MEDISHIELD

MEDISHIELD:

(Coverage of big hospital bills): 2.

Mdm Halimah Yacob asked the Minister for Health (a) whether he can give an update on the progress made in the coverage of big hospital bills up to 80% after the last MediShield review; and (b) whether any persons had dropped out of the scheme because they could not afford the higher premiums.

Mr Khaw Boon Wan: Sir, we adjusted the MediShield payouts in December last year – nine months ago. I am not quite ready yet to discuss the full impact of the changes. However, the preliminary data are positive. For example, the MediShield payouts for large hospital bills have gone up from an average of $9,000 per bill to $10,600. What this means is that such patients would have saved hundreds of dollars per hospitalisation episode. As for the MediShield lapsed rate, I spoke about it just awhile ago. Less than 1% of MediShield members have seen their coverage lapse due to insufficient Medisave money. Among them, how many dropped out because of increased premiums? As the premium increases are less than a dollar a month, I think the number is likely to be very small, but I do not have such a number.

Mdm Halimah Yacob: I would like to ask the Minister whether hospitals have seen a reduction in the number of patients who are not able to pay for big hospital bills because the payout has now been increased. Secondly, I would like to ask if the Minister could give us an estimate of the state of health of our MediShield funds now that the premiums have increased but payouts have also increased.

Mr Khaw Boon Wan: Generally, public hospitals do not have a major default problem of arrears whereby patients cannot pay, whether for big bills or small bills. A lot actually depends on the family financial situation. We do have some bad debts which we have to write off periodically, but offhand, I cannot recall the rate. These are manageable. We need to understand why we are in such a situation. It is due to Medisave which we put in place 20 years ago. Can you imagine Singapore without Medisave? I think affordability of hospital bills would then have been a major problem. It is precisely because we have enforced savings and rational withdrawal rules, that we are able to afford increasingly high standards of healthcare which inevitably come with high costs. And the general population, including the lower income group, can afford it. I would say that for acute hospitals, we are in a reasonably satisfactory situation. My job in the last two to three years has been focused on long-term care, care outside of acute hospitals. I am not saying that acute hospitals are perfect. There are still gaps here and there, and we are trying to fix them as we go along. But the bigger gap now is in care outside of acute hospitals, or what the Prime Minister described as step-down care. This is an area that we will be focusing on, and that includes community hospitals, home nursing, as well as in the community – GPs and so on.

As to what is the financial position of MediShield, it was heading towards insolvency prior to 2005, and the reason was what we discussed yesterday, ie, cherry picking, which Prof. Straughan mentioned as a possible phenomenon. We have fixed that. We have now won back all the "cherries". The risk pool of MediShield has now been restored, and we have been able to preserve the financial solvency of MediShield. Offhand, I do not have the data, but it is healthy. But like all things, because of escalation in costs and inflation, it requires constant nursing and adjustments – not every year, but every few years or so.