Question:
How much healthcare must a Singaporean consume per year to "break even" under SDP's proposed "National Healthcare Plan"?
Working:
Under SDP's "NHP", the average Singaporean pays an annual contribution of $600. To offset this compulsory payment, he must consume $600 worth of healthcare to begin with.
However, since the "NHP" covers only 90% of that $600, he has now paid $660 to consume $600 worth of healthcare!
To make up that difference, he must consume another $60 of healthcare, which will mean he has to come up with another $6 out of his pocket, which put him out by another $6, which means he has to consume a further...
Answer:
$666...
(Yes, it's closer to $667, but that number is more dramatic...)
Now you may think that that is a joke (and not a very good one at that), but I will not be surprised if Singaporeans who previously spent fewer than a hundred dollars on healthcare each year mysteriously start chalking up $666-healthcare bills if SDP's scheme comes into effect.
You may ask why we do not already over-utilise services such as the police, ambulance and fire services since we have all already "pre-paid" for them via taxes. Well, for one thing, these payments are hidden in the sense that they are not separate accounts into which you pay, and the prices of these services are also not known, making it impossible to determine where the break-even point is. Secondly, people do in fact utilise them inappropriately, which is why there are penalties for calling the police, an ambulance or the fire department frivolously.
What about the Medisave account that we have presently?
Yes, that is a distinct account into which you are compelled to contribute to, but that money stays in your account if not expended - it is not "forfeited" at the end of the year if not consumed (like those eMart credits - ever seen a reservist buy more pairs of socks than he can wear out just because he has $200 left in his account?). Also, that amount is reserved for your own use or the use of your family, and is returned to your "estate" if sums remain after your death, so there is no incentive to ensure that you use all you can every year of your life while you live so that money doesn't go towards paying for some stranger's illness.
Yet...
Yet even under those terms, patients still make healthcare choices based on CPF policies instead of medical reasons. For example, they will decide on whether or not to undergo an investigation or procedure based on whether it is "Medisave-claimable". After MOH started allowing Medisave to be used for outpatient chronic care, my colleagues in primary care related to me how some patients would try to make sure their bills exceed the minimum co-pay amount so that they can utilise their Medisave (yes, actually wanting to pay more in total so that they can pay less out-of-pocket!), to the point of asking the doctor to prescribe a longer duration of medication, to not discontinue medications which are no longer needed, or to prescribe vitamins and supplements to bulk up the bill.
Sounds bizarre? Well, don't just take my word for it - ask a friend who is in healthcare if what I wrote in the second part is true, and what I wrote in the first part is likely to happen. Perhaps SDP should have asked some healthcare workers too before coming up with their... Wait a minute...
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6 comments:
Since both the annual contribution approach and medisave result in the same behavioral distortions, perhaps you are suggesting that we move to a capitated system?
I think regardless of the payment mode, patients' health-seeking behaviour will be influenced by financial considerations.
My point is that we need to be aware that patients will do things that seem bizarre to us because from their point of view, it is the rational thing to do; SDP's proposal didn't seem to take that into account.
What a "perfect" system is depends on your point of view. A patient will always want to pay less and have short waiting time, a doctor will want unlimited resources so he can give all patients the time and treatment they need, and a selfish person like me will prefer not to be forced to pay for other people's healthcare consumption.
Hey angrydoc, I know you have criticized the SDP plan a lot. And you are not exactly happy with the current Singapore healthcare system.
Can you share with us what your wish list would be? I know you are not a politician and it is not your job to come up with these things, but you have said so much against other plans that I think you have an idea what might work.
Care to share what your framework would be?
I read in the other comments that government only runs regulation and protect against fraud. So an entirely private healthcare system? How much of our taxes will be reduced that way or will the money be better spent on other things?
As for the private healthcare system, what happens to people who cannot afford to pay? If they turn up at the private A&E and say I cannot pay upfront then where should they go?
I too would love to pay less taxes and only pay for what I use for healthcare and not have to pay for others, but I also wouldn't like to see ugly scenes where people are turned away from hospital for being unable to pay and die on the street or at home.
A 26 year-old woman is admitted to the Emergency Department and diagnosed with bacterial endocarditis. The patient has a history of intravenous drug abuse, which is what led to her condition. The indicated treatment is open heart surgery, to replace the prosthetic heart valve that she was given two years earlier, also due to endocarditis resulting from intravenous drug abuse. After the first value replacement, the patient was sent for drug abuse treatment and rehabilitation, but now the medical team is disturbed that that treatment seems to have failed. A few of the team members suggest that replacing the patient's valve again would constitute "futile" medicine, or a waste of medical and surgical resources.
Which of the following is most accurate?
1) Replacing the damaged valve would indeed be futile, and therefore a waste of resources
2) Replacing the valve would not be futile, but would constitute a waste of resources anyway
3) The valve should be replaced, but only if the patient is able to pay for the procedure
4) The valve must be replaced, so long as the patient consents to the procedure
5) The valve must be replaced, unless those members of the medical team opposing the operation obtain a court order to the contrary
Criteria used by the organ donor network to determine whether a potential organ recipient will receive a particular organ include all of the following, EXCEPT
1) HLA typing
2) The size of the organ
3) The geographical location of the donor and the potential recipient
4) The ability of the potential recipient to pay for the transportation and transplantation of the organ
5) The severity of the illness
6) The amount of time that the recipient has been on the waiting list
7) NONE OF THE ABOVE
What is another $66 if you take into account of inflation rate every year?! You are making a mountain out of molehill. Besides, people don't need police or ambulance or fire services most time. But healthcare is different. So is a bad analogy you are using.
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