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HEALTHCARE FINANCING :moneybag: (Medifund Singaporean Received…
HEALTHCARE FINANCING :moneybag:
Medisave
Small portion of CPF will go into Medisave account
Earn interest of 4% yearly
Get to use it when hospitalise, day surgery, wife pregenancy, children's and own vaccination, scan, diagnosis and treatment, stay in community hospital and hospice
Can be shared with immediate families (parents, husband and children,
siblings are not immediate families
)
Can use at any public hospital, Medisave-accredited private hospital, outpatient clinics
Can cover expenses in class B2 and C
Flexi-Medisave
65 years old and above
$200 per patient per year for outpatient medical treatment
Outpatient
Scans and diagnosis for cancer patient: $600 per year per patient
Scans and treatment of medical condition: $300 per year per patient
Renal dialysis treatment: $450 a month per patient
Withdrawal limits
Screening and vaccination: $400 per year per account
19 chronic disease: 15% co-payment, $400 per year per account
Surgical inpatient
: $450 per day
Day surgery
: $300 per day
Maternity package
: $450 each day, additional $450 and surgical withdrawal limit depending on type of delivery procedure
Home palliative care
: $2,500 per patient per lifetime
Stay in approved community hospitals
:
Before 1 jun 2010: $150 per day, including maximum $30 for doctor's fee, max $3,500 a year
After 1 Jun 2010: $250 per day, including $30 doctor's fee, max of $5,000 a year
Healthcare landscape
save cost
Finance Shared Services (FSS)
Outsourced accounts payable, account receivable and payroll service provider to various institutions under NHG/SHS group and other related companies
Back end accounting functions are consolidated/shared to reduce the manpower and operating cost
Integrated Health Information System (IHIS)
conceived in 2008 by the MOH to be the central employer for all public healthcare IT professionals
Group Purchasing Office (GPO)
Bulk buying of medical consumables and materials
Increases leverage of hospitals to demand lower prices
Advantage is standardization of cost prices throughout the cluster
Cost reduction
consolidating common services for the healthcare institutions
Transfer stable patients from hospitals to community hospitals, nursing homes/hospices (reduce medical equipment and manpower)
Future healthcare landscape
3 cluster
West (NUH, Clementi polyclinic, Pioneer polyclinic
Central (NHG, woodlands general/community hospitals, hougang polyclinic)
East (SingHealth, SGH, sengkang general/community hospital, bedok polyclinic)
Medifund
Singaporean
Received treatment as subsidized patient (class B2/C for inpatient/subsidized outpatient)
Received treatment from Medifund-approved institution
Not able to pay healthcare bills despite using Medisave, Medishield Life and cash
Only C cash patient enjoy 100% Medifund Assistance (NR and PR not eligible)
Medifund Silver
Singaporeans 65 years or above
Rolled out to the rest of the Medifund-approved institutions in the Intermediate and Long-term care sector to benefit more elderly patients
Medifund Junior
Age below 18 years old
Target low-income families
Hospital can make decision to help middle-income family that has large hospital bill
How to calculation of Household Income
Sum of income (after deduction of CPF) for patient himself, all immediate family members (parents, spouse and children regardless of whether they are living together/apart) and all other non-immediate family members staying in the same household
Total income/no.of people staying in the house
Medifund aprroval
Level 1: Public Assistance, approval by
exemption
Level 2: Straight Forward Applicant, approval by
MSW
Level 3: Non-Straight Forward Applicants, approval by
medifund committee
Medication Assistance Fund (MAF)
Help lower income patients who may not be considered straight forward cases for Medifund
Focus on selected clinically-effective medications that may be expensive
Financial coverage for non standard drugs
Maximum subsidy level of 75% upon assessment
Per capita household income $1,500 or less
Data will be submitted to MOH
Clinical audits to check on application and approval process
MAF Plus
Expand MAF to cover non-standard drugs
Increase subsidy level from 50% to 75%
Deducted first before using patient's Medifund/Medisave
To qualify: patient need documented history of non-response/serious side effect to standard drugs or no other clinical drug alternatives
Data will be submitted to MOH
Clinical audits to check on application and approval process
All applications are reviewed by MAF Plus Panel and approved by CMB
Medishield Life
Basic health insurance plan that helps patients cope with large hospital bills and selected costly outpatient treatment
Cover medical expenses for Class B2/C at public hospital
Patients can pay less Medisave/cash for large hospital bills
Protection for life
Higher claim limits, lower co-insurance rates
Type of Health Insurance
Catastrophic Medical Insurance
Cover major illnesses
Covers inpatient and outpatient
Only can claim when it is after a certain amount
Own-self need to pay a certain percentage of claimed amount
E.g. Medishield Life
Long-term care insurance
Can only activate when you cannot perform 3 ADL, get doctor certification
$400 per month for 6 years
Long term care insurance (pay for medication, maid, get someone to come in and monitor your health)
Limitations
Medical insurance policies have coordination of benefits clause
Claim processing rules requires submission of original bills
Further reprints will be as "duplicate bill"
Future evolution
Fast medicine
Residents who require emergency/inpatient care
Medical conditions managed would be complex
Healthcare service received would be fast pace and high intensity
Cannot be scheduled and can be difficult to organise
Costly and the number of patients receiving curative care (treat patient with the intent to curing them,not just reducing their pain/stress) at any one time might be small
Acute sector must consistently push patients to community hospitals/ community
Slow medicine
Community hospital focus on providing a stimulating environment for preparing the patient for home
Average length of stay would be about 3 weeks (patient would be assessed if there is good potential for recovery)
Provided with high quality physical rehabilitation and sub-acute medical care
Community hospital will help to minise the length of hospitalisation
Focus on promoting in-home care
Partnerships and service links with ILTC providers can be fostered
Affordable basic medical services
Subsidy
Non-Patient
Patients seeking allied health services in a healthcare
E.g. if you are a patient of SGH but SGH don't have eye centre, they refer you to other hospital, you are called a non-patient --> not subsidized
Subsidy are given for consult episodes within the doctor's institution
Allied health services are obtained from another institution
Community Health Assist Scheme (CHAS)
Aim to provide Singaporean lower and middle income households with better access to primary healthcare by bringing affordable healthcare services closer to patients
GP and private dentists can be used
Covers treatment of 19 chronic illness (diabetes, HBP, stroke, schizophrenia, asthma, osteoporosis), basic dental services and chronic illness
Patients referred to restructured hospitals, SOCs and National Dental Centre will pay subsidized rates
Blue card
Singaporean
Household monthly income per person (household with income): $1,100 and below
Annual Value of home (households with no income): $13,000 and below
Common conditions (flu, headache, cough): up to $18.50 per visit
Chronic conditions:
$80 (simple --> 1 disease) per visit
$120 (complex --> more than 1 disease) per visit
$320 (simple) per calendar year
$480 (complex) per calendar year
Dental services: up to $11/$256.50 per procedure
Subsidy at SOCs: 70%, additional 50% for PG card
Drug subsidy: 75%, additional 50% for PG card
Orange card
Household monthly income per person (household with income): $1,101 to $1,800
Annual value of home (household with no income): $13,001 to $21,000
Common conditions: not applicable
Chronic conditions:
$50 (simple) per visit
$75 (complex) per visit
$200 (simple) per calendar year
$300 (complex) per calendar year
Dental services: up to $65.50/$170.50 per procedures (dentures, crowns, root canal treatment only)
Subsidy at SOCs: 60%, additional 50% for PG card
Drug subsidy: 75%, additional 50% for PG card
No CHAS card
Subsidy at SOCs: 50%, additional 50% for PG card
Drug subsidy: 50%, additional 50% for PG card
Pioneer Generation Package
Singaporean who were 65 years/older in 2014
Became a Singaporean by 31 December 1986
Receive CHAS benefits, regardless of income/AV of home
Common conditions: up to $28.50 subsidy per visit
Chronic conditions:
$90 (simple) per visit
$135 (complex) per visit
$360 (simple) per calendar year
$540 (complex) per calendar year
Dental services : up to $21/$266.50 per selected procedure
SOCs
Singaporean:
50% (without Means testing)
50%,60% or 70% (After MT)
PR: 25%
Non-resident: 30% surcharge
Foreign Resident: 0%
Day surgery
Singaporean: 65%
PR: 40%
Non-resident: 30% surcharge
Foreign resident: 0%
Insurance terms
Deductibles
Initial amount an insured member needs to pay for claims made in a policy year before any payout from Medishield Life
To avoid first-dollar coverage and help MediShield target only large bills
Co-insurance
Percentage of the claim that an insured member needs to pay, on the portion of the claim above the deductible
To guard against over-consumption
Claim limits
Daily ward limit, policy year limit
To address excessive claims
Financial Counselling
Counsel patient on the financial impact of their medical treatment
Estimated bill size of their forthcoming treatment must be communicated
Patient will get to choose their choice of wards, to proceed or not proceed with treatment, seek alternative options at other institutions, standard or non-standard options
Mandatory
that
estimated bill size
information be given for inpatient/day surgery treatment as they are
large bills
Help to prevent financial burden for patients and families
Rules and Regulations
Upgrading
: To higher ward class, all charges incurred at the lower ward class up til the upgrading will be recomputed and charged at the higher class rate
Downgrading
: Downgrade from private to subsidized wards class need to pass means testing
Both are subjected to availability of beds
Follow-up at SOCs after discharge
:
Class A/B1 and other citizenship charge at private rate
Class B2/C charge at subsidized rate
Means testing
Individual:
For inpatient admission
Employed: calculate average monthly income received for the last available 12 month period (Voluntary contribution of CPF will not affect)
Self-employed: calculate either monthly income within the last 2 years
Unemployed/no income: Receive full subsidy (class B - 65%, class C - 80%), if live in property with an annual value of more than $11,000 subsidies class B2 - 50% and class C - 65%
Household:
Inpatient downgrading, ILTC subsidy, CHAS application, Medifund application
Calculate of per capita monthly household income: total monthly gross income of family member living in the household above 21 years old including patient/no. of household member
Process of FC
Consent form for Class B2 and C wards
Payslip and bank statements
Means-test declaration form
Consent to release of Medisave/Medishield life
Acknowledgement that FC is performed
Bill
Medisave authorization form for withdrawal/claim of medisave/medishield
Key steps in FC
Check availability of previous means testing (Vaild for 1 year)
Obtain authorization from patient before means testing (Patient's income is private and confidential information)
Means test declaration form (capture signature, serial number for MOH's record and tracking)
Conduct on-line means testing (determine amount of government subsidies patient is entitled to)
Patient signs Admission FC form (acknowledge that patient has done FC)
Introduced the different class of wars to patients
Subsidies may varies due to MT (Qualify that subsidies may varies due to MT)
Allow time for patient to decide (A lot of information and complex decision making)