Financing for Healthcare Mindmap Lesson 1 - 12 Irfan E65F (LESSON 5…
Financing for Healthcare Mindmap
Lesson 1 - 12
Types of Bills in Restructured Hospital
The Unbilled or Interim Bill stage refers to the period when the bill or invoice is open to addition of new charges
The Provisional Bill stage refers to the period when the bill or invoice is closed to addition of new charges but it is not ready for generation. In the Singapore context, the bill or invoice is submitted via CCPS or Central Claim Processing System for claiming against MediSave, MediShield Life and Private Medical Insurance
The Final Bill is when all the services rendered has been keyed in the system when the bill returns from CPF Board and is ready for generation
Once the bill is finalised, an original bill will be printed and given to patient. In the event that patient request for extra copies of the bill, it will be duplicate copies. Bill stamped with ' certified true copy' and acknowledged by the staff will be treated as original copy.
Fee Cap Inpatient
Fee cap were introduced in 1984 for Class B2 and C patient
Purpose is to ensure subsidized patients would not be put to excessive difficulty in meeting the revised hospital charges due to unnecessary tests/investigations
Currently, fee caps are applied on surgical operations, laboratory tests and specialized investigations, X Rays, rehabilitative services and standard medications
What is Billing?
It is defined as generation of invoice for the purpose of payment collection from a customer
LESSON 1 Financing For Healthcare
Singapore Healthcare Financing Philosophy
Offer universal healthcare coverage to all
Individual responsibility and affordable healthcare to all citizens
Financial Schemes in Singapore
MediSave is a national medical savings scheme which helps CPF members put aside part of their income into their MediSave Accounts to meet their future personal or immediate family's hospitalisation, day surgery and certain outpatient expenses.
MediShield Life is a basic health insurance plan, administered by the Central Provident Fund (CPF) Board, which helps to pay for large hospital bills and selected costly outpatient treatments, such as dialysis and chemotherapy for cancer.
MediFund is an endowment fund set up by the Government. It provides a safety net for patients who face financial difficulties with their remaining bills after receiving Government subsidies and drawing on other means of payment including MediShield Life, MediSave and cash.
ElderShield was set in September 2002 and it offers disability insurance to all 40 year old Singaporeans with CPF Accounts to risk pool against the financial risks of suffering a severe disability.
Eldershield will be replaced by CareShield by 2020.
MOH Committee of Supply Debate 2019
Keeping Healthcare Affordable & Sustainable
Supporting aspirations and needs for Merdeka Generation
Extension of MediShield Life Coverage
Enhancing Community Care & Caregiving
Strengthening our primary care foundation
Building communities of care to support ageing in place
Empowering Singaporeans To Live Healthily
Supporting Women's Health
Strenghtening community mental health services
Equipping Professionals & Providers
A progressive future ready workforce to meet healthcare demands
Challenges facing our healthcare system
Increasing incidence of chronic disease
Increasing demand for more healthcare service
Increasing demand for more affordable healthcare
LESSON 2 Subsidies & Subvention
Community Health Assist Scheme
It provides Singaporean lower and middle income household with better access to primary healthcare by bringing affordable healthcare services closer to patients.
Patient with chronic conditions:
CHAS subsidies at treatment listed under CDMP (20 chronic conditions) can make use of MediSave to pay
Green CHAS Card
From 1 Nov;
Household monthly income per person - $1800 and above
Common Conditions : No applicable
Chronic Conditions (simple) - up to $28 per visit, up to $112 per year
Chronic Conditions (Complex) - Up to $40 per visit, up to $160 per year
Blue CHAS Card
Household monthly income per person $1100 and below
Common conditions - Up to $18.50 per visit
Chronic conditions (Simple) - Up to $80 per visit, $320 per year
Chronic conditions (chronic) - Up to $120 per visit, $480 per year
Dental Services - Up to $11 to $28.50
Subsidies at SOC - 70%
Drug Subsidy - 75%
Orange CHAS Card
Household monthly income per person : $1100 -$1800
Not applicable for common conditions
Chronic conditions (simple) - up to $50 per visit, up to $200 per year
Chronic conditions (complex) - up to $75 per visit, up to $300 per year
Dental Services - up to $26.60 to $170.50 per procedure for selected dental procedures
Subsidies at SOC - 60%
Drug Subsidy - 75%
Criteria - Were born from 1 January 1950 to 31 December 1959 and become Singapore citizen on or before 31 December 1996.
From 1 Nov,
Common Conditions - Up to $23.50 per visit
Chronic conditions (Simple) - up to $85 per visit, up to $340 per year
Chronic conditions (Chronic) - up to $130 per visit, up to $520 per year
Dental Services - up to $16 - $261.50 per procedure for selected dental procedures
To recognize and honor the Pioneer Generation
Criteria - Singaporeans who are 65 years old and older in 2014, and become a Singaporean by 31 December 1986
Additional 50% off subsidized services at SOC and polyclinics on top of means test subsidize
ALL PG receive CHAS benefits regardless of income
Common Conditions - up to $18.50 subsidy per visit
Chronic Conditions (Simple) - up to $90 per visit, up to $360 per year
Chronic Conditions (complex) - up to $125 per visit, $450 per year
Dental procedures - $21 - $266.50 per procedure for selected dental procedures
Government funded ILTC services
-Enhancement to subsidy framework for ILTC framework was one of the key initiatives in Budget 2014
2 out 3 Singapore households which are 80% elderly receive some form of financial assistance with mid income households seeing the highest increase in subsidy levels.
Singapore Citizen 50% without means test, 60-70 % (after means test)
Permanent Resident - 25%
Foreign Resident - 0%
Non- Resident - -30%
Singapore Citizen - 65%
Permanent Resident - 40%
Foreign Resident - 0%
Non Resident - -30%
Inpatient( Restructured Hospital)
Singapore Citizen C Class (65-80%) B2 (65%-30%)
Permanent Resident C Class (32.5-55%) B2 : (25% - 40%)
Lesson 3 MediSave
MediSave usage for outpatient treatment
MediSave usage has increased to $500 per year per account
What I can use MediSave for?
Mammogram screening for woman aged
50 and above
Outpatient treatment for 20 chronic conditions
Medical scans and old age treatment
Paying for insurance
Going for surgery/hospitalization
Who can i use MediSave for?
Immediate family members
MediSave can be used at?
Rehab center/ Dialysis
Lesson 4 Insurance and Employment Medical Benefit
Common types of insurance
Catastrophic Medical Insurance
Cover major illnesses where the associated medical is substantial
Example - MediShield Life
Long Term Care Insurance
Fix monthly amount for long term nursing treatment
Example like ElderShield
What it offers?
Better protections and higher payouts so patients pay lesser MediSave/cash for large hospital bills
Protection for life
Protection for ALL Singapore Citizens and PR includes old and have pre-existing conditions
Covers Singaporean and PR who were not previously covered under MediShield
Integrated Shield Plans
Example of IP's ;
NTUC Income IncomeShield
GreatEastern Supreme Health
ElderShield/ CareShield Life
It provide better protection and assurance in 4 ways
Lifetime cash payouts
Payouts increase over time
Government subsidies making it affordable
Premiums can be fully payable by MediSave
LESSON 5 MediFund
Key Principles MediFund Assistance
Patient expected to co- pay according to ability
Based on necessity, hence exclude non-essential choices
Use immediate family member's MediSave if posible
Many Helping Hands
MediFund to complement, not replace charity funds
Encourage philanthropy to provide additional assistance
MediFund Eligibility Criteria
Received treatment as a subsidized patient
Unable to pay healthcare bills despite receiving government subsidies and and drawing on other means of payments like MediShield, MediSave & Cash.
MediFund Approval Level
MediFund Level 1: Pre Qualified Case (Auto)
MediFund Level 2 : Straightforward Application (SF)
MediFund Level 3: Non- Straightforward Application (NSF)
Needy families with children will be able to draw on MediFund junior for assistance with their medical bills at the public hospitals.
MOH can target more financial assistance for sick children from needy families.
Set up capital of $500 million that was launched in November 2007 in restructured hospitals and institutions.
It was rolled out to all to the rest of MediFund approved institutions in the intermediate and Long- Term Care sector to benefit more elderly patients in 2008.
MOH decided to carve out of MediFund as MediFund Silver to deliver assistance to needy elderly patients.
Calculation of Household Income
Household income is calculated by summing up income (including bonus and allowances, but after deducting CPF)
All immediate family members
All non immediate family members but living in the same household
Lesson 6 Financial Counselling
Rationale For Financial Counselling
Estimated bill size of their forthcoming treatment must be communicated so patient must be informed to enable to make following decisions
Choice of class, Private/Subsidized
To proceed with the treatment or not
Seek alternative options at other institutions
Standard /non standard options
General Rules & Regulations
Upgrading - By requesting to higher ward class, all charges incurred at lower ward class up till the upgrading will be recomputed and charged at a higher class rate.
Downgrading - Patients can be downgraded from private subsidized ward class if they pss the downgrading procedure
Upgrading/Downgrading : subject to availability of beds
Follow up at SOC after discharge
Class A/B1 patients will be charged at private rate
Class B2/C patients will be charged at subsidized rate
All other citizenships will be charged at private rate
Steps in Financial Counselling
Patients/NOK to be introduced to different class of wards and their charges
Subsidized charges on chart is based on 100% subsidies
Subsidies may vary to MT
Allow time for patient/ NOK to decide
Check if previous valid means test result available
Obtain authorization from patient for means testing
Use of paper Means Test Declaration Form
Conduct online means testing
Patient signs Admission/ eFinancial Counselling Form
Lesson 7 Documentation and Inflight Management
Documents Required During Registration
Patient Identification Number
Date of Birth
Other Neccessary Information
3rd Party Payer
Next of Kin Information
Medical Claims Proration System
MCPS is a secure web based medical benefits and claims processing that helps Singapore Civil Service to centrally manage and process employee healthcare benefits.
The system which is integrated with healthcare providers, insurance companies, various government agencies, has significantly streamlined medical claim processes, ultimately enabling public service employees to enjoy medical benefits at clinics and hospitals.
Purpose of Discharge Summary & Interim Bill
Upon discharge, the summary provides details of the patient medical condition. It is given to the patient in the event that the employer or insurer needs the medical information for processing of medical bills
An interim bill is given for the following reason
To collect any cash oustanding before patient leaves the hospital
To ensure patient aware of his medical bills upon discharge
Lesson 8 Charging( Charge Capture Process)
A charge form is a document used by nurses to record the services rendered for a patient.
Data entry of services will then be performed billing staff reading from the charge form.
Services entered into the bill must be reconciled with the charge form
Charges reviewed regularly to ensure that prices and services are updated.
Direct Entry vs Batch Interface
Direct entry of services into billing system by billing staff
They usually use a batch interface to collect transactions over a period of time and then process all the transactions at once
Batch interface of services from ancillary medical system to billing system.
For an online interface system, transactions are processed as and when they are entered.
Benefits of Batch Interface
It can shift the time of job processing to when the computing resources are less busy.
It avoids the adling the computing resources with minute by minute manual intervention and supervision.
By keeping high overall rate of utilization, it amortizes the IT system