Singapore's Healthcare Financing System
Medisave
The rich will have more Medisave savings than the poor
Applicable for personal or immediate family's hospitalization, day surgery and certain outpatient expenses
Depending on age, between 8% - 10.5% of one’s monthly salary is automatically deposited into Medisave account
National scheme of mandatory individual medical savings account
MOH
Role: Executive
CPF Board
Precedent
Exception
Role: Regulatory
Singapore's Public Healthcare Landscape
Post 2010 Public Healthcare Landscape
“Build partnerships and seek synergies beyond the public sector”
Partner with general practitioners, polyclinics and other health-care providers in the area
Hospitals, polyclinics, community hospital, education centre and specialty centers under each group
Regional Groups or Clusters were created to enable integrated care
Competition & Centralization: Leading to better service and lower costs
Competition creates price diversity and amidst regulation
Centralization through Clustering: Creates cost savings through consolidation
Integrated Health Information System (IHIS)
Finance Shared Services (FSS)
Group Purchasing Office (GPO)
Singapore's Healthcare Financing Philosophy
3 major shifts to Singapore’s healthcare financing framework
Enhance collective responsibility for healthcare
Gradually expand Medisave use
Increase Government share of our national healthcare expenditure
Individual responsibility and affordable healthcare to all citizens (multiple tiers of protection)
Promoting competition and transparency
Offers universal healthcare coverage to all citizens
Challenges of Singapore's Healthcare System
Increasing demand for more affordable healthcare
Increasing demand for more healthcare services
Increasing incidence of chronic disease
Ageing population
Insurance & Employment Medical Benefit
Civil Service Medical Benefits
Co-Payment on Ward Charges Scheme (CPW)
Medisave-cum-Subsidised Outpatient Scheme (MSO)
Comprehensive Co-payment Scheme (CCS)
Insurance Concepts
Co-ordination of benefits clause
Claim processing rules requires submission of original bills
Total claims made by the owners will always be equal to the total medical expenses incurred
Medical Insurance policies has Co-ordination of Benefits clause
Long-term Insurance (ElderShield)
Premium is automatically deducted from Medisave when the individual reached 40 years of age, unless the individual opts
ElderShield is a long-term care insurance scheme targeted at severe disability which provides monthly payouts of $300 or $400 per month
Form of risk pooling
National insurance scheme which provides basic financial protection to individuals with severe disability and need long term care
Catastrophic medical insurance (MediShield Life)
Better Benefits
Medishield Life pays more patients pay less
Lower co-insurance rates
Higher claim limits
Philosphy
Co-payment and deductibles can be paid using Medisave or cash but not for payment of riders
Avoiding "buffet syndrome" by setting limits on payouts and requiring patient co-payment (coinsurance)
Affordable premiums
Covering them through their lives by taking advantage of risk-pooling
Offers
Protection for all Singaporeans and PR, including the very old and those who have pre-existing conditions
Cover Singaporeans and PR who were previously not covered under Medishield
Protection for life
Better protection and higher payouts, so that patients pay less Medisave/cash for large hospital bills
Designed to cover medical expenses (excluding the deductible and co-insurance) for stay in Class B2/C wards at public hopsitals
Basic health insurance plan that helps patients cope with large hospital bills and selected costly outpatient treatments
To help members meet medical expenses from major illnesses, which could not be sufficiently covered by their Medisave balance
Financial Counselling
Application of Means Testing
Household
Means Testing
Programme for the Elderly (IDAPE)
Interim Disability Assistance
Seniors’ Mobility and Enabling Fund (SMF)
CHAS application
Medifund application
ILTC subsidy
SOC enhanced subsidy
Inpatient downgrading
Individual
Means Testing
Inpatient admission
Rationale
To save patients and families from financial burden
Mandatory that estimated bill size information be given for inpatient or day surgery treatment because they are large billstopic
Patient's Decision
Standard or non-standard options
Seek alternative options at other institutions
To proceed or not to proceed with treatment
Choice of class: Primary private or subsidized
Out-of-pocket
Most regressive form of financing
Cash paid by the patient
Medifund
Maximum Medifund Assistance
Non-resident (NR) and Permanent Resident (PR) are not assisted by Medifund
Only C class patient enjoy 100% Medifund Assistance
Inpatient Admission
Calculation of Household Income
Household Income (HI) = Monthly Per-Capita Household Income (gross income net of CPF deductions)
Medical Assistance Fund (MAF)
Deducted first before using patient's Medifund or Medisave
Increase maximum subsidy level of 50% to 75% upon assessment by MSW
Cover NSDL drugs
Medifund Approval Level
Level 3
Approval by Medifund Committee
Non-Straightforward (NSF) Applications
Level 2
Approval at MSW level
Straight forward (SF) Applications
Level 1
Approval: Exemption
Public Assistance
Medifund Junior
For needy Singaporean children below 18 to tap on to defray their healthcare cost
Medifund Silver
Singaporean aged 65 years or above
ILTC sector to benefit more elderly patients
Principles of Medifund Assistance
Many helping hands
Family responsibility
Medical necessity
Personal responsibility
Govt. endowment fund set up to help needy Singaporeans to access healthcare
Strictly subjected to means testing
