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Healthcare Financing (Lesson 1 (Challenges (Ageing population, Increasing…
Healthcare Financing
Lesson 1
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Eldershield
Offers disability insurance to all 40 year old Singaporeans with CPF accounts, to risk-pool against the financial risks of suffering a severe disability.
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Lesson 4
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Limitations
In the event that if a person is covered under more than 1 healthcare insurance policy, the total claims made by the insured will always be equal to the total medical expenses incurred.
The original or duplicate bill label is printed on the invoice. Claim processing rules requires submission of original bills. System prints only one original bill. Further reprints will bear the duplicate bill label.
Medishield Life
What is it?
Basic health insurance plan that helps patients cope with large hospital bills and selected costly outpatient treatments
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Better protection and higher payouts, so that patients pay less medisave / cash for large hospital bills
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To avoid "buffet syndrome" where patients may over-consume healthcare because a third party pays, by setting limits on payouts and requiring patient co-payment
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Lesson 3
Medisave
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How to use?
- Let hospital or clinic know if you would like to use medisave to pay for your treatment
- Sign a form to authorize the hospital or clinic to check how much medisave your available, and to deduct from your medisave account.
- Hospital or clinic would work out the bill and submit a claim to the CPF board, CPF then would deduct the allowed amount from yur medisave account and send you a statement of account.
What can i use it for?
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For treatment in old age
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generally covers consultation fees, medical services, drugs and tests necessary for diagnosis or treatment of a medical condition, as ordered by your doctor
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To stay healthy
- Protect yourself against diseases
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Flu and pneumococcal vaccinations for high-risk groups such as the very young, elderly and persons with chronic medical conditions or poor immune function.
- Go for recommended screening
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Lesson 2
Patient subsidy schemes
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CHAS card
Coverage?
Common illnesses such as cold, cough etc.
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Purpose?
Provide Singaporean lower and middle income households with better access to primary healthcare by bringing affordable healthcare services closer
Engages Private practitioners and dentists to provide common outpatient medical and dental treatment to the needy
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Different CHAS cards
CHAS blue
Criteria?
Household monthly income per person: $1,00 and below
Annual Value of home (for households with no income): $13,000
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Coverage?
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Up to $80 (simple) or $120 (complex) per visit and up to $320 (simple) or $480 (complex) per calendar year.
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CHAS orange
Criteria?
Household monthly income per person: $1,101 to $1,800
Annual Value of home (for households with no income): $13,001 to $21,000
Coverage?
Up to $50 (simple) or $75 (complex) per visit and up to $200 (simple) or $300 (complex) per calendar year.
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Subvention
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Types
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Piece Rate Subvention
funds awarded based on the total number of patient days and volume of outpatient consult episodes consumed. Funding is based on usage.
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Casemix Subvention
funds allocated based on DRG. Every DRG depending on the complexity of treatment will command a different subvention amount.
Global Budget Subvention
funds allocated based on lump sum, piece rate and case mix funding principles.
(LESSON 1)
Why were there price variation across institutions?
- Cost structure of every healthcare institutions differs, resulting in price variation. Prices are up to cover costs of the institution. Prices may also differ between inpatient and outpatient
Cost Reduction
- By consolidating common services for the healthcare institutions.
- Resources like medical equipment and manpower can be saved by transferring table patients from hospitals to step-down care institutions like community hospitals, nursing home or hospices.
(Lesson 2)
Why Non-Patient is not eligible for subsidy even though they are Singaporean?
- Non-patients refer to patients seeking allied health services in a healthcare institution that is different from the institution their doctors are practicing in
- Subsidy are given for consult episodes within the doctor's institution
SIMPLE
Refers to visits for a single chronic condition.
COMPLEX
Refers to visits for multiple chronic conditions, or a single chronic condition with complications.
Regaining mobility after hospitalization
Inpatient at a community hospital: $250 per day up to $5000 per year
Outpatient at a day rehabilitation centre: $25 per day up to $1500 per year
For palliative care
Inpatient hospices: $200 per day
Home palliative care: $2500 per lifetime (if you have terminal cancer or end-stage organ failure, there is no limit and you can use your full medisave balance.
Why are there limits on Medisave withdrawals?
So that you have enough medisave for your future medical needs, especially after retirement.
- Limits are genrally enough to cover expenses incurred for subsidized hospitalization at class B2 and C wards in public hospitals.
- Medisave can only be claimed if the patient stays in the hospital for at least 8 hours (unless the patient is admitted for day surgery)
Claim limits:
- Medical / surgical inpatient cases: $450 per day for hospital charges. This includes a maximum of $50 for doctor's daily attendance fees.
- Approved day surgeries: up to $300 per day for daily hospital charges. This includes a maximum of $30 for doctor's daily attendance fees.
- Surgical operations (inpatient and day surgery): fixed limit
- Medisave Maternity package: up to $450 for each day in the hospital plus an additional $450 and surgical withdrawal limit depending on the type of delivery procedure you undergo.
- Home palliative care: $2500 per patient per lifetime
- Psychiatric treatment: up to $150 per day and a maximum of $50 for the doctor's daily attendance fees or a maximum of $5000 a year
- Stay in approved community hospitals
- Stay in approved convalescent hospitals
- stay in approved hospitals
- day in rhabilitation
- treatment in approved day hospitals
Deductible: is the initial amount an insured member needs to pay for claims made in a policy year before any payout from medishield life
Co-insurance: is the % of the claim that an insured member needs to pay, on the portion of the claim above the deductible.
Letter of guarantee
- an official document issued on an episodic or corporate basis by a business entity to undertake the medical bills of patients
- on a corporate basis in the form of a contract is termed the Hospitalization identity card (HIC) scheme