ElderShield: Why rebate and then premium hike?
I REFER to the article, 'Look out for add-ons to supplement ElderShield' (ST, April 23).
Why pay a rebate, and increase premiums at the same time? Why not just use the excess funding accumulated to reduce future premiums or increase benefits?
At the end of last year, there were about 750,000 policyholders, with a total of 2,366 successful claims. About 16 per cent of claims declined.
The claims payout last year was about $8.5 million (2,366 claims x $300 monthly x 12 months). Even if we assume all 750,000 policyholders paid the lowest premiums at age 40 of $169.74 (male $148.84 + female $190.63 divided by 2), premiums per year were $127.3 million ($169.74 x 750,000 policyholders).
This means the claims ratio was only about 6.7 per cent ($8.5 million in claims but $127.3 million in premiums). As the 2,366 claims were the cumulative total for the four years since the scheme started, the claims payout over premiums per year is actually much lower.
What was the claims ratio for each of the four years of the scheme? I believe this may be the most profitable insurance scheme in the history of insurance in any country. How much profit has been made since the scheme started?
Notwithstanding the proposal to increase the monthly payout by $100 and the payout period from five to six years, in view of the above, how is it possible that the proposal now is to have existing policyholders pay a one-off adjustment to make up for lower premiums paid in earlier years under the current ElderShield scheme, increase premiums of about $10 a month for the older age group, and have policyholders registered automatically for the new scheme after September pay premiums of $1 to $2 more a month?
As to the opt-out rate having gone down steadily from 38 per cent when the scheme was launched to 14 per cent last year, there are 1.26 million residents (Singaporeans and PRs) aged 40 to 64, according to the Department of Statistics' 'key statistics demography Singapore residents by age group end June 2006'. So, isn't the opt-out rate about 40 per cent (with about 750,000 policyholders among 1.26 million residents)?
Does the Ministry of Health study's opt-out rate refer to the current opt-out rate of new entrants who reach age 40, or the overall opt-out rate of those eligible?
Leong Sze Hian
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Copyright © 2007 Singapore Press Holdings. All rights reserved. Privacy Statement & Condition of Access
May 1, 2007 Straits Times
Why the surge in fee for Yellow Fever jab?
I WENT to the Travellers' Health and Vaccination Clinic at Tan Tock Seng Hospital for a Yellow Fever vaccination recently. The charge was $130.20, compared to just $15 for the same vaccination I had at the same clinic 10 years ago. This is an increase of 768 per cent or a 24 per cent compounded increase per annum.
The clinic was furnished lavishly with leather sofas, leather chairs, paintings on the walls, flowers in vases, etc, like a five-star hotel.
The same vaccination costs about HK$200 (S$39), A$50 (S$63) and 35 euros (S$72) in Hong Kong, Australia and Ireland, respectively. Why has the cost of vaccination increased by so much over the last 10 years, when inflation in Singapore was less than 2 per cent per annum?
When I paid the $130.20 fee, the staff gave me a brochure and said that if I had a platinum credit card, I would receive a 12 per cent discount for health screening.
Why do the more affluent who qualify for a platinum card get a discount of 12 per cent, whereas the lower income has to pay 13.6 per cent more, in a government restructured hospital?
Is this not, in a way, like reverse means testing - the rich pay less, the poor pay more?
Leong Sze Hian
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Copyright © 2007 Singapore Press Holdings. All rights reserved. Privacy Statement & Condition of Access
Business Times - 15 Feb 2007
LETTER TO THE EDITOR
Regulatory costs hurting consumers
I REFER to the articles 'Medical devices first to be regulated under Bill' (BT, Feb 13) and 'Regulations for medical devices to be implemented', on the proposed Health Products Bill (BT, Feb 7).
MP Halimah Yacob, GPC chairman for health, voiced her concern in Parliament on Feb 12 about regulation costs for businesses, especially smaller companies.
On the licensing and registration fees for medicinal and cosmetic products, before 1991, there were hardly any fees payable for the registration of medicinal products.
When registration began in 1991, the per product licence fee was $66 a year. Since a new regulatory agency was created a few years ago, the fees have increased to $80, $100, $120, $360, $750, and up to $77,500 per first year, in 1992, 1996, 1998, 2003, 2006 and 2007 respectively. Not counting 2007, this fees increase was at a compound rate of 18 per cent a year, for the last 15 years until 2006.
This has resulted in pharmaceutical businesses reducing their product lines and is also a deterrent to expanding their product ranges in Singapore. The higher costs are also being passed on to consumers. More Singaporeans are buying from Johor Baru and neighbouring countries.
For example, the price of Norvasc 5mg tablet box of 30 for heart condition and Lipitor 10mg is $28.70 (RM65) and $55.30 (RM125) in Johor Baru, compared with $75.20 and $96, respectively, in Singapore.
In the context of Singapore's small population, on a per capita basis, our registration fees may be one of the highest in the world. This may also affect Singapore's plans to become a biomedical hub.
The new $77,500 registration fee for a new drug may deter the introduction of new drugs. This may deprive patients of much-needed new drug treatments.
For example, had the new $77,500 registration fee been in force when Viagra was introduced in Singapore, it may never have made it to the pharmacies - which may result in an even lower procreation rate. For new drugs that are already approved by the Food and Drug Administration (FDA) of the USA, why do we need to impose the new $77,500 registration fee?
To put this in perspective, according to the ChannelNewsAsia programme, War on Cancer, on Feb 11, the cost of cancer drugs has gone up 500-fold over the last decade.
Singapore may like to rethink its strategy before going down the road of trying to emulate the best in the world for the registration of drugs. The time period required for registration has also risen from three months previously to over two years now.
Developed countries like the US and Canada do not impose registration on cosmetics. So, why do we now require licensing for cosmetic products? Consequently, many cosmetic products have disappeared from the Singapore market. Retailers and distributors alike are losing sales to other countries that have a wider range and lower prices.
It would appear that every time a new regulating agency is created, businesses and consumers may end up paying much more. In fact, the fees only started to escalate about five years ago when the new regulating agency was created.
I would like to ask what is the operating expenditure and profits of the regulatory agency over the last few years.
Leong Sze Hian
Singapore
Business Times - 13 Dec 2006
LETTER TO THE EDITOR
Raising costs for foreigners may not benefit S'poreans
I REFER to the article 'Foreigners to pay more for healthcare costs from Oct' (BT, Dec 11).
Increasing medical costs for foreign workers, may lead to employers reducing the take-home pay, particularly for lower-skilled workers.
In the past, when foreign worker's levy, accommodation requirements, polyclinic and Communicable Disease Centre fees, were raised - take-home pay generally declined.
With the increasing trend of outsourcing, particularly for low-skilled work, employers in the outsourcing industry typically have quite low margins, and are thus quite sensitive to higher labour costs, which they may have some difficulty in absorbing, because they may already have committed to long-term contracts with fixed pricing.
A spokesman from the Humanitarian Organisation for Migration Economics has already raised the concern that the increase in medical costs will be passed on to workers.
The reality on the ground, is that employers cannot have Singaporeans and foreigners working side by side, doing the same low-skilled job, with different pay.
So, the implication for low-skilled Singaporeans may be that their wages may decline too.
This is reflected in the Department of Statistics' General Household Survey 2005, that the 11th to 20th percentile of households by income, had declining incomes by 4.3 per cent per annum from 2000 to 2005.
The playing field between foreigners and Singaporean workers may never be level, as long as foreigners do not have to contribute CPF, whereas Singaporeans have to.
Singaporean males also have to do reservist training.
Employers save by not having to contribute CPF for foreigners, and Singaporeans may find it harder to survive with 20 per cent less take-home pay compared to foreign workers.
The fact that most Singaporeans have families to provide for, compared to foreigners who are here alone, may make it even harder for Singaporeans to take on low-skilled jobs.
Instead of removing the subsidy for foreigners, reducing it for permanent residents, and maintaining the status quo for Singaporeans, why not increase the subsidy for Singaporeans using the expected $36 million additional revenue?
Since many Singaporeans may have to bear the brunt of the increase for foreigners and permanent residents for whom they are responsible for, it is akin to a no-win situation for everyone, if the savings are not channelled directly back to citizens.
For example, last year, Medifund paid out $39.1 million to 288,000 patient applications, giving an average subsidy of $136.
Giving the $36 million additional revenue to Medifund could increase the average payout to $261.
Thus, increasing the help to needy patients by 92 per cent. Alternatively, current subsidies for Singaporeans could be increased across the board, for lower class hospital wards.
I would like to suggest that we explore the possibility of not charging foreigners and permanent residents more, but giving more to Singaporeans instead. In so doing, all will be happy, instead of one out of four (non-citizens) on the island being unhappy, and perhaps another one or two of the remaining three (citizens) being unhappy too, because they may have to pay for the former.
Why not use some of the hundreds of millions collected in foreign worker levies annually, so that Singaporeans do not have to end up paying for them?
In trying to address the issue that Singaporeans should have more privileges than non-citizens, are we inadvertently creating other problems for Singaporeans?
Leong Sze Hian
Singapore
This story was printed from TODAYonline
Singaporeans bear the side effects
Lower foreign workers' levy to offset costs for employers Higher medical costs will rebound on citizens
Weekend • December 9, 2006
Letter from Harry Chia
Letter from Leong Sze Hian
I refer to the article, "Insurance the key" (Dec 8), on the issue of making health insurance mandatory for foreign workers.
With the cutback in health subsidy for foreign workers, employers will bear a higher medical cost. With the construction of the two Integrated Resorts and the many shopping malls and private property projects on stream, the 135,000 foreign workers now in Singapore will most likely double or even treble in numbers.
If a pandemic hits, the medical cost for the construction companies will be staggering. So, having medical insurance will mitigate such a scenario, and make that cost steady and predictable year after year.
The Government could lessen the additional cost by lowering the foreign workers' levy for at least the first year of implementation, in order to monitor the claims versus the premiums pattern. As the companies are GST-registered, the GST increase next year can compensate for the loss in revenue from the reduced levy.
Who will pay for the higher medical costs of the 160,000 foreign domestic helpers? Singaporean employers.
Who will pay for the 420,000 low-skilled non-domestic foreign workers? Singaporean employers, including many small businesses that may just pass on the higher costs to consumers — again, Singaporeans.
The 65,000 highly-skilled employment pass holders and the 25,000 mid-skilled workers holding S-Passes are generally on more generous employment contracts, which typically include perks such as paying for the medical costs of the employees and their family. Therefore, any increase may drive up business costs, which may also be passed on to customers.
About 30 per cent of Singaporean men married foreigners and permanent residents (PRs) last year. Who will pay for the medical costs of their spouses and relatives? Of course, Singaporeans.
Perhaps foreign entrepreneurs and foreign students will also bear the brunt of the increase. There has been much debate about the problems of parents accompanying young foreign students here and the situation of the older students. The increase may add to their financial burden, which may have even greater social implications as they strive to earn more income here.
By increasing the costs of living and doing business, it may become harder to attract foreign investment and talent. At the end of the day, who may suffer? Singaporeans.
By the way, polyclinic charges for foreigners have already been increased from Jan 1 this year, when consultation and prescription subsidies were withdrawn for foreigners and a 50-per-cent cut was implemented for PRs.
Copyright MediaCorp Press Ltd. All rights reserved.
Business Times - 24 Nov 2006
LETTER TO THE EDITOR
Drug treatment fails to rehabilitate addicts
I REFER to media reports on the Parliament session in November, regarding the proposed changes to the penal code to toughen some of the laws, the Ministry of Home Affairs' launching of the book Slaying The Dragon - Singapore's Fight Against Drugs on Nov 20, and a statement on the Ministry of Health's (MOH) website, 'Long Term Imprisonment for Recalcitrant Subutex Abusers'.
The first two Subutex abusers have been jailed under the new tougher laws which have longer-term jail terms. Let's just imagine and try to put yourself in the place of a Subutex user. In the first place, it was prescribed by medical practitioners. So, should Subutex users be entirely to blame for ending up addicted to a drug that was approved by the MOH in 2002, to solve the heroin addiction problem, but became an even bigger problem?
If you were asked to voluntarily sign up for the rehabilitation programme within two weeks or be forced to undergo rehabilitation if caught, you would be understandably afraid that you may not be able to take the cold-turkey treatment. So, you would likely err on the side of caution and give a fake identity, address and contact number. Some may have adopted a 'wait-and-see' attitude, to see how others fared. True enough, the worst fears have come true, as shown by the large number who have skipped treatment, and gone into hiding. About half of the 3,000 Subutex abusers who initially signed up have dropped out.
If the programme had started with a small number as a pilot test, so that we can learn from the experience, one step at a time, to make it a success and to encourage others to follow, wouldn't most Subutex users be better off now? Instead of encouraging you to seek treatment again, the latest penalty of up to seven years in jail and six strokes of the cane, is akin to sentencing and punishing you for good, even though you have tried to kick the habit, but found it unbearable. According to the dictionary, rehabilitate means 'to restore to a condition of good health'. How can a rehabilitation programme fail to rehabilitate the majority, but punish the majority instead?
After this saga of a rehabilitation programme that has failed miserably to help the majority of users, who in his right mind would volunteer for drug addiction treatment in future? Perhaps it should be called a drug punishment instead of a drug rehabilitation programme.
Leong Sze Hian
Singapore
Copyright © 2005 Singapore Press Holdings Ltd. All rights reserved.
Copyright © 2005 Singapore Press Holdings Ltd. All rights reserved.
This story was printed from TODAYonline
A pill that doesn't cure the ill
Raise medical subsidies for Singaporeans instead Levies more than cover subsidies
Wednesday • December 13, 2006
Letter from Leong Sze Hian
Letter from Seah Leong Khai
I refer to the article, "Cuts, costs and citizens" (Dec 11). In the past, when foreign workers' levy, accommodation requirements, polyclinic and Communicable Disease Centre fees were raised, the take-home pay generally declined.
With the growing outsourcing trend, particularly for low-skilled work, employers in the outsourcing industry typically have quite low margins and are, thus, sensitive to higher labour costs. They may have some difficulty in absorbing these because they may already have committed to long-term contracts with fixed pricing.
A spokesman from the Humanitarian Organisation for Migration Economics has already raised the concern that the increase in medical costs will be passed on to workers.
The reality, on the ground, is that employers cannot have Singaporeans and foreigners working side by side, doing the same low-skilled job with different pay. So, the implication for low-skilled Singaporeans may be that their wages may decline, too.
This is reflected in the Department of Statistics' General Household Survey 2005: The 11th to 20th percentile of households had declining incomes by 4.3 per cent a year from 2000 to last year.
The playing field between foreigners and Singaporean workers may never be level, as long as foreigners do not have to contribute to the Central Provident Fund (CPF) and Singaporeans do.
Employers save by not having to contribute CPF for foreigners, and Singaporeans may find it harder to survive with 20 per cent less take-home pay. The fact that most Singaporeans have families to provide for, compared to foreigners who are here alone, may make it even harder for them to take on low-skilled jobs.
Instead of removing the subsidy for foreigners, reducing it for permanent residents (PRs), and maintaining the status quo for Singaporeans, why not increase the subsidy for Singaporeans using the expected $36 million freed-up revenue?
Since many Singaporeans may have to bear the brunt of the increase for foreigners and PRs for whom they are responsible, it is akin to a no-win situation for everyone, if the savings are not channelled directly back to citizens.
For example, last year, Medifund paid out $39.1 million to 288,000 patient applications — an average subsidy of $136. Giving the $36 million additional revenue to Medifund could increase the average payout to $261 for needy patients.
Alternatively, current subsidies for Singaporeans could be increased across the board for lower class hospital wards.
I would like to suggest that we explore the possibility of not charging foreigners and PRs more, but giving more to Singaporeans instead. In so doing, all will be happy, instead of one out of four (non-citizens) on the island being unhappy, and perhaps another one or two of the remaining three (citizens) being unhappy over having to pay for the former.
Why not tap some of the hundreds of millions collected in foreign worker levies annually, instead?
In trying to address the issue that Singaporeans should have more privileges than non-citizens, are we inadvertently creating other problems for Singaporeans?
According to the Ministry of Manpower statistics, there were 671,000 foreign workers in Singapore last year. For each of these workers, the employers pay a levy every month of between $100 for an unskilled worker and $470 for a skilled one. For domestic maids, the levy is $200.
With an average levy of $200 per foreign worker, the Government adds about $1.6 billion a year to its coffers. This huge sum more than covers the $36 million in current annual healthcare subsidies for these foreign workers and PRs.
The employers paid the levies for employing these foreign workers because they cannot get enough Singaporeans to work at construction sites and to clear the garbage generated by us.
Thus, the Government should retain the healthcare subsidies for foreign workers. Doing so will avoid an increase in business costs, and give employers no excuse to pass the costs on to consumers.
Copyright MediaCorp Press Ltd. All rights reserved.
Copyright © 2005 Singapore Press Holdings Ltd. All rights reserved.
Paper: Business Times, The (Singapore)
Title: More healthcare subsidies needed
Author: Leong Sze Hian Singapore
Date: June 27, 2006
ACCORDING to the Ministry of Health's website, subsidies for subsidised
patients have been rising from $560 million in 1997 to $1.39 billion in
2005.
Particularly for the poor, increases in subsidies may need to be viewed
in the context of rising healthcare costs. For example, if healthcare
costs rise by 10 per cent, and subsidies also increase by the same
amount, the net impact on the poor is zero.
Notwithstanding rising subsidies, the poor were most affected as
healthcare spending of the lowest 20 per cent of households by income, had
the highest increase of 81 per cent among all items of expenditure from
1998 to 2004. This increase is further compounded by the decline in
average monthly household income of this group by 3.2 per cent a year from
1998 to 2003. A statistic that may need to be looked at is whether the
poor's co-payment for every incremental dollar of healthcare costs
vis-a-vis the government's share has risen over the years.
A slew of changes in healthcare policies in recent years may have
contributed to rising healthcare costs for the poor, such as the 9 per cent
increase in polyclinic fees to cover renovation work; no more free
treatment for infectious diseases like dengue fever and chicken pox at the
Communicable Disease Centre; increase in MediShield deductible and
premiums; maximum waiver of only up to 60 per cent for non-air-conditioned
6-bedded ward under Medifund; means testing for disabled care; means
testing for community hospitals elderly care, etc.
For example, means testing since 2000 for community hospitals elderly
care, starts at $301 per capita income. How can a family with a per
capita monthly income of $301 be considered not poor?
With over three per cent of Gross Domestic Product (GDP) spent on
healthcare, I understand that Singapore's healthcare spending over GDP is
one of the lowest in the world.
The poor is perhaps not interested in the debate or statistics on
healthcare, but rather the issue of affordability and whether healthcare
will continue to be a rising financial burden.
Author: Leong Sze Hian Singapore
Copyright, 2006, Singapore Press Holdings Limited
****************************************************
Paper: Straits Times, The (Singapore)
Title: Spend more on health care to help the poor
Date: June 3, 2006
HEALTH-CARE spending of the lowest 20 per cent of households by income
had the highest increase of 81 per cent among all items of expenditure
from 1998 to 2004.
According to the World Health Organisation's (WHO) World Health Report
2004, Singapore's per capita government expenditure on health, at an
average exchange rate, fell gradually from US$365 (S$577) in 1997 to
US$274 in 2001.
The WHO Report 2005 showed that Singapore's general government
expenditure on health - as a percentage of total expenditure on health -
declined gradually from 41.6 to 30.9 per cent from 1998 to 2002.
General government expenditure on health as a percentage of total
government expenditure also dropped from 8.7 to 5.9 per cent for the same
period.
We should spend more on health care to help the poor.
Leong Sze Hian
Copyright, 2006, Singapore Press Holdings Limited
****************************************************
Paper: Business Times, The (Singapore)
Title: Healthcare resources focus on the needy
Date: February 7, 2006
IN HIS letter 'Fix rich-poor health spending imbalance' (BT, Feb 2), Mr
Leong Sze Hian used FY2003 and FY2004 statistics to conclude that the
government is spending less on healthcare. But his comparison is
incomplete and misleading.
FY2003 was the year when Severe Acute Respiratory Syndrome (Sars) hit
Singapore when the government had to invest additional funds on
Sars-related items as well as post-Sars measures in order to be better prepared
for the possible re-emergence of Sars and similar threats. As a result,
the total government health expenditure (GHE) in FY2003 was
significantly higher than normal.
The correct approach is to look at the government's spending over a
longer period. Actually, Singapore's GHE rose from $870 million in FY1994
to $1.17 billion in FY1997, $1.21 billion in FY2000, $1.53 billion in
FY2002 and $1.71 billion in FY2004.
We share Mr Leong's wish to lessen the financial burden of healthcare
on the needy. That is why we have particularly focused our healthcare
resources on them.
A total of 70 per cent of Singapore's GHE goes to subsidies to help
Singaporeans pay for their hospital and polyclinic treatments, nursing
home fees and so on. Healthcare subsidies had been increasing steadily
from $560 million in FY1997 to $850 million in FY2000, and further to
$1.28 billion in FY2004.
In addition to direct healthcare subsidies, the government has spent
$420 million in recent years to top up the Medisave accounts of
Singaporeans, with larger top-ups for those in greater need, especially older
Singaporeans. MediShield was also reformed to ensure it covers more
adequately large hospital bills, while ensuring that the scheme remains
affordable for lower-income Singaporeans.
The government has also set up the Medifund as the medical safety net
to help needy Singaporeans pay for their medical expenses.
Last year, Medifund provided financial assistance to 16,400 applicants
in financial difficulties to help pay for their Class B2/C hospital
bills. They each received an average of $984, double the GHE per person of
$491 in FY2004. We will continue to refine our healthcare policies to
help the needy in particular. Karen Tan (Ms) Director, Corporate
Communications Ministry of Health
Copyright, 2006, Singapore Press Holdings Limited
****************************************************
Paper: Business Times, The (Singapore)
Title: Fix rich-poor health spending imbalance
Author: Leong Sze Hian Singapore
Date: February 2, 2006
I REFER to recent media reports on Singapore's medical schemes.
The feedback group on health matters has suggested that a new central
charity fund be set up to raise and distribute funds to medical
charities, to allow 'staff to focus on helping the needy and not be distracted
by having to raise money, as in the case of the NKF'.
The health minister said at the annual conference of feedback groups
last month that Singapore has one of 'the best health-care financing in
the world' which others are copying and that 'people in the lower-income
group don't have to worry, although I know they worry'.
According to the Department of Statistics, expenditure on healthcare
had the highest increase among all items of household expenditure.
The lowest 20 per cent of households by income spent 6.7 per cent in
2004 compared with 3.7 per cent in 1998. This is an increase of 81 per
cent or 10.4 per cent per annum, compared with inflation of only 1.7 per
cent.
Meanwhile, the increase among the highest 20 per cent of households was
smaller, 55 per cent or 7.6 per cent per annum. Healthcare's share of
spending went up to 4.8 per cent from 3.1 per cent.
Why is it that our healthcare policy and system have resulted in the
poorest being burdened with paying 47 per cent (81 divided by 55) more
relative to the rich?
On a per annum increase basis, this means that the poor have been
paying 37 per cent (10.4 divided by 7.6) more a year, relative to the rich.
If this trend continues, the poor may be further stressed when they
fall ill.
According to the Ministry of Health's website (last updated April
2005), total government health expenditure per person declined by 16 per
cent to $491 in 2004 from $584 in 2003, recurrent health expenditure fell
16 per cent to $1.6 billion from $1.9 billion, and development health
expenditure slipped by 6 per cent to $97 million from $103 million.
Healthcare's share of total government expenditure also decreased fell,
to 5.9 per cent from 7 per cent.
In this connection, the National Kidney Foundation report revealed that
the health ministry asked NKF to raise funds for cancer.
The more funds health charities raise may in effect mean less
government spending on healthcare.
Has the above declining healthcare spending contributed to the
increased healthcare spending among the poor?
As the rich would typically choose higher class hospital wards and more
expensive outpatient treatment and medicine, this disparity is all the
more glaring.
According to the Feedback Unit's publication, Shaping Our Home: Turning
Ideas Into Reality, released last month, the Health Feedback Group
urged that we 'consider new ways of distributing subsidies to the needy;
subsidies for Singaporeans should be made available to those who need
it'.
The above statistics clearly indicate that more may need to be done in
this regard, to lessen the financial burden of healthcare on the needy
relative to the rich.
I would like to suggest that our healthcare policies be reviewed to
address the increasing imbalance between the poor and the rich in
healthcare financing.
Author: Leong Sze Hian Singapore
Copyright, 2006, Singapore Press Holdings Limited
****************************************************
Paper: Straits Times, The (Singapore)
Title: Lesson from kids: Stop passing the buck
Author: Leong Sze Hian
Date: December 24, 2005
I REFER to the article 'PwC rapped for not spotting lapses' and the
letter 'Former NCSS president clarifies chain of events' by Dr Robert Loh
Choo Kiat (ST, Dec 22).
I overheard some children talking about the National Kidney Foundation
(NKF) saga, and was struck by their satirical take on the issue.
In gist, they were saying everyone seems to be passing the buck and
making excuses.
'Durai pass to NKF board, board pass to patron,' they said.
In fact, the patron did not even know Mr T.T. Durai's remuneration, and
did not 'know and endorse' it as alleged by the board.
'National Council of Social Service pass to Commissioner of Charities,
COC pass to Health Ministry, ministry pass to auditors, auditors pass
to..?'
Dr Loh, former president of NCSS, has clarified to the media that 'the
revocation of NKF's Institution of Public Character status by itself
would send a strong signal that something was not quite in order. The COC
had to be informed of this action and why it was taken'.
Within less than a month of the NKF's IPC revocation, the Health
Ministry restored it, relying on the assurance of past periodic routine
audits by the auditors that the financial statements did not show any
unusual transactions.
The auditors have responded in a statement that 'our primary
responsibility was to express an opinion on whether the NKF financial statements
show a true and fair view. We believe we have discharged that
responsibility'.
To echo Dr Loh's concerns, if regulators globally relied only on the
cursory facade of routine audit reports, despite 'red flags' being raised
periodically, financial scandals like Enron and now the NKF might never
come to light.
Parents tell their children: 'Admit your mistake. Don't make excuses.'
In this instance, the children may have taught us adults something, by
the clarity and simplicity of their logic.
It has been said many times that we must restore public confidence,
otherwise at stake are the hundreds of thousands of needy Singaporeans who
are the beneficiaries of the 1,700 charities and voluntary welfare
organisations in Singapore. My fear is that if the children's perception
permeates through to the general population., public confidence may
continue to slide.
On Internet blogs and forums, thousands are 'screaming for blood' and
asking 'who's to blame'.
In a sense, we need to reflect how many of us have to take part the
blame for our gullibility in donating to glitzy TV charity shows in the
hope of winning a $500,000 property we now know was not sponsored but
paid for by our donations, and donating more in a year to the NKF with
only 1,700 beneficiaries than the Community Chest with more than 300,000.
Going forward, we should say no to extravagant charity shows with
prizes and telephone call charges, so a greater percentage of donations goes
to beneficiaries.
Perhaps we can learn a thing or two from countries like Japan, where,
whenever there is a serious financial scandal, those responsible admit
their mistakes, apologise and resign.
While I do not advocate this, what is at stake is so great - the future
of the charity and volunteer sector in Singapore - we must move on. I
would like to commend the Health Minister, as to date, I believe he is
the only one who has apologised - not Mr Durai, the former NKF board,
the auditors or anyone else.
To restore public confidence, perhaps we should listen to the children.
We must stop passing the buck and making excuses.
Author: Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
****************************************************
Paper: Business Times, The (Singapore)
Title: Subsidy cut at polyclinics will hit locals
Author: Leong Sze Hian, Singapore
Date: December 15, 2005
I REFER to media reports that there will be no fee and prescription
subsidies for foreigners at polyclinics from next year, and that subsidies
for permanent residents will also be cut by 50 per cent.
According to the Department of Statistics, foreigners number 753,4000
out of the total population of 4,240,300.
If 10 per cent of the resident population are permanent residents,
according to the Total Population by Residential Status, Census of
Population 2000, the total number of foreigners and permanent residents should
be 1,102,090.
Therefore, a cost-cutting policy change as in the case of the
polyclinic fee subsidy may affect about one in four of the population.
From 1998 to 2003, about 97 per cent of total marriages were resident
marriages, which refer to marriages where either or both the groom and
bride are residents. I believe there are many Singaporeans with spouses
or dependants who are not citizens.
Therefore, the removal and reduction in fee subsidies may add to the
financial strain of these Singaporeans, too.
The fact that attendances at polyclinics had increased by 14 per cent
from 3,337,300 to 3,791,700 from 2003 to 2004 may indicate that more
people have been turning to polyclinics because of the lower fees they
charge.
Other recent cost-cutting measures like the closure of night
polyclinics and the termination of free treatment for some infectious diseases at
the Communicable Disease Centre, and the mandatory increase in
deductibles for CPF Shield medical insurance plans, may also increase medical
costs for the poor.
Consequently, poorer residents may become more inclined to delay or
avoid seeking medical treatment, or resort more to self-medication.
Since Total Government Health Expenditure per person has already
declined by 16 per cent from $584 to $491 from 2003 to 2004, do we really
need to cut spending further, to the extent of increasing the burden on
lower-income Singaporeans whom I believe have relatively more non-citizen
dependants than those of higher income?
According to the Economist magazine (Nov 19), a Chinese 'government
survey published last year, said nearly 30 per cent of city residents
recommended for hospitalisation refuse to be admitted with some 70 per cent
citing the cost'.
This highlights how relentless cost-cutting in healthcare may affect
the poor.
Medical costs will also go up for the few hundred thousand Singaporeans
who employ domestic maids and foreign workers.
It has been said that 'with the subsidies removed, it makes sense for
employers to buy medical insurance for their foreign workers'.
The cheapest medical insurance premium that I can find to cover my maid
for outpatient treatment is quite high at $250 a year for a female
below age 31, and there are also co-payments of $5 per outpatient visit,
$15 per specialist care visit, and 10 per cent of the total eligible bill
for B2 hospital care.
The annual premiums increase to $350 and $460 for those above age 30
and 40 respectively.
This change in fee subsidies may, therefore, actually affect more
Singaporeans than foreigners, because in many cases, it is Singaporeans who
will ultimately be footing the bill.
As the Health Ministry is also looking at withdrawing government
subsidies on hospital care for foreign workers, medical costs may increase
further in future, for Singaporean employers and Singaporeans with
non-citizen dependants.
Author: Leong Sze Hian, Singapore
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Continue free treatment for infectious diseases
Date: December 2, 2005
I REFER to the article, 'Vietnam's bird-flu pandemic drill' (ST, Nov
28), and Ms Salma Khalik's 'Wider review of disease centre's no-charge
policy' (ST, Oct 21).
In the second article it was stated that 'with the free treatment for
dengue and chickenpox patients at the Communicable Disease Centre (CDC)
already stopped, the Health Ministry now wants to review the no-charge
policy for other infectious diseases as well'.
I would like to suggest that this policy review be re-considered in the
light of heightened fears about a possible bird-flu pandemic.
The Minister Mentor recently expressed concern over the spread of bird
flu and warned Singaporeans not to take it lightly.
All we need is for maybe just one infected person to hesitate seeking
treatment or hospitalisation because of financial reasons, and the
result could be the death of thousands and economic losses in the billions.
With about 240,000 people earning less than $1,000 a month, 74,000
needy households in the ComCare database, and around 39,000 HDB households
in arrears on their service and conservancy charges, the $272 mean cost
of hospital treatment for dengue at CDC's adjoining Tan Tock Seng
Hospital for a C-class patient may be a financial strain on the lower-income
group. The cost for flu may be higher as the typical stay in hospital
may be longer.
It may thus be penny wise and pound foolish to save $400,000 a year
from stopping free treatment for 1,180 patients, compared to the risks
should infectious diseases spread. Saving lives is paramount and should be
weighed against any cost savings.
I was struck by the contrast between US President George Bush's US$7.1
billion (S$12 billion) plan to cope with a flu pandemic and Singapore's
termination of free treatment for infectious diseases to save just
$400,000.
The historical rationale for offering free treatment in the hope that
patients would seek treatment and so prevent the spread of infectious
diseases may still be sound, as we never know what new diseases we may
have to contend with, like Sars and a flu pandemic.
The fact that the number of chickenpox patients seen at the CDC has
dropped from 60 a month to just six in two months could mean either that
they are going elsewhere for treatment because it is no longer free, or
that some may be delaying or avoiding treatment altogether.
The latter is particularly true of foreign workers, who, besides having
to foot the bill, may fear having their wages cut, or even losing their
jobs.
Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: In elective cases, hospital service does differ
Author: Karen Tan (Ms) Director Corporate Communications Ministry of
Health
Date: June 29, 2005
IN THE letter, 'Cutting waiting time at govt hospitals: Have private
patients seen at private hospitals' (ST, June 21), Mr Leong Sze Hian
suggested that public hospitals do not serve unsubsidised patients.
If they do, Mr Leong felt that the hospitals would end up being
discriminatory as patients would inevitably receive different treatment or
levels of service.
Much as this would be an ideal, no society can guarantee equal
treatment for all patients. In practice, for example, even the same surgical
procedure performed by two equally-competent consultants cannot guarantee
identical outcomes.
But what is achievable is to ensure that all patients have equal access
to good basic medical care. For example, all patients with emergency
medical conditions will receive immediate medical attention, regardless
of their paying status.
For non-emergency elective cases, service levels do differ. For
instance, unsubsidised patients expect and are prepared to pay for branded
drugs, when generic drugs would suffice. They would be most unhappy if we
do not dispense such drugs.
To reduce waiting time, Mr Leong would like us to emulate the British
National Health Service. But we have been able to achieve better waiting
times.
According to British data, the waiting time last year for cataract
surgery was up to eight months; for hip-replacement surgery it was 11
months; and for knee-replacement surgery, 12 months. As a result, patients
who can afford it opt out of public hospitals for unsubsidised care. The
end result is that a non-discriminatory outcome remains elusive.
Author: Karen Tan (Ms) Director Corporate Communications Ministry of
Health
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Have private patients seen at private hospitals
Author: Leong Sze Hian
Date: June 21, 2005
I REFER to the Ministry of Health (MOH)'s reply, 'Patients' needs based
on objective clinical appraisal' (ST, June 8), to my letter, 'Treat
patients based on needs, not ability to pay' (ST, June 3).
It states that 'the waiting time for clinic appointments is generally
shorter for private patients ... but there is no reason not to
accommodate the wishes of those patients who demand and want to pay more'.
This means that for every patient who is willing to pay the
non-subsidised fee, patients who cannot afford to pay the full fee are falling
further behind in the queue, and end up waiting even longer.
The wage gap means that there may be more people who are able and
willing to pay full, non-subsidised fees, and also more people who cannot
afford other than subsidised fees. This can only lead to a further
widening of the 'health-care waiting times' gap.
Those who can afford to pay the full rate should be directed to private
hospitals, instead of displacing needy patients from the queue.
In a way, this policy also enables public hospitals to compete unfairly
against private ones because some may go for subsidised fees, and are
less likely to switch to private hospitals when they realise that they
have to pay the full rate if they do not wish to wait.
In the letter, 'Public services are meant to serve people' (ST, June
8), Ms Catherine Lim Suat Hong said that using scarce resources as the
thrust of MOH's reply to a Forum letter does not help people who live
with this problem day to day, and that institutions in the health service
need to remember they serve the people - and if a policy is designed to
help needy patients, they should not let challenges they face in
implementing policy blind them from their goal.
As needy patients currently have to wait for up to nine months for
dental procedures, how much longer do they have to endure before policies
that perpetuate the 'health-care waiting times' gap are changed?
It is hard enough for some Singaporeans to be falling relatively
further behind on the economic ladder, so should they face discriminatory
policies like 'there is no reason not to accommodate the wishes of those
patients who demand and want to pay more'?
Prioritising the use of limited resources in health care according to
one's ability to pay, albeit only for non-emergency treatment, is
discriminatory.
I understand that in Britain, its National Health Service cannot
discriminate on this basis.
The disillusion and despair of those in the lower-income group may grow
because of health-care policies that saw the closing of all polyclinics
at night ('Resources finite, hence closure of night clinics'; ST, April
30), the stopping of doctors from advertising that they charge
polyclinic rates ('Why stop doctors from charging polyclinic rate?'; ST, April
5), declining spending on health care over the years ('Individuals
paying more for top-grade health care?'; ST, March 19), and increases in
premiums and deductibles, despite MediShield accumulating over $500
million of surplus ('MediShield's financial status must be protected'; ST,
Feb 16).
Author: Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore))
Title: Patients' needs based on objective clinical appraisal
Author: Bey Mui Leng (Ms) Assistant Director, Corporate
Communicationsfor Permanent Secretary, Ministry of Health
Date: June 8, 2005
WE AGREE with Mr Leong Sze Hian that public hospitals should 'treat
patients based on needs, not ability to pay' (ST, June 3). This is indeed
our approach.
A patient's needs are based on objective clinical assessment, not a
layman's individual preference.
Hence, in the emergency department, all patients requiring urgent
medical treatment are attended to immediately, regardless of their paying
status. Others will have to wait their turn.
In non-emergencies, the waiting time for clinic appointments is
generally shorter for private patients. But treatment for subsidised patients
is not compromised as these are non-acute conditions.
Even where needs are indicated, treatment options are not identical.
There is a wide range of drugs, implants and devices, from generic to
branded products.
We ensure that all patients receive an adequate level of care. But
there is no reason not to accommodate the wishes of those patients who
demand and want to pay more for branded drugs or devices.
Author: Bey Mui Leng (Ms) Assistant Director, Corporate
Communicationsfor Permanent Secretary, Ministry of Health
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Straits Times, The (Singapore)
Title: Treat patients based on needs, not ability to pay
Date: June 3, 2005
I REFER to the article, 'Going paperless slashes waiting time at skin
centre' (ST, May 30).
It was reported that keeping medical records electronically saved the
National Skin Centre $237,000 in labour costs at the end of the year,
and cut patients' waiting time.
I also refer to media reports that said two hospitals here retrenched
108 workers, presumably to cut costs.
When you go to a hospital to seek treatment for a dental problem, you
may be told that as it is not something which warrants immediate
attention, you may have to wait for up to nine months if you pay subsidised
fees.
However, if you opt to pay the non-subsidised rate, you can be treated
immediately.
The same goes for eye operations.
As the question of whether an ailment is serious enough to require
treatment sooner rather than later is sometimes subjective, patients who do
not want to take a chance may opt to pay the full rate.
Those who cannot afford or do not wish to pay the full rate may risk a
deterioration in their condition.
As a matter of principle, should the priority of treatment not be based
on one's health condition, rather than ability to pay more?
Is this fair to the poor and less economically well-off?
What if the rest of the health-care system, such as specialists,
polyclinics and general practitioners, follows the example of the dental and
eye centres?
Hypothetically, if one's health condition worsens and irreversible
damage is done because of the delay in treatment, can the medical facility
and medical practitioner be held liable?
The Health Ministry should examine the ways in which hospitals manage
their financial objectives and resources.
Which is a bigger problem that should be given priority: cutting
waiting time by 30 minutes, or letting those who cannot pay wait for months?
Leong Sze Hian
Copyright, 2005, Singapore Press Holdings Limited
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Paper: Business Times, The (Singapore)
Title: Hello? Anybody listening?
Author: Leong Sze Hian, Singapore
Date: May 25, 2005
I REFER to the editorial 'The matter of governance' (BT, May 13) and
the article 'Singapore slips, but still high in political governance'
(BT, May 16).
For 'voice and accountability', Singapore was placed in the 43.2
percentile rank last year.
In response to the media, the Public Service Division, Prime Minister's
Office, said that public agencies are required to reply to all
feedback.
But in the Ministry of Health's (MOH) replies, 'Mistaken views on
MediShield' (BT, March 1) to my letter 'Suggestions for MediShield' (BT, Feb
23), and 'MediShield's financial status must be protected' (ST, Feb
16), to my letter 'Cap co-insurance, so Class C patients pay less' (ST,
Feb 11), my question, 'Now that MediShield Plus will be hived off to a
private insurer, will the surplus accumulated be transferred to
MediShield and, if so, what is the estimated amount?', has not been answered.
In the Housing and Development Board's reply, 'It's still no to singles
renting HDB flats singly' (ST, Feb 4) to my letter, 'Let singles rent
vacant flats without pairing up' (ST, Jan 20), the question that I asked
about how many rental flats are vacant in addition to the 10,000 unsold
flats, has still not been answered.
As the above two questions are merely requests for factual and
statistical information, I would like to ask why is there no reply after so
many months?
This issue was highlighted by media reports about Madam Cynthia Phua
(Aljunied GRC), who recounted in Parliament the difficulties of getting
civil servants to respond to the public.
Members of the public have also repeatedly raised this issue.
In the April 2005 quarterly newsletter of the Feedback Unit, Feedback
News, Dr Wang Kai Yuen, chairman of the Feedback Supervisory Panel,
wrote with reference to the Feedback Unit's Annual Conference of Feedback
Groups in January, that the government must strive to meet the public's
four 'great expectations':
Singaporeans want to be consulted;
Close the feedback loop
Singaporeans want quality government responses to their feedback
Singaporeans want open discussions and they want the feedback process
to be transparent and inclusive.
By the same token, as a citizen giving feedback, I feel that my
expectations of 'close the feedback loop' and 'quality responses' have not
been fulfilled. The article, 'Singapore among world's best in government
services: Responsiveness to citizens among factors rated highly in
Accenture study of 22 countries' by Raju Chellam (BT, April 27), underscores
the need for Singapore to improve its 'voice and accountability'
ranking, in order to maintain its 'responsiveness to citizens' rating.
In the Economist magazine (March 26 issue), it said that in the United
Kingdom, 'recent data suggests there is a need to restore public faith
in the numbers'.
In an opinion poll last October, 68 per cent of respondents said they
believed official figures were changed to support a particular argument;
58 per cent thought there was political interference in their
production.
It isn't just the statisticians whose reputations suffer as a result.
The government hoped to use figures to prove to voters how well it was
doing. But if the voters don't believe the numbers, it can't.
When will I get a reply to my two questions?
Author: Leong Sze Hian, Singapore
Copyright, 2005, Singapore Press Holdings Limited
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