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Lesson6: Financial Counselling (Key Steps and Considerations (Patients or…
Lesson6: Financial Counselling
Rationale
Require healthcare institutions to counsel patient on the financial impact of their medical treatment
Estimated bill size must be communicated, allowing patients to decide: choice of class (private or subsidised); proceed or don't proceed with treatment; seek alternative options at other institutions; standard or non standard options
Mandatory to give estimated bill size information for inpatient or day surgery treatment (large bills) prior to or upon admission
Intent: save patients and families from financial burden
Should observe intent of this requirement for ALL medical bills that are potentially financial crippling (includes SOC)
Should be done when there are subsequent changes to the estimated bill size (complications, longer length of stay, more drugs or treatment required)
Second FC should be done within 48 hours of admission (diagnosis and/or treatment that the patient may require at the point of admission may still be uncertain)
General Rules and Regulations
Upgrading
request for upgrade to higher ward class, charges except patient daily standard ward fee incurred at the lower ward class up till the upgrading will be recomputed and charged at the higher class rate
subjected to availability of beds and takes effect when the patient physically occupies the lower/higher class bed
Downgrading
can be downgraded from private to subsidised ward class if pass the downgrading procedure (means testing)
subjected to availability of beds and takes effect when the patient physically occupies the lower/higher class bed
Follow-up at SOC after discharge
Class A/B1 patients: private
Class B2/C patients: subsidised (only for SC and PRs)
All other citizenship charged at private
patients classified under Industrial Accident would be charged at private
Social over-stayer (not applicable for Class A1)
Class B1: ward charge (235), daily treatment fee (90), all procedures and service discharge medication (full rate)
Class B2: ward charge (200), daily treatment fee (90), all procedures and services discharge medication (full rate)
Class C: ward charge (170), daily treatment fee (90), all procedures and services discharge medication (full rate)
Means testing
What
Targeted at preventing the undeserving "rich" from abusing the subsidies
Middle-income group is expected to be worst hit by means testing
Those with chronic conditions requiring long-term healthcare fear they might not be able to cope with the financial burden should the existing subsidies be lowered
There are 16 MT bands per patient class, with 4 subsidised patient class: PRB2, PRC, SGB2 and SGC
Hence: 64 MT bands (automation is required for financial counselling)
Current means testing framework impedes free movement of patients (complexity and difficulties of household means testing vs individual means testing
Patient will resist admission to community hospital or ILTC if entire household must be subjected to means testing
Admission to inpatient far less complex (only patients will be means tested)
Online signature is legal in court of law but the document and signature must be fused together (document and signature must not be saved as separate element)
Individual means testing
Used for inpatient admission
Employed: based on the average monthly income received for the last available 12 month period (bonuses, but not the last salary, are included for calculation). Voluntary contributions to CPF will not affect the income information
Self-employed: based on either the monthly income derived from the last available net trade income assessed by IRAS within the last two assessment years; or the income declared to CPF Board within the last 2 years
Unemployed or no income: receive full subsidy (65$% for Class B and 805 for Class C). BUT if have property with annual value of more than $11,000 (50% for B2 and 65% for C)
Household means testing
Used for inpatient downgrading, SOC enhanced subsidy, ILTC subsidy, Medifund application, CHAS application
Takes into consideration:
gross income of the person needing care, his/her spouse and all immediate family members living in the same household; and total number of family members living in the same household
annual value of place of residence for households with no income
the norm to determine eligibility for subsidy and assistance
Per capita monthly household income = (total monthly gross earnings of the family members living in the same household who are 21 years and above, including the patient/care recipient) / (number of family members living in the same household, including the patient/care recipient)
Family members living in the same household: all related family members (blood, marriage or legal adoption) staying at the same residential address with the patient, as indicated in the NRICs
Key Steps and Considerations
Patients or Next of Kin to be introduced to their different class of wards and their charges (different ward types with different subsidy levels, and possibility of ward switch)
Subsidised charges on chart is based on 80% subsidies (information before means testing is performed)
Subsidies may varies due to MT (qualify that subsidies may varies due to MT)
Allow time for patient/next of kind to decide (a lot of information and complex decision making to the patient and next of kin)
Check if previous valid means test result available (means test result valid for 1 year)
Obtain authorisation from patient before means testing (patient's income is private and confidential information)
Use of paper Means Test Declaration Form (capture signature; serial number for MOH's record and tracking)
Conduct on-line means testing (means testing determines amount of government subsidies patient is entitled to)
Patient signs Admission/eFinancial Counselling Form (obtain acknowledgement from patient that FC is done)
Ways hospital staff can help with choosing appropriate types of service
inform patients on the doctor(s) charges, estimated total bill size, comparative information on the average bill size/day at the various government, restructured and private hospitals
ensure that patients are provided with key information on hospital deposit requirements, Medisave, Medishield Life and Medifund
made known to the patient and/or a family member if Medifund scheme is not applicable
NOTE: ensure that an acknowledgement is signed by the patient or, if he is unable to do so, by the patient's family member, to indicate that they have been given adequate financial counselling either prior to or upon admission to the private hospital