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Financing for healthcare (L01: Multi-pillared system (L05:Medifund (Means…

- - - - MOH allows each hospital to determine how to use subvention funds on its own to cover resources like manpower, consumable, supplies(e.g.forceps ,syringes and cotton pads), operating theatres, and buildings.
    - - Piece rate
        
        Funds award based on the total no. of patient days and vol. of out patient consult episodes consumed. Funding is based on usage.
      - Casemix
        
        Funds allocated based on DRG. DRG depend on the complexity of treatment which will command a different subvention amt.
      - Lump sum
        
        Operating funds given to healthcare institution based on budgetary forecast
      - Global budget subvention
        
        Funds allocated based on lump sum, piece rate & casemix funding principles
  - - - Updating in MOH Healthcare plan 2020
      - A&E
        
        Doctor's consultation, Nursing care & treatment, Basic investigation, Basic treatment, Standard medication
      - Government-funded ILTC services
        
        2/3 of Singaporean households (80% of elderly) will be able to receive some form of financial assistance
        
        GST chargeable for healthcare services will be absorbed by MOH for all subsidised ILTC patients
      - Primary care
        
        CHAS
        
        Eligibility Criteria
        
        Blue
        
        Household monthly income per person (For households w/ income)->
        $1,100 and below
        
        Annual value of home (For households w/ no income) -> $13,000 & below
        
        Orange
        
        Household monthly income per person (For households w/ income)->
        $1,101 to $1,800
        
        Annual value of home (For households w/ no income) -> $13,0001 to $21,000
        
        Pioneer Generation
        
        Intent to recognise and honour the Pioneer Generation.
        
        All pioneers will receives CHAS benefits, regardless of income or AV of home.
        
        Criteria: Singaporean, 65 years or older in 2014; became Singaporean by 31 Dec 1986
        
        Additional 50% off subsidized services at SOC and Polyclinics on top of Means Test Subsidies
        
        Additional 50% off medication listed under Standard drug list or Medication assistance fund (MAF)
    - - Singaporean
        
        Documents
        
        Pink NRIC, birth cert., Singaporean father and/or mother
      - Permanent resident
        
        Documents
        
        Blue NRIC, Entry/Re-entry permit, Neonate [PR Mother]
      - Foreigner
        
        Documents
        
        Foreigner civil servant/pensioner OR Gunkha employee, Work permit, employment pass, student pass with SG or PR father, Below 15 years with Singapore Birth cert stating Not Singapore Citizen at birth
      - Non-patient
        
        Documents
        
        Dependent pass, student pass, social visit pass, tourist passport, Malaysian NRIC, Above 15 years with Singapore birth cert stating Not SG citizen at birth
        
        Refers to patients seeking allied health services in healthcare institution that is different from the institution their doctors are practicing in.
        
        e.g polyclinic refer a patient to a hospital and then the patient is treated as a non-patient in the hospital.
        
        Subsidy will be given for consultation within doctor's institution
        
        Non-patients will not be subsidized when allied health services are obtained from another institution
- - - - purpose
        
        Helps to pay for large hospital bills & selected costly outpatient treatments
        
        Integrated Medishield Plan
        
        made up of
        
        2 parts: Additional private insurance coverage & MediShield Life
        
        They also covers those with pre-existing conditions
        
        For serious pre-existing conditions, pay an Additional premium of 30% of Medishield life premiums for 10 years
    - - Automatic inclusion: It covers everyone (All SG citizens & PRs)
        
        Additional premium support for the needy (who cannot afford premiums even after subsidies)
        
        NO ONE will lose MediShield Life coverage due to the inability to afford premiums
  - - - Key Principles of Medifund Assistance
        
        Medical necessity (Exclude non-essential choices like Class A & cosmetic surgery)
        
        Family responsibility (Use Immediate family member's Medisave where possible)
        
        Personal responsibility (Expected to co-pay according to ability)
        
        Many helping hands (Encourage philanthropy to provide additional assistance)
      - Eligibility criteria
        
        •Singapore citizen
        •Receives treatment as a subsidized patient (outpatient/inpatient [B2/C])
        •Received treatment from a Medifund-approved institution,
        •Unable to pay healthcare bills despite gov. subsidies & drawing on other means of payments (e.g Medishield life & Medisave)
        
        Inpatient admission
        
        Only C class patients can enjoy 100% Medifund assistance
      - Application Process
        
        Patient who expressed financial difficulty at any point, is referred to Medical Social worker (MSW)
        
        MSW needs patient's relevant documents & information
        
        MSW will assess them based on household income testing
        
        If patient fulfills criteria...
        
        MSW notifies Patient & Business Office of coverage. Application are submitted for signature
        
        If patient fulfills criteria AND is deserving
        
        MSW will recommend assistance and they along with Business office will prepare Non Straightforward applications to Committee.
        
        Medifund Committee will deliberates during meeting and decision is made
        
        MSW notifies patients of the outcome: Zero/partial/full assistance
        
        3 Approval levels
        
        Level 1
        
        (Auto) Pre-qualified cases
        
        Public assistance
        
        Level 2
        
        Straight Forward applications (SF)
        
        Recommended % based on Household income are the same or lower than Eligible %
        
        Level 3
        
        Non Straight Forward Applications (NSF)
        
        Recommended % is Greater than Eligible % based on Household Income
    - - To benefit elderly patients; deliver assistance to needy elderly patients in a more targeted manner
        
        For Singaporeans, 65 years & above.
      - Can be used for Medifund-approved institutions in ILTC sector
    - - Applicable to children aged below 18
        
        Needy families will be able to draw on Medifund Junior for help with their children's healthcare bills at public hospitals
      - Healthcare institutions will assess the out-of-pocket expenses by the needy families and their family resources before offering them assistance under this new fund
    - - •Help lower income patients who may not be considered as SF for Medifund
        •Focuses on selected clinically-effective medications that may be expensive
        •Separate funding from Medifund, provide more flexibility
      - Eligibility criteria
        
        1.Clinical evaluation (Clearly shown in the form)
        2.Evidence of efficacy (Well supported clinical studies in peer-reviewed journals)
        3.Favorable safety profile
        4.Ethical consideration (No off-label indications + HSA-approved indications only)
      - MAF Plus
        
        Expands to cover non-standard drugs (NSDL)
        
        Increase maximum subsidy level from 50 to 75% upon assessment by Medical social service
        
        Deducted first before using patient's Medifund or Medisave
        
        Eligibility criteria
        
        If clinically appropriate & deemed necessary for patient's condition
        
        To qualify: A documented history of no serious side effects to SDL drugs OR no other clinical drug alternatives
  - - - By managing costs through individual financing
    - - Elderly aged 65 & above
        
        Outpatient treatment: Can use up to $200 of Medisave a year
    - - To meet their future personal or immediately family's medical expenses
        
        Can help to pay for
        
        Hospitalization & surgeries
        
        Scanning (e.g CT & MRI)
        
        Pay for insurance premiums [Medishield life, integrated Shield Plans and Eldershield]
        
        Falling ill when old (Flexi-medisave)
        
        Staying healthy; screenings, vaccinations & chronic disease treatments
        
        Rehab & recovery
        
        Needs repeated treatment e.g renal dialysis or cancer treatments
        
        Treatments to help w/ conceiving, pregnancy & delivery expenses
        
        Palliative care (hospice or at home)
  - - - In the event of severe disability, one is eligible to receive a monthly cash payout for a period of time, depending on the plan.
        
        “Severe disability” is the inability of an individual to perform three or more Activities of Daily Living (ADLs) independently, with or without mobility aids (e.g. walking aids, wheelchair).
      - Automatic Covered for life - Once you start paying premiums, you can make a claim @ any age, should you suffer from severe disability
        
        Even after your premium term is completed @ age 65, you still will remain insured for life
        
        Cash payouts in the event of severe disability, regardless of care setting
        
        Annual Premium payment until age 65 OR when you need to make a claim
- - - - MOH requires healthcare institutions to counsel patients on financial impact of their medical treatment because to save patients & family from financial burden.
        
        MANDATORY - Estimated bill size of their forthcoming treatment must be communicated and patient must be informed to enable them to make decisions
        
        Patients will make decisions:
        
        Choice of class [Private/Subsidized]
        
        To proceed or not to proceed w/ treatment
        
        Alternative options at other institutions
        
        Standard or non-standard options
        
        ALL medical bills are potentially financial crippling (Inpatient treatment, Day surgery, Expensive SOC treatment)
    - - Downgrading
        
        Can be downgraded from private to subsidized class ward if they pass means testing procedure
      - Downgrade/upgrading
        
        Subjected to availability of beds & takes effect when patient physically occupies lower/higher class bed
      - Upgrading
        
        All charges (except patient daily standard ward fee) incurred @ lower ward class up till upgrading will be recomputed & charged at higher class rate
      - Follow-up @ SOC after discharge
        
        Class A/B1 will be charged @ Private rate
        
        Class B2/C patients will be charged @ subsidized rate
        
        All other citizenship will be charged @ private rate
        
        Patients classified under Industrial Accident would be charged @ private rate
    - - Subsequent changes to the estimated hospitalization bill sizes
        
        Due to complications, longer length of stay, more drugs & treatment required, etc.
        
        For patients admitted through Emergency department
        
        A second FC will be done within 48h of admission because the diagnosis and/or treatment that patient require at the point of admission may still be uncertain.
    - - Individual means testing
        
        Inpatient admission
      - Household means testing
        
        •Inpatient downgrading
        •SOC enhanced subsidy
        •ILTC subsidy
        •Medifund application
        •CHAS