Singapore's Healthcare Financing System

Strictly subjected to means testing

Govt. endowment fund set up to help needy Singaporeans to access healthcare

Principles of Medifund Assistance

Personal responsibility

Medical necessity

Family responsibility

Many helping hands

Medifund Silver

ILTC sector to benefit more elderly patients

Singaporean aged 65 years or above

Medifund Junior

For needy Singaporean children below 18 to tap on to defray their healthcare cost

Medifund Approval Level

Level 1

Public Assistance

Approval: Exemption

Level 2

Straight forward (SF) Applications

Approval at MSW level

Level 3

Non-Straightforward (NSF) Applications

Approval by Medifund Committee

Medical Assistance Fund (MAF)

Cover NSDL drugs

Increase maximum subsidy level of 50% to 75% upon assessment by MSW

Deducted first before using patient's Medifund or Medisave

Calculation of Household Income

Household Income (HI) = Monthly Per-Capita Household Income (gross income net of CPF deductions)

Maximum Medifund Assistance

Inpatient Admission

Only C class patient enjoy 100% Medifund Assistance

Non-resident (NR) and Permanent Resident (PR) are not assisted by Medifund

Cash paid by the patient

Most regressive form of financing

Patient's Decision

Choice of class: Primary private or subsidized

To proceed or not to proceed with treatment

Seek alternative options at other institutions

Standard or non-standard options

Rationale

Mandatory that estimated bill size information be given for inpatient or day surgery treatment because they are large billstopic

To save patients and families from financial burden

Application of Means Testing

Individual
Means Testing

Inpatient admission

Household
Means Testing

Inpatient downgrading

SOC enhanced subsidy

ILTC subsidy

Medifund application

CHAS application

Seniors’ Mobility and Enabling Fund (SMF)

Interim Disability Assistance

Programme for the Elderly (IDAPE)

Insurance Concepts

Catastrophic medical insurance (MediShield Life)

To help members meet medical expenses from major illnesses, which could not be sufficiently covered by their Medisave balance

Basic health insurance plan that helps patients cope with large hospital bills and selected costly outpatient treatments

Designed to cover medical expenses (excluding the deductible and co-insurance) for stay in Class B2/C wards at public hopsitals

Offers

Better protection and higher payouts, so that patients pay less Medisave/cash for large hospital bills

Protection for life

Cover Singaporeans and PR who were previously not covered under Medishield

Protection for all Singaporeans and PR, including the very old and those who have pre-existing conditions

Philosphy

Covering them through their lives by taking advantage of risk-pooling

Affordable premiums

Avoiding "buffet syndrome" by setting limits on payouts and requiring patient co-payment (coinsurance)

Co-payment and deductibles can be paid using Medisave or cash but not for payment of riders

Better Benefits

Higher claim limits

Lower co-insurance rates

Medishield Life pays more patients pay less

Long-term Insurance (ElderShield)

National insurance scheme which provides basic financial protection to individuals with severe disability and need long term care

Form of risk pooling

ElderShield is a long-term care insurance scheme targeted at severe disability which provides monthly payouts of $300 or $400 per month

Premium is automatically deducted from Medisave when the individual reached 40 years of age, unless the individual opts

Co-ordination of benefits clause

Medical Insurance policies has Co-ordination of Benefits clause

Total claims made by the owners will always be equal to the total medical expenses incurred

Claim processing rules requires submission of original bills

Civil Service Medical Benefits

Comprehensive Co-payment Scheme (CCS)

Medisave-cum-Subsidised Outpatient Scheme (MSO)

Co-Payment on Ward Charges Scheme (CPW)

Ageing population

Increasing incidence of chronic disease

Increasing demand for more healthcare services

Increasing demand for more affordable healthcare

Offers universal healthcare coverage to all citizens

Promoting competition and transparency

Individual responsibility and affordable healthcare to all citizens (multiple tiers of protection)

3 major shifts to Singapore’s healthcare financing framework

Increase Government share of our national healthcare expenditure

Gradually expand Medisave use

Enhance collective responsibility for healthcare

Competition & Centralization: Leading to better service and lower costs

Centralization through Clustering: Creates cost savings through consolidation

Group Purchasing Office (GPO)

Finance Shared Services (FSS)

Integrated Health Information System (IHIS)

Competition creates price diversity and amidst regulation

Post 2010 Public Healthcare Landscape

Regional Groups or Clusters were created to enable integrated care

Hospitals, polyclinics, community hospital, education centre and specialty centers under each group

Partner with general practitioners, polyclinics and other health-care providers in the area

“Build partnerships and seek synergies beyond the public sector”

CPF Board

Role: Regulatory

Exception

Precedent

MOH

Role: Executive

Precedent

National scheme of mandatory individual medical savings account

Depending on age, between 8% - 10.5% of one’s monthly salary is automatically deposited into Medisave account

Applicable for personal or immediate family's hospitalization, day surgery and certain outpatient expenses

Applicable for personal or immediate family's hospitalization, day surgery and certain outpatient expenses

The rich will have more Medisave savings than the poor