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

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

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

Promoting competition and transparency

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

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.

Keep to the ruling 

Different institution different pricing

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

 

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. 

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 

-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

-Disadvantages: Pre-existing illness or medical conditions 

-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

o   Patient expected to co-pay according to ability

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

-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. 

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

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

-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

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

-Drugs must be listed under the MAF form

-Data will be submitted to MOH

-Clinical Audits

-All applications go through CMB

(Pharmacist, doctor, CMB must sign)

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

-To proceed or not to proceed with treatment

-Seek alternative options at other institutions

-Standard or nonstandard options

o   Will switch the remaining charges to A class

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.

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

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

-Medisave/ Medshield life calculator