SINGAPORE: Patients will be able to get up to 80 per cent in subsidies regardless of whether they are admitted to B2 or C class wards in public hospitals from the middle of next year, the Ministry of Health (MOH) announced on Friday (Mar 5).
Currently, 50 to 65 per cent of a B2 ward hospitalisation bill is subsidised, while this proportion is 65 to 80 per cent for C ward bills.
Making the announcement in Parliament during his ministry’s Committee of Supply debate, Senior Minister of State for Health Dr Koh Poh Koon said that the acute inpatient subsidy framework will also be applied to day surgeries. Such surgeries are currently subsidised at 65 per cent.
“This will increase subsidies for 70 per cent of day surgery bills and encourage day surgeries instead of inpatient admission when appropriate,” he said.
The step away from the “legacy system” comes in line with a change in the basis of means-testing for patients admitted to acute hospitals.
Currently, the basis of means-testing for these patients is their monthly income. From mid-2022, means-testing will instead be done on a per capita household income (PCHI) basis.
MOH said this “better reflects the means of the patient, as it takes into account the overall financial resources of the household against the number of household members who are supported by that income”.
“With the adoption of PCHI, we now have a better basis for means-testing in the acute inpatient setting and no longer need to rely on our legacy system of using ward choice as a proxy of means to differentiate the levels of subsidies,” an MOH spokesperson said.
Dr Koh said that in his clinical practice and during Meet-the-People sessions, he has seen how sole breadwinners may earn a high individual income, but shoulder the full responsibility for his or her household’s needs.
“For such individuals, healthcare costs can become a significant strain, and I have great sympathy for them,” he said.
He added that physical differences between B2 and C wards “are no longer so obvious” due to infrastructural improvements to raise patient safety and infection control standards.
However, while the subsidy level will be unified for both B2 and C class wards, charges for patients in C wards will still be lower than B2 charges.
“Their out-of-pocket costs would still be higher in B2 because the original bill – the unsubsidised bill – would be higher in B2,” MOH said.
The majority of patients receiving subsidies will not see a change in their out-of-pocket payments, the ministry said.
About a third of patient bills, mainly from households with lower PCHI, will see a median decrease in such payments by about S$150, MOH said. On the other hand, 15 per cent of patient bills, mainly from households with higher PCHI, will see a median increase by about S$200.
RISING HEALTHCARE EXPENDITURE
The subsidy changes come as Singapore’s healthcare expenditure is expected to rise as its population ages, incidence of chronic diseases increases and the accessibility and quality of care improves.
In the recent financial year, government expenditure on patient subsidies is projected to hit S$6.5 billion compared to S$4 billion five years ago, MOH said.
While the Government will continue to set aside a higher healthcare budget over time to support the needs of the population, “we must ensure that our resources are distributed in a manner that better targets those who need greater support", MOH said. Subsidies must also encourage patients to seek care at the most appropriate healthcare settings, it added.
“These changes to the subsidy framework fine-tune our system to achieve these objectives,” MOH said.
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CHANGES TO SUBSIDIES AT COMMUNITY HOSPITALS
MOH also announced changes to subsidies for patients at community hospitals and specialist outpatient clinics.
The maximum subsidy level at community hospitals will be raised to 80 per cent from 75 per cent, in a move to facilitate “right siting” of patients. This will be aligned with that of acute inpatient care. The minimum subsidy level at community hospitals will also be raised from 20 to 30 per cent. Overall, almost all patients will see an increase in subsidies, MOH said.
Average daily bill sizes are smaller at community hospitals and subsidy levels are therefore also lower, MOH explained.
Community hospitals play an increasingly important role in Singapore, said MOH. These hospitals provide key services such as rehabilitation and sub-acute care for patients with complicated medical conditions, but who do not require the more intensive care provided in hospitals.
The majority of sub-acute and rehabilitation patients are expected to benefit from higher subsidies. After accounting for MediShield Life claims, close to 60 per cent of community hospital patient episodes will cost less in co-payment. The median decrease in co-payment will be about S$120, MOH said.
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CHANGES TO SUBSIDIES AT SPECIALIST OUTPATIENT CLINICS
At specialist outpatient clinics, lower-income families receive subsidies of 60 to 70 per cent of their bills, while all other patients receive 50 per cent in subsidies.
Two new subsidy tiers will be introduced. Patients whose PCHI is above S$3,300 and up to S$6,500 will receive a 40 per cent subsidy. Those with PCHI of more than S$6,500 will receive a 30 per cent subsidy.
“These changes will allow resources to be distributed to those who are of greater need,” MOH said.
About 30 per cent of all subsidised specialist outpatient clinic patients, mainly from higher PCHI households, will see an increase in their bills, MOH said. Of them, 70 per cent will see an increase of less than S$100 in total co-payment in a year.
In another change, patients who opt to be admitted to A or B1 wards at public hospitals will be eligible for subsidies in specialist outpatient clinics should they require follow-up visits at these clinics. About 20 per cent of inpatient admissions today are to such private wards, MOH said.
“Some of these patients who require a long tail of post-discharge specialist outpatient clinic follow-ups have concerns over affordability,” MOH said. Their eligibility will be based on the means-testing framework.
Taken together, the changes do not result in a reduction in government expenditure on patient subsidies, MOH said.
“These latest comprehensive subsidy changes will allow us to ensure our subsidies are progressive, so that those with more need, especially lower- to middle–income households, will receive the support they need, while also encouraging patients to seek care at settings appropriate to their medical needs. It will also make for more streamlined healthcare system,” MOH said.
From June this year, the Flexi-MediSave limit will be raised from S$200 to S$300 per year to better support elderly patients, MOH added.
The Flexi-MediSave scheme allows patients aged 60 and above to withdraw from their own or their spouse’s MediSave Accounts to pay for outpatient expenses at polyclinics, public specialist outpatient clinics and CHAS GP clinics. The scheme may also be used in conjunction with other outpatient MediSave schemes.