BILL SIZES IN DIFFERENT CLASSES OF WARDS

BILL SIZES IN DIFFERENT CLASSES OF WARDS: 1.

Mdm Halimah Yacob asked the Minister of Health for 2009, what is (i) the average bill incurred by patients in the A, B1, B2 and C wards respectively; (ii) the distribution of patients over the different classes of wards; (iii) the amount of out-of-pocket expenses incurred by patients in the different classes; and (iv) the increase in bill sizes from 2008.

The Minister for Health (Mr Khaw Boon Wan): I do not have the complete 2009 data yet. Based on the claims submitted during the first nine months of 2009, the average acute hospital bills incurred in Class A, B1, B2 and C wards were respectively: $4,751; $3,873; $1,660; and $1,506.

The distribution of patients was 8% in Class A, 12% in B1, 39% in B2 and 41% in C.

Patients would tap on various kinds of payment modes, from Medisave, insurance, employers’ medical benefits to outright cash. I do not have the breakdown of these payment modes.

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However, we know that 80% of all subsidised patients would not need to fork out any cash, after Medisave and MediShield deductions.

Between 2008 and 2009, the increase in the average bill sizes ranged from 3% in Class B1 to 10% in Class B2.

Mdm Halimah Yacob (Jurong): Mr Speaker, Sir, I have two questions to ask the Minister. My first question is this. In most countries, the most significant impact on people's ability to pay for their medical bills is the out-of-pocket expenses. The Minister said that only 20% need to pay cash – what is the Minister's sense of whether this will increase in future, and whether this out-of-pocket component will have an impact on affordability, particularly now that the population is ageing and people have less income after retirement. Of course, we need to be concerned about those who are not working – the women who are staying at home.

My second question is to ask the Minister whether the increase in bills, particularly for the lower-end wards, is something that is reasonable and would still make staying in hospitals affordable.

Mr Khaw Boon Wan: Indeed, affordability has to do with ability to pay. In our case, quite unique in the world, we have a compulsory savings scheme through Medisave. Without Medisave, healthcare costs would be quite difficult to afford. I think this is one advantage that we have built up over more than 24 years now. And it is an advantage that will continue to be beneficial to Singaporeans.

As I said earlier, with Medisave and MediShield, 80% need not have to come out with a single dollar. The other 20% of patients have to come out with some money but it has not been a major issue. That has been our experience in the hospitals. One evidence is the extent of

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bad debt. In many countries, hospital bad debt is a problem. That is an expression of unaffordability, where they are not able to pay and therefore ending up with an inability to pay their bills. But in our public hospitals, bad debt has not been a problem. The last I saw, bad debt was about 2% of total revenue, which is quite reasonable.

I gave a range of increases in bills – from 3% in Class B1 to 10% in Class B2. The other classes are in between. Class A is 7% and Class C is 8%. The reasons for cost increases have been discussed several times in this House. Wage increase is one because this is a very labour-intensive industry. Some of the cost increases are deliberate because as I explained to this House in 2007, we wanted to improve the staff-to-patient ratio. We launched a five-year programme in 2007 to increase doctors, nurses and allied professionals substantially. Next week, when we discuss our Ministry's budget, I will give an update on the progress of this significant increase in staffing level. That was a deliberate move and would push up costs. But as I promised when we launched that programme three years ago, the bulk of the cost increases will be borne by the Government because our subsidy policy remains unchanged.

Dr Lam Pin Min (Ang Mo Kio): Thank you, Sir. I have two supplementary questions. One is with regard to the utilisation of the different classes of wards. Does the Minister think there is any shift in the utilisation of the different classes after the implementation of means testing? Are we pushing Singaporeans to use Class B2 and C wards, rather than Class B1 and A because of the decreased subsidies? Secondly, with regard to the bad debt issue, is there a mechanism whereby the hospitals can advise Singaporeans, especially those from the low to middle-income groups, not to opt for the higher classes of wards because,

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at the end of the day, the bill may be quite substantial?

Mr Khaw Boon Wan: Bed occupancy for the different classes of wards does differ. I do not have the figures off hand. In subsidised wards, it is higher. The shift is noticeable in one aspect – when patients know that their illnesses are complex, they would generally ask to be downgraded to Class C or B2 as they know they may end up in ICU and Class A charges in ICU can be very expensive. We would do some means testing and where they are obviously in financial difficulty, we will allow the downgrading. That is why the length of stay in Class C is the longest compared to Class A. Those who have minor ailments – likely three or four days in hospital and generally with MediShield and Medisave, they can afford it – they will opt for a private ward. I think this is rational behaviour. The question is whether there was a shift with means testing. If there was, it was not noticeable. We expected that with means testing, only about 10% of the higher-income group would be in Class C or B2, and that has been our experience so far. By and large, Singaporeans are choosing their wards according to their means, which is good. Those who can afford it and do not require as much subsidy, go to the higher classes of wards, and those who cannot afford it, go to the Class C wards. This is the principle behind means testing. The short answer is, "so far, so good".

As to advising patients on choice of ward, we do that systematically. At admission, every patient would be given financial counselling. By that time, we would know the preliminary diagnosis and from experience, we could estimate the likely length of stay for a patient with such an aliment, and the cost of the stay. With computers, we are able to churn out the data and present to family members the estimated bill size for a stay in Class B1, B2, C wards. And they make the

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choice. I think that is a good approach which we have been able to refine as we go along.