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-Inpatient ward charges,
-Approved day surgeries

Outpatient charges
-Chronic diseases treatment
-Cancer treatment
-Renal dialysis
-Health screening and selected vaccinations
-Community hospital and hospice

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- $450 a day for hospitals stay and varying limits for surgical operations to ensure that medisave is enough for future medical needs.
-Enough to cover Class B 2 and C wards

-Medisave/ Medshield life calculator

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-A portion of your CPF savings account to pay personal or immediate family medical bills
-Medisave can be used for spouse, parents and children medical bill
-Medisave to pay insurance premiums for many shield and integrated shield plans

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-Providing public hospitals subvention funds
-Block funding for patients using subsidized services (Class B2 and C)

-To cover resources such as manpower and consumable supplies

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Lump sum subvention
-Operating funds given to healthcare institution based on budgetary forecast

Piece rate subvention
-Funds awarded based on total number of patients days and volume of outpatient.
-Funding based in usage

Casemix subvention
-Funds based on DRG
-Depends on complexity of treatment

Global budget subvention
-Funds based on lum sump, piece rate and casemix funding principles

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CHAS BLUE
Common conditions
-Up to $18.50 per visit

CDMP
-Up to $80 (simple)
-Up to $120 (complex)
PER VISIT
Up to $320 (Simple)
Up t0 $480 (complex)

Dental Service
-Up to $11 or $256.50 per procedure

CHAS ORANGE
CDMP
-Up to $50 (simple)
-Up to $75 (complex)
PER VISIT
-$200(simple)
-$300(complex)
PER YEAR

Dental service
-Up to $65.50 or $170.50 per procedure selected dental procedures

CHAS FOR PIONEER GENERATION
-Additional 50% off subsidized services at SOC and polyclinics on top of means test subsidies

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-Better access to primary healthcare for  Singaporean lower and middle income
-GP and private dentist
-Subsidized rates
-Covers common illness, basic dental service and chronic diseases under CDMP

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P01-P06

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- Consent Form
-Payslip/Bank statement
-Means- Test declaration form
-Cinsent to release Medisave/ Medishield Information
-Acknowledgement that FC is performed by  patient signing
-Blll
-Medisave authorization form

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-Individual means testing

o   Inpatient admission

For employed: average monthly income for past 12 months
For self-employed:  monthly income within last two years

For unemployed or no income, received full subsidy (65% Class B 80% Class C)

BUT property with an annual value more than $11,000 they are given subsidies of 50% and 65% respectively for B2 and C wards.

-Household means testing

o   Inpatient downgrading

o   SOC enhanced subsidy

o   ILTC subsidy
o   Medifund application

o   Community health assist scheme (CHAS) applications
- Gross income (no deduction of CPF) of person needing care all spouse and immediate family members.

- Annual value of place residence for household with no income

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Upgrading

o   Will switch the remaining charges to A class

Downgrading

o   Must do a means test (household meanest). To check every family household income

o   Normally only need to give personal income (mean test) to go in but if want to downgrade, household mean test is required.

Downgrading/Upgrading

o    Subject to availability. If no slots, remain put.

·        Follow up at specialist outpatient clinic after discharge

o   Class A/B1 charge at private rate

o   Class B2/C charge at subsidized rate

o   Patient classified under industrial accident charge at private rate (injure during worktime by law company needs to pay)

o   All other citizenship will be charge at private rate

Social over-stayer

o   NOT applicable for Class A1

o   Overstay with no medical reason

o   For patients that doctor say can be discharge but want to still stay in the hospital

o   Charge different rate

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- Estimate bill size must be communicates
(If there is a wrong communication wrong bill size, hospital can be sued.)

Patient must be informed to enable decision such as
-Choice of class, primary, private, sub

-To proceed or not to proceed with treatment

-Seek alternative options at other institutions

-Standard or nonstandard options

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-It is to perform before pre-admission testing
-Before and after admission
-Emergency
-If medical condition change within 48 hours, in need to do of another financial counselling under the PHMC actSubsequent changes to hospital bills due to length of stay, medication, complications, more treatment or drugs.

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-Mandatory under the Private Hospitals and Medical Clinics regulation to go through financial counselling.

-To help/save patients and families from financial burden.

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Audit and checks for MAF Plus

-Data will be submitted to MOH

-Clinical Audits

-All applications go through CMB

(Pharmacist, doctor, CMB must sign)

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-To cover non standard and non formulary
-·Drugs must be listed under MAF plus form

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Clinical evaluation
Evidence of efficacy
Favorable safety profile
Ethical consideration

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-To help lower income patient on medication (drugs)

-Max subsidy 75%
-Per capita income $1,500 and below

-Drugs must be listed under the MAF form

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Level 1- Public Assistance
-Pre Qualified Cases
-Medical fee exemption card
-IMH
-Public Assistance Card

Level 2-Straight Forward Applications
-When recommended  % based on household income are eligible (same or lower)
Approved by medical social worker

Level 3- Non straight forward application
-When % is greater than eligible % based on Household income
-Approves by medifund committee

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-Singaporean 18 years old and below

-Low income family

-Medifund don’t help middle income but Medifund junior helps

-Medifund Junior is based on the hospital bill is high and household income, status of family

-Medifund amount of assistance: Different principles

-Household income per capita

ONLY C class patient can enjoy 100% Medifund assistance

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-Singaporeans age 65 and above
-Medifund Silver introduce in 2007 to provide more targeted assistance
2008 Medifund silver was rolled out
-Subsidised patient
-And has taken and absorb all the medisave from the family

Medifund Silver targets at needy elderly as they generally have higher medical bills and are financially more dependent on their family members upon retirement

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Needy patients who has problem paying their medical bills can approach Medical Social Workers of Medifund-approved restricted hospitals and institutions for assistance.

Local Medifund committees at the approved hospitals and institutions will decide on the appropriate level of assistance fir the applications

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Medifund general scheme:
-Medifund assistance:

-Is a Singapore citizen;

-Is a subsidised patient;

-Has received treatment from a Medifund-approved institution
- Patient and family have financial difficulties paying for his healthcare bills despite receiving

- Government subsidies and drawing on other means of payments including MediShield Life/Integrated Plans, Medisave and cash.

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Personal responsibility

o   Patient expected to co-pay according to ability

Medical Necessity

o   Basic

o   Based on necessity, hence exclude non-essential choices

o   No class ward A or cosmetic surgery
Family responsibility

o   Family resources

o   10 medisave can use, use that first
Many helping hands

o   Can rely on charity

o   Charity available use the charity but after charity still not enough than able to use medifund

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-Set up in April 1993

-A safety net is for patients facing financial difficulties with their remaining bills after government subsidies.

·        One specially for elderly.  (Medifund Silver)

·        One specially for needy Singaporeans children age 18 years old and below      (Medifund Junior)

to provide more targeted assistance to two vulnerable groups

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-Advantage:Employed Singaporeans have medical insurance coverage provided by their employers

-Disadvantages: Pre-existing illness or medical conditions

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DEDUCTIBLE
- Initial amount an insured member needs to pay for the claims made in a policy year before any pay out from Medishield Life

-Renew every year

-If paid fully for that year, sessions in the year do not need to pay but still need pay coinsurance.
-To avoid first-dollar coverage and help Medisheild target only large bills

COINSURANCE
-The percentage of the claim that an insured member needs to pay for claims made in a policy year before any pay out from Medishield Life
-To guard against over consumption

CLAIM LIMITS
-The maximum amount you can claim from an insurance policy for each type of expenses
-Example: Daily ward limit, policy year limit, lifetime limit: To address excessive claims

EXAMPLE OF A CASE

If the claimable amount from an inpatient bill is $3,000 and the insurance policy has a deductible amount of $2,000 with a co-insurance of 10%. What is the insurance coverage?

$3000 - $2000 = $1000
$1000 x 90% = $900

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MEDISHIELD LIFE AND INTEGRATED SHIELD PLAN

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MEDISHIELD LIFE AND INTEGRATED SHIELD PLAN

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click on it

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Coordination of Benefits clause

o   To prevent clients to make profit from insurance companies

o   Company would check health bill to check

o   Claim processing rules requires submission of original bills only

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Insurance can be that company buy the insurance for individual or individual would buy.

Two types of health insurance
Catastrophic Medical insurance

o   Cover major illness where the associated medical cost is substantial

o   Example: Medishield Life
Long term care insurance

o   Fix monthly amount for long term nursing treatment

o   Cannot do 3 of ADL, can approach insurance company and activate it

o   Example hypertension and get stroke, paralyzed.

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- Slow Medicine
Longer time to recover
Treatment take a long time to heal for example, high blood pressure, diabetes
Maintain the diseases by going for treatment

An elderly fall feel better but still not stable to walk, go to community hospital (rehab do leg exercise to improve mobility-  slow medicine)

-Fast Medicine
Treatment, medication, drugs

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West
Central
East

Each cluster has their own hospital, community hospital, polyclinics, specialist center, medical school partner.

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Competition creates price diversity

Keep to the ruling

Different institution different pricing

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Centralization creates cost savings through consolidation

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Centralization creates cost savings through consolidation

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o   Group purchasing office (GPO):
Allows for bulk buying of medical consumables and materials. Consolidation of purchases greatly increases leverage of hospitals to demand lower prices.
Standardization of cost prices throughout the cluster.

o   Finance shared services (FSS):
an outsourced account payable,
account receivable and payroll service provider to various institutions under NHG or SHS group and other related companies.
Back end accounting functions are consolidated or shared to reduce the manpower and operating  cost

o   IHIS or integrated health information system was conceived in 2008 by the ministry of health to be the central employer for all public healthcare IT professionals.

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Challenges Singapore healthcare system
Ageing population
Increasing incidence of chronic diseases

Increasing demand for the more healthcare services

Increasing demand for more affordable healthcare

MOH Committee of supply debate 2017
Accessibility

Quality
Affordability

Beyond hospital to community

Beyond Quality to value

Beyond Healthcare to health

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Singapore healthcare financing philosophy

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

Promoting competition and transparency

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MEDISAVE

o   Can take from children

o   Est. April 1984

o   National Scheme help individual set aside part of their monthly income in to Medisave account to meet medical expenses

o   This amount is to help pay their medical bills (CPF)

o   Increase demand for healthcare service, medisave usage is expanded due to increase of ageing population

MEDISHEILD LIFE

o   Revamped in 2015

o   Insurance

o   MOE tie up with insurance company

o   Basic health insurance scheme

MEDIFUND

o   Medisave use up, cash use up than use Medifund

o   A set up to help the poor or the needy

o   Safety net

o   To qualify must be Singaporean, under the Subsidies  and Regulations

ELDERSHEILD

o   For 40 years old and above

o   Only effective when you are disabled

- Stroke, cannot move etc

o   Call insurance to apply Eldershield

o   For 72 months

o   To risk pool against the financial risk of a severe disability

o   Provide monthly cash pay out

Examples of  SUBSIDIES

o   CHAS, Pioneer Generation

SUBVENTION

o   Government pays through subvention

o   Government grant gives to the hospital. Example: $100 medical, patient pay only $20. $80 government pay

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Financial Counselling

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Medifund

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Medishield Life

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Medisave

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Financing for Singapore Healthcare