MEANS TESTING IN PUBLIC HOSPITALS

MEANS TESTING IN PUBLIC HOSPITALS: 9.

Dr Lim Wee Kiak asked the Minister for Health with the adoption of means testing in all public hospitals (a) how successful is this initiative in meeting its objectives; and (b) what is the average hospital bill for a patient.

The Minister for Health (Mr Khaw Boon Wan): Sir, the purpose of means-testing in public hospitals is to enable lower-income patients to enjoy more subsidies than higher-income patients. It is a fair scheme and its implementation has been uneventful. With computerisation, the process is hassle-free and no patients have been inconvenienced.

More than 90% of the patients are unaffected by means-testing and they continue to get the full Government subsidy. The average hospital bill sizes for Class B2 and Class C have remained relatively stable at below $1,500 and well within the Medisave withdrawal limits.

Dr Lim Wee Kiak: Sir, I thank the Minister for the answer. I would like to check with the Minister whether the socio-economic groups that chooses each class between C, B2 and B1 have shifted because of the implementation of means-testing. Are more people from the middle-income and the upper middle-income groups choosing C class and B2 class wards because they are getting less subsidy?

Mr Khaw Boon Wan: If there is, it is not noticeable. When I was working on the proposal, we also looked at the demographic profile of the patients in existing Class B2 to Class C wards. We

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projected that more than 90% will not be affected. The actual results show the same thing. I think, by and large, Singaporeans choose their ward class carefully. We have financial counselling to advise patients to choose the right ward class. If you belong to lower income group, you go for the heavily subsidised wards. The outcome shows it. As I have explained before, the idea of means-testing is to pre-empt a future problem. I want to continue to upgrade Class C and Class B2 wards, and if you do not introduce means-testing, you will draw in many patients who can actually afford Class A and Class B1. Without means-testing, I will lose that leverage in ensuring that Class C and Class B2 remain reserved largely for lower income patients.

Mr Speaker: Dr Ong, last question.

Dr Ong Seh Hong (Marine Parade): I would like to ask the Minister, step-down care currently has a very different means-testing regime. This has caused confusion for the public, and sometimes prevented a smooth transfer of patients from the acute hospital into the step-down care facility. Does the Minister foresee that in future, there will be one unified means-testing regime that is applied across the whole healthcare system, and that would minimise all administrative problems as well as confusion to the families?

Mr Khaw Boon Wan: I see less need for a unified scheme for the reason that the extent of subsidy varies with bill sizes. The key point for the patient is "Can I afford the bill?" Is it a thousand dollars or is it ten dollars or is it one hundred dollars? Affordability will depend on the quantum of the bill size. In the step-down care, particularly at the outpatient level, outside of hospitals and nursing homes, the bill sizes are much

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smaller. On the other hand, in acute hospitals, the bill sizes can be very big. That is why we have very heavy subsidy for the expensive end and we reduce the subsidy level at the lower-cost end. That is why I think a unified approach will not work because it will end up either over subsidising those who may not need that subsidy or being too stringent on those who actually require a much bigger subsidy.