MEDIFUND (Review of eligibility criteria)

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MEDIFUND:

(Review of eligibility criteria): 9.

Dr Amy Khor Lean Suan asked the Minister for Health (a) if his Ministry will be reviewing the eligibility criteria for Medifund along with the MediShield revamp; and (b) what are the justifications for his Ministry's decision to review or not to review the criteria.

The Minister for Health (Mr Khaw Boon Wan): Sir, Medifund is to help needy Singaporeans pay for their medical care. It is an important component of our medical safety net.

The main operating principle is to ensure that financial assistance goes to the deserving cases. Patients in need are assessed locally at the hospitals or nursing homes by the respective Medifund Committees. These committees comprise experienced individuals drawn from the community.

While there are general guidelines, each patient is assessed on his own merit. Typically, the Medifund Committee will take into account factors such as the patient's financial background, the size of the medical bill, and whether the treatment is likely to be prolonged. Each committee has considerable leeway to decide if a patient warrants the assistance, and, if so, the extent of the assistance.

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My Ministry consults periodically with the Medifund Committees, and will adjust the guidelines when necessary. Whether the proposed MediShield reform will require a revision of the Medifund guidelines will depend on the nature of the MediShield reform. We will only know this later when the reform is finalised.

Dr Lily Neo (Jalan Besar): May I ask the Minister whether there has been an increased number of applications for Medifund over the years? Will this trend be progressively going upwards with time and an aging population? Has the disbursement so far been from money derived from the interest on the capital of Medifund only or it is already involving the principal of Medifund as well? Will this capital be further topped up to cope with the increasing demand?

Mr Khaw Boon Wan: Sir, the trend is indeed a rising one, because, firstly, the population is expanding and, secondly, aging. So, the number of admissions goes up and the number of applicants who require assistance also goes up.

As to whether we have dipped into reserve fund, we have not. It is an endowment fund. So the Committees have been quite prudent. But we do not really put an upper bound to the number of applications. It is all subject to the market. And, so far, I am quite satisfied. I look at the data periodically. The applicants who applied are not 100% approved. I would be troubled if every application is simply approved. Then it becomes like a cash grant. There have been some rejects, but not that many. And I think the Medifund Committees have been quite responsible.

As for growth of the Medifund itself, that depends on the economic growth. As and when there is strong economic growth, my Ministry will certainly try to make a bid for an increase in the

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Medifund. And I succeeded this year. So there is an increase of 10%, by $100 million, to now $1 billion.

Dr Amy Khor Lean Suan: Sir, while the Minister has noted that there are no fixed criteria, but, as regards the income level, is there any ceiling on a per capita basis for applicants? Because as the size of medical bills increases, say, for people with critical illness, the sandwich class - people with income of $2,000 and above - may have problems footing the bills.

Mr Khaw Boon Wan: We have a choice of model. We can have very tight criteria and then we leave the hospital or nursing home committees very little leeway. But my preferred approach is we keep the guidelines loose, and then we let maximum flexibility on the ground. That is my preferred arrangement.

Of course, there are some simple rules. One, only citizens need apply. So, if you are a non-citizen, sorry, you are out. Two, it is very hard to judge who is poor and who is rich. If you earn $10,000 a month, please do not bother to apply. But whether you stay in a private property or a 3-room HDB flat, that depends. In my constituency - I just did a house-to-house visit - we have quite a number of old walk-up apartments. Look at their conditions - furnishing and so on - I think many of my constituents in 3-room flats fare much better. So, obviously, deciding on who deserves help and who does not is quite an art. It can never be strictly mathematical. And I think the best is to make sure we have good sensible people who are able to decide on each application both with the heart as well as the head.