Sadly, I read in the papers that the rich who can afford the highest level medical insurance plans are probably the biggest/ worst exploiters of the compulsory national healthcare insurance scheme in Singapore. As it is reported in 'New riders for IP plans will include co-pay feature' [ST, 08 March 2018]: "People with full riders have bills that are 60 per cent higher than those without riders." http://www.straitstimes.com/singapore/health/new-riders-for-ip-plans-will-include-co-pay-feature
As I understand, the 60% difference refers to the difference between already rich people: i.e. the rich (own just medishield-life integrated plans) vs the ultra rich (own insurance riders in ADDITION to the integrated plans). As compared to the poor (only have compulsory basic 'medishield-life'), the difference cannot be more stark since as the example highlighted by Mr Gilbert Goh (appended below or at https://www.facebook.com/goh.gilbert/posts/10157361126798975?pnref=story ) some poor Singaporeans skip medical treatments due to inability to afford transportation costs. Having more comfortable care at government and private hospitals may also mean that richer patients live longer and thus stand to benefit from the concept of 'pre-funding' since poor people finding it hard to physically transport themselves to medical care locations implicitly benefit less from the compulsory national healthcare insurance scheme since they will die earlier for reasons of transport costs difficulties and other obvious benefits ONLY available to private integrated medishield-life insurance coverage such as pre/post hospitalization care, cancer immunotherapy, prosthesis benefits, ability to port care benefits to other parts of the world (evacuation costs, overseas treatments) etc. 'Role of pre-funding' https://www.moh.gov.sg/content/moh_web/home/pressRoom/Media_Forums/2013/role-of-pre-funding-.html
I thus will not be surprised that based upon the concept of 'pre-funding', the shortened life expectancy of poor people, the ability of the rich to afford higher quality/ comfort care / greater options, medishield-life has inadvertently (?or by design?) become a means by which the poor are now implicitly if not explicitly funding the healthcare/ treatment costs for rich people.
My suggestion to this obviously obtuse, inhumane, unjust and untenable system of exploiting the poor is to stop any one subscribing to any integrated shield plan or worse still, insurance plan riders (conferring further medical fees waivers) from receiving any subsidies usually accruable to the basic medishield-life portion of the insurance plan. To provide subsidies to anyone who can afford to subscribe to integrated shield plans is a travesty of justice akin to funding private taxi fares (which is an obvious luxury as compared to public transport (bus/ MTR fares)), to fund people subscribing to any integrated medishield-life plan with an additional rider would be like providing subsidies for people who want to own their own automobiles (just because they under declare their income tax or report a small dwelling place as their residential address): an obvious squander of government funds and worse: complicity in the robbery/ exploitation of the poor since as earlier described, any person who gets a deliberate/ unfair 60% (upwards) upperhand in the nett 'access' to common pool medishield-life funds obtained under the communist/ socialist concept of compulsory 'pre-funding' reveals the gross injustice implicit in the design of medishield-life that blindly subsidises holders of private healthcare insurance plans; which obviously will erode national cohesion and trust in government in the long run.
Instead of disbursing medishield-life subsidies liberally (indiscriminately) like one distracts children with cheap candies, a more targeted carrot-stick based upon health consciousness can keep overall cohort medicals claims costs low: e.g. maintaining a low % body fat (below 15% for males and below 25% for females), performing well in fitness tests (modeled after universally used military fitness test like IPPT, with swimming/ cycling alternatives), non-smoking status are all very good (anti-diabetes) options to consider for substantive 'earned' waivers from the costs of premiums for compulsory medishield-life which can be implemented on a national level, as well as the total banning of the use of riders, would make the basic medishield-life scheme a more trusted medical insurance scheme whereby the concept of healthcare insurance returns to the original philosophy of insuring calamities which are unpreventable by doing everything within control to avoid the avoidable (e.g. type 2 diabetes due to sedentary lifestyle, high% body fat causing diabetes etc). Rather than a sneaky way for the rich to siphon $$$ from the poor to fund their own irresponsible and lavish lifestyles in the ultimate tragedy of the commons and let Singapore go bankrupt due to the lawless, free for all, self-serving buffet syndrom mentality, the result of an extremely poorly planned and executed national healthcare insurance policy.
Visited a 50-year-old man who skips his medical appointment twice because he could not gather enough transport money to visit the doctor. He is suspected to have initial stage of cancer of the pancreas and liver. He lost about 30 kg from his previous weight and looks jaundiced.
He also owes a few months of utilities, rental and town council charges but feels most worried about the rental debts as HDB has dropped by already to check on him. He is afraid of losing the home though I assured him that so far HDB has not go hard on rental defaultors unlike purchased flat owners.
Surprisingly, SSO has rejected his welfare application citing that he still has a son who is now working as an intern earning $1200/month. His Malaysian wife is currently back in Malaysia undergoing dialysis for her diabetic condition. Of course, the SSO wants him to get back to work but his ill health and frail body are not helping him much.
He is currently awaiting approval from Comcare side after visiting his MP.
I left Jefri after leaving him with a small amount of cash for his meals and assured him that we will assist in one way or another.
A regular donor has pledged $500 to offset the $600-over rental default and someone has already paid $100 into the SP bill. At least he will have a roof over his head as he nurses his health slowly back to normal.
Apologise that the video is abit soft and last five minutes.
Poor People's Campaign: a ground-up community initiative to improve the living condition of the poor among us.
Everyone must compulsorily conform to the concept of 'pre-funding', however, ultimately, it is the poor who paradoxically subsidise the rich since the rich (leveraging upon insurance 'riders') get to claim 60% more (even after proration is considered):
Reply from MOH
27 Nov 2013, Straits Times
Role of pre-funding
WE THANK Mr David Boey ("Problems with pre-funding"; Nov 19), Ms Maria Loh Mun Foong ("Merits of pre-funding"; last Thursday) and Mr Tan Kin Lian ("Pre-funding not feasible for MediShield Life"; Forum Online, Monday) for sharing their views on the concept of pre-funding for MediShield.
The letters from Mr Boey and Ms Loh may have created the wrong impression that the proposed pre-funding concept will require the younger generation to cross-subsidise the current elderly.
For MediShield, the pre-funded amount contributed by each cohort is set aside for the future use of their own respective cohorts, and not used to cross-subsidise the current elderly.
To address concerns over affordability of premiums among the current cohort of elderly Singaporeans, the Government has indicated its plans to provide help for the older generation of Singaporeans.
As noted by Mr Tan, health-care costs tend to be higher for the elderly. This, plus the effects of medical advancements and changing expectations, will put further upward pressure on future premiums as we age.
For this reason, it will be even more important to set aside some premiums in advance, or pre-funding, to address concerns of premium affordability during old age.
With pre-funding, members pay higher premiums during their working ages and, in return, can receive rebates to offset their own future premiums when they grow old.
With the ongoing review and enhancement of MediShield to MediShield Life, one of the key issues the MediShield Life Review Committee hopes to engage the public on is increasing the role of pre-funding. The committee welcomes all Singaporeans to provide their feedback or sign up for upcoming discussion sessions through http://www.medishieldlife.sg
Ministry of Health