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Thursday, May 22, 2014

Healthcare in Singapore: socialising the benefits and privatising the costs

How to reassure Ah Pek on the Pioneer Package

"Perhaps the challenge really lies in the complexity of the design. From a policy perspective, the PGP sits on top of the existing 3M (Medisave, MediShield, Medifund), Chas (Community Health Assist Scheme) and CDMP (Chronic Disease Management Programme) schemes, which arguably, most Singaporeans do not fully understand anyway. In the proposed system, there are multiple tiers of subsidy depending on whether the presenting disease is deemed "simple" or "complex", whether the disease is included in the CDMP, and so on.

The contrast with many countries with universal health coverage is stark. The message should be simple: At the point you need health care, concentrate on getting well; don't worry about money. In many schemes globally, there are no co-payments required, or if there are, these are in the form of fixed amounts with annual limits. In Singapore, the individual's co-payment can soar while the Government's share (subsidy amount) is capped.

Australia announced in its Budget last week that the government would impose a A$7 (S$8.20) co-payment for each visit to the general practitioner, up to a total of A$70 a year for concessional patients.

No caveats depending on type of disease, no exclusions depending on housing type or income. Just a simple A$7 figure to understand and remember.

This brings me to the second point. It is better to frame the scheme to be viewed through the lens of the pioneer and not the policymaker.

While $9 billion is an admirable commitment to the health- care needs of the pioneer generation, the pioneer would much rather know what he needs to pay individually rather than the amount the Government subsidises.

Imagine the thoughts running through the mind of a pioneer: "Yes, it is good to know there is a $28.50 per visit subsidy for a common illness like a cough or cold, but how much do I need to pay? Nothing? $10? $20? More?"

In stores, it is clever marketing to highlight a large discount - but what really matters to the customer is what he pays, not the discount. The Government's concerns over unanticipated costs and the instinct to safeguard public coffers are understandable and perhaps even natural.

But to the Singaporean living on $1,000 a month, a mis-estimation of the medical bill by $50 is 5 per cent of all he has; to the Government, the same mis-estimation occurring for even 10 per cent of our pioneers is $2.25 million, or barely a quarter of a per cent of the $9 billion allocated.

Perhaps the risk of getting the numbers wrong is a yoke easier borne by the Government's accountants than by elderly Singaporeans."

(Emphasis mine)

Me: let me guess.. gahmen partly owns our restructured hospitals

Someone: no
Gaahmen 100% owns restructured hospitals

then restructure simi

Someone: restructure the costs
"socialise the costs... and privatise the benefits"
that's 1 aspect. the other is that healthcare workers were previously considered civil servants

Me: so more expensive

Someone: meaning they enjoyed civil service benefits, and yes more ex
not to mention that the life expectancy of HCW is actually slightly lower
cos of the stresss, night shifts and constant garbage that MOH threw out

Me: actually since 1994 new civil servants have had SHIT benefits

Someone: yea well... $$$

Me: trying to keep the civil service young
well too bad young people wont stay

Someone: also, HCW as civil servants meant that the old fear of a commie insurrection thru the ranks of HCW, was still alive

that's my conspiracy theory
but essentially the new scheme afforded them the powers of a corporate entity, that could fire people at will
purely to "cut costs"
but have administrative bloat

Me: ah yes very important
and can hire lots of foreigners
cos no longer civil servants
and can claim that civil service has few employees
lower turnover!

Someone: MOH owns MOH Holdings, which owns all the hospitals
thru the clusters

yes, forgot about that
becos of the neverending exodus of HCW (nurses, drs, and allied health)
this new system afforded Ah Gong flexiibility to hire cheap foreign labor in unlimited numbers

yea... cos I think staff turnover is a minor KPI for civil service? can't recall
in 2004-2007, when the system shifted to the flat rate reimbursement
some people made noise

MOH responded by getting MOHH to fire them
"services no longer required"
"corporate decision"

Last time, in 1994 during the restructuring, MOH paid hosp per subsidised pts seen
so hosp made money based on factory converyor belt
but still made money seeing subsidised, so it was in a sense still ok

sicne the recent change, its flat rate and "I don't care if you sink or swim"
which causes the hospitals to scramble to get rid of subsidised patients

Me: no wonder so hard to have subsidised appts now

eh so how does the "subsidy" work if hospitals are not paid per patient?
and how do they ensure govt hospitals dont dump subsidised patients

Someone: they don't.

like i said, MOH 2010 ruling: dump subsidised
essentially a Gahmen decree to turn a profit at the expense of subsidised patients, but also not to let the public find out

Me: hurr

Someone: now hosp must stretch their dollar... and the rich subsidise the poor, indirectly, so... dunno good or bad

Me: so the so-called subsidy is really a price ceiling set by the government
and not a real subsidy

I'm sure this is not a secret
can I blog it

Someone: well
it says something about the system that a cold chill runs down my spine just when ou asked that question
and i worry about my license

well since there's no hard copy of the decree, its all hearsay anyway

Me: yeah so a hard copy exists somewhere

Someone: heh. so who's gonna find it?
Lisbeth Salander?
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