Currently, government subsidies cover up to 80% of treatment costs in public healthcare. In FY19, the Ministry of Health (MOH) spent about $5.7 billion or about 60% of the ministry’s total operating budget. This expected to increase by 13.6% to $6.5 billion in FY20.
To ensure that the subsidies go to those with greater needs, MOH announced on 5 March 2021 a set of changes to the healthcare subsidy framework. This is considerable as much of our healthcare needs are serviced by public healthcare and healthcare subsidies have a significant impact on the cost that we need to pay out-of-pocket. These subsidy changes are expected to be implemented in mid-2022.
Here are 6 things you need to know about the latest changes in Singapore’s healthcare subsidy framework.
#1 Per Capita Household Income (PCHI) Will Be Used To Determine Patient Subsidy For Inpatient Admission To Acute Hospitals
Currently, inpatient admission to acute hospitals is means-tested by individual income. However, in other healthcare settings (such as at public specialist outpatient clinics (SOCs), polyclinics and community hospitals), the mean-testing is already determined by Per Capita Household Income.
The mean-testing for inpatient admission to acute hospitals will be aligned to Per Capita Household Income. This computed as the total gross monthly household income divided by the total number of family members living together in the household. This means that a sole breadwinner who has a high individual income, but many dependents will receive the healthcare subsidy support needed, regardless of he or she is treated at a hospital, SOC or polyclinic.
#2 Same Subsidies (50% To 80%) For B2 And C Wards And Day Surgeries
Currently, B2 wards are subsidised at 50% to 65% of the hospitalisation bill while C wards are subsidised at 65% to 80%. As hospital infrastructure improves, the differences between a B2 and C ward have narrowed. Thus, relying on ward choice to determine subsidies has become increasingly inadequate.
Instead of separate subsidies, patients admitted to B2 and C wards will enjoy the same subsidies ranging from 50% to 80%. The actual subsidy levels will be determined by means-testing of Per Capita Household Income. While the subsidy levels will be the same, the charges for C wards will continue to be lesser than B2 wards. Thus, in terms of absolute bill size, a patient choosing C ward will pay less.
Additionally, the same subsidies level will apply for day surgeries. This means that patients will no longer have to consider the subsidy levels when choosing an inpatient surgery or day surgery as both options would receive the same subsidies.
Subsidy Levels For Day Surgery and Inpatient B2 and C wards for Singapore Citizens. Source: MOH
According to MOH, about 30% of patient bills, mainly from households with lower per capita household income, will see a median decrease in out-of-pocket payments by about $150. This includes 70% of day surgeries which will receive the higher subsidies. About 15% of patient bills, mainly from households with higher per capita household income will see a median increase of about $200.
#3 Higher Subsidies (30% To 80%) In Community Hospitals
Community hospitals provide sub-acute care to patients who no longer require the more intensive care provided in acute hospitals and rehabilitation care. However, due to the existing higher subsidy levels at acute hospitals, patients may be reluctant to move to community hospitals.
To encourage right-siting of care, MOH will increase the subsidies in community hospitals to 30% to 80% and it will apply to both sub-acute and rehabilitative care.
With the changes, 95% of patients are expected to receive higher subsidies. Almost 60% of community hospital patient episodes will see a median decrease in co-payment of about $120, after accounting for MediShield Life claims.
Subsidy Levels For Community Hospital for Singapore Citizens. Source: MOH
#4 Lower Subsidies For Higher PCHI Patients At Specialist Outpatient Clinics (SOCs)
Currently, the subsidies for median and higher-income households (PCHI above $2,000) are set at 50%, while lower-income households (PCHI of $2,000 and below) receive 60% to 75% subsidies.
To better distribute healthcare resources to those with greater needs, MOH will be introducing two new subsidy tiers at SOCs for patients with PCHI above $3,300. Those with PCHI between $3,300 and $6,500 will receive 40% subsidies while those with PCHI above $6,500 will receive 30% subsidies. This is a reduction of 10% to 20% subsidies depending on your PCHI.
Subsidy Levels For Specialist Outpatient Clinic (SOC) for Singapore Citizens. Source: MOH
About 30% of all subsidised SOC patients, mainly from higher-income households, will see an increase in their bills with 70% of these patients expected to see an increase of less than $100 in total co-payment in a year. Once MediShield Life and MediSave is factored in, some patients may not see a higher out-of-pocket payment.
#5 Private Patients In Acute Hospitals Can Opt For Subsidised Follow-Up Care At SOCs
Today, private patients in public hospitals (i.e. A or B1 wards) are not eligible for subsidies in SOCs if they require follow-up SOC consultations after being discharged. For patients with chronic issues that require a long series of SOC follow-ups, this can quickly become an issue of affordability.
To make it easier for patients to access subsidised SOC consultations, private patients will be allowed to opt for subsidised follow-up care at SOCs, with the subsidies determined by their PCHI as part of the mean-testing framework.
According to MOH, this will benefit about 20% of inpatient admissions that are to private wards.
This has implications on those who have private Integrated Shield Plans (IPs) as these plans cover hospitalisation stays but usually have a limit on the outpatient treatment claims. The ability to opt for subsidised follow-up care will mean that a patient can choose to utilise their IPs for their inpatient admission to private wards in public hospitals and then opt for subsidised follow-up care at SOCs without worrying about whether it is covered under insurance.
#6 Flexi-MediSave Limit Will Be Raised to $300
The Flexi-MediSave scheme allows seniors, aged 60 and above, to use an additional $200 of their (or their spouse’s) Medisave a year, for outpatient medical treatments at public specialist outpatient clinics (SOCs), polyclinics and CHAS-registered GPs.
To better support elderly patients, this limit will be raised to $300. The scheme can be used together with other outpatient MediSave Schemes, such as MediSave500 and MediSave700.
MediSave500 and MediSave700 allow patients with complex chronic conditions to use up to $700, while other patients will be able to use up to $500 a year for treatments including the outpatient treatments covered under the Chronic Disease Management Programme (CDMP), vaccinations under the National Childhood Immunisation Schedule and National Adult Immunisation Schedule and selected health screenings.
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