the Civil Service machinery controlled by them to weaken them and to disadvantage them, or be driven out of the scene completely through the use of the judiciary.

    Those that end up running our country are those who care for themselves. They inadvertently will be those roped in to join PAP with unimaginable personal financial rewards, often at the expense of the poor citizens through the self-serving policies and totalitarian rule.

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  • Broken oath r ...:

    if a 9 yo asked you
    Is an oath a promise n why it must be sworn before the Chief Justice on a Holy Book of the faith of the one who swe

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  • Christopher Bong:

    It is meant to be confusing and to obfuscate things. How do you think they can make money?

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  • Irene Vanessa Wan San Si Hung:

    Went for my right eye cataract op at Spore National Eye Center (SNEC) as a private patient in 2010. The surgeon was very good and it was over in a minute. After several post operation consultations, I asked if he would operate on my left. His attitude changed and he did not respond to my questions including those on eye. Finally he said curtly:”It’s a matter of whether we want to do it or not.”

    Baffled by his bizarre behavior, I switched to the subsidised option at Balestier on 2011. The nurse was rather clumsy and spilled eye lotion all over.Before the op, I asked if the doctor would give me the same lens as my right eye. You see the lenses on my right is calibrated for near sightedness. She said yes and had me sign a form that said she explained everything to me and that I understood all the risks. After the op, I discovered that the lens on the left is calibrated for far sightedness. So I got double vision. I was rather angry but the doctor simply avoided answering my questions and simply passed me to another one.

    This other lady doctor back at SNEC SGH tried to suppress her giggles and said I have to make glasses so the sight matches up. Now opticians will do both lenses on your spectacles either as a long sighted pair or near sighted pair. In my case, it would be near on the left and far on the right? Again she simply avoided answering my questions as they liked.

    I am greatly disappointed by the attitudes of these doctors. I mean I pay private as well as public rates not to get any response during consultations?

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  • patriot of TUMASIK:

    Irene Vanessa Wan San Si Hung:
    Went for my right eye cataract op at Spore National Eye Center (SNEC) as a private patient in 2010. The surgeon was very good and it was over in a minute. After several post operation consultations, I asked if he would operate on my left. His attitude changed and he did not respond to my questions including those on eye. Finally he said curtly:”It’s a matter of whether we want to do it or not.”

    Baffled by his bizarre behavior, I switched to the subsidised option at Balestier on 2011. The nurse was rather clumsy and spilled eye lotion all over.Before the op, I asked if the doctor would give me the same lens as my right eye. You see the lenses on my right is calibrated for near sightedness. She said yes and had me sign a form that said she explained everything to me and that I understood all the risks. After the op, I discovered that the lens on the left is calibrated for far sightedness. So I got double vision. I was rather angry but the doctor simply avoided answering my questions and simply passed me to another one.

    This other lady doctor back at SNEC SGH tried to suppress her giggles and said I have to make glasses so the sight matches up. Now opticians will do both lenses on your spectacles either as a long sighted pair or near sighted pair. In my case, it would be near on the left and far on the right? Again she simply avoided answering my questions as they liked.

    I am greatly disappointed by the attitudes of these doctors. I mean I pay private as well as public rates not to get any response during consultations?

    It is No Longer a CALLING or Oath of Hippocrates more likely Hypocritical…It is Prestige and BOTTOM line Monthly or Yearly…I must admit there are those who are dedicated Dr Patrick Kee now serving or helping the those terminally ill for one

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  • Health Minister 'Must Go...'!:

    He would have been replaced long ago if the late LKY was still calling the shots!

    Be a gentleman like LTY. Don’t wait to be asked to go…

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  • Change We Must:

    Still cannot understand why the polyclinics charge S47 for consultation?

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  • all the bunch of bastards:

    motherfxxker…
    who want to waste own money and who wish to go hospital for nothing
    medisave money not our $$ ????
    make medical bills affordable as possible, no such thing as A class
    when admitted, all equal bed class
    admit the old and children first when diagnosed with critical condition
    no such thing there is no bed at the moment
    for this next GE, please use some brain logic

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