Compulsory National Healthcare Insurance is a Raw Deal for Singaporean Poor. - Politics Forum.org | PoFo

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#14920694
Compulsory National Healthcare Insurance is a Raw Deal for Singaporean Poor.
Orig title: Calculation: Medishield-life is a Swindle of Singaporean Poor.

Calculation: Medishield-life is a Swindle of Singaporean Poor.

Rich Singaporeans claim 2.03786x more then middle class, what more the poor?

According to MOH stats, "Nine per cent of full rider policyholders made claims in 2016, compared to 7 per cent of those without riders"

"According to MOH, the average bill claimed by a full rider policyholder cost S$9,093 in 2016, about 58.5 per cent higher than that of an average IP holder (S$5,738). Patients with riders were more likely to visit private hospitals than those without riders, contributing to a bulk of this differential. "


Calculation:
Since hospitalization claims rate for rider holder is 9% as opposed to 7% for non-rider holders and also 1.585X more for rider holders,
Increase payout value to rider holders= 9/7 X 1.585= 2.03786 times that of average IP holders.

Since private insurers selling IP plans make claims from (and basic premium payments) to MOH wrt medishield-life, it can be said that those with full riders make in excess of 2X claims from the common medishield-life insurance pool.

Pls note that the actual multiple may actually be even higher than 2.03786 times, since MOH own definition of the 'average IP' holder is likely to also include BOTH partial and full rider holders, the latter of whom make up 30% of the IP pool which in itself is constituted by the more wealthy 68% of Singaporeans.

It was also reported that poorer Singaporeans are unable to receive proper public healthcare cancer treatments because even the public transport costs to and from hospital may turn out to be a hindrance in itself.

It is also noted that the MOH is subsidising many wealthy Singaporeans indiscriminately just based on their declared household address and income levels even though by the fact that these Singaporeans can afford not just IP plans or worse, even very expensive full rider add-on plans, remains prima facie evidence that (MOH is squandering state funds to buy votes given that) by their expensive taste for expensive insurance products, these same wealthy folks are indeed very well to do.

In its inception, MOH explained the huge jump in compulsory medishield-life premiums over the old optional medishield plans by using 'prefunding' (with the option of future premium discounts and refunds) as the reason why basic medishield-life premiums for the young increased so much. Yet, short of doing IP plan insurance companies a business favour and helping them mediate amongst themselves an agreement to cease the sale of loss making full rider for medishield-life IP plans (and coincidentally reducing the population of (double value claims) full rider holders in the process), MOH is doing precious little independently to lead in reducing the raw deal that medishield-life especially gives to the poor ('prefunding') and the SQUANDERING OF STATE FUNDS, aka increase in GST. Perhaps, for a start, all basic medishield-life subsidies to anybody with an IP rider should be REMOVED with immediate effect and those with IPs, 1year later. Only those on BASIC medishield-life compulsory insurance (and no other hospitalization insurance plans) can qualify for medishield-life premium subsidies of any form.

In short, medishield-life and its subsidy structure is a raw deal for poorer Singaporeans and a big extravagance of government funds with the consequence that GST has to be unnecessarily raised for all.
#14924379
01asdf (HWZ) wrote:*Yawns* Reposting again after admitting that caps and claims limits mean people with riders are actually paying for their so-called inflated claims through insurance instead of "cheating the poor"?


There is ZERO lifetime limit where basic medishield-life claims is concerned. Also, caps and claims limit on the basic medishield-life portion apply EQUALLY across the board whether or not the citizen has private shield plan (insurance) or not, just that all costs are pro-rated to C/B2 class costs when private insurers attempt to back claim from gahmen for the basic medishield-life compensation portion of actual private etc hospitalization costs.

There is presently no discrimination by condition; as such, a 2.04X over-serviced wealthy patient cohort will also translate to private insurers making 2.04X higher claims to MOH for prorated basic medishield-life compensation for a same patient demographic cohort (because rich patient cohorts don't feel any concern about costs because their riders cover everything 100%)... inadvertently, the poor suffer because basic medishield-life has to pay out 2.04X higher claims to the private rider owning medishield-life cohort despite both cohorts paying the exact same annual premiums into the basic medishield-life insurance fund pool.

Whilst caps and limits exists, they are of MINIMAL RELEVANCE to the fact that rich Singaporeans are exploiting the poor. By the time claim caps/ limits are reached, the situation is totally out of control already.

Therefore, please do not attempt to evade the fact that rich Singaporeans do claim DIRECTLY 2.04X more than average /poor Singaporeans from the common basic medishield-life fund pool by using the minimal effect of caps and claims limits which is of almost zero significance to begin with.

Perhaps due to rich Singaporean cohorts claiming 2.04X the average poor cohort payouts from medishield-life, MOH should DOUBLE the basic medishield-life premiums of integrated shield plan holders, with private insurers paying MOH double in basic medishield-life insurance premiums... That way, the historically doubled payouts demanded by wealthy integrated plan holders (with riders) can be fairly balanced by their appropriately doubled (2.04X) contributions to the compulsory (prefunded) common medishield-life public insurance fund pot.
#14926038
SGuy1976(HWZ) wrote:TS should spend some time trying to understand how MediShield and isp works.
Patient goes for operation, if patient is on full rider. The patient claims from insurance company and insurance company claims the normal class C operation fee from the MediShield base plan. The rest have to be absorbed by the insurance company, which is why they are screaming to change the terms.
The only problem is that those on full riders are more likely to visit a doctor and a private one.
So now moh has declared that they are going after private doctors who were naughty with unnecessary procedures and inflated bills.
Moh is getting the data ready for publishing fees guidance which will most probably be used by insurance companies to cap the payout. So supposedly full riders will no longer cover the full bill if the doctor’s bill is outside of the guidance range. So no more business for Susan Lim from the insured.
Read more at the old appleyum thread.
Cancel my cheesepie Prudential insurance policy ! At last can sleep well at night !


Of course MOH/ insurers can publish fee guidelines, however there exists many ways to skin a cat and unless a charge is a definite outlier or very egregious, MOH is unlikely to quibble and just pay the prorated C/B2 class amount.
However, one must consider also that because private specialists are more experienced and have fewer patients to see than public hospital specialist, they can easily over service the patient on full rider who also may have less reason to suppress hypochondriac behavior because rider covers all costs and either repeatedly makes the same complaint or else goes doctor hoping resulting in duplicate tests being done (e.g. 12 nose scopes in 1 year) or seeking out the latest, most expensive treatments (e.g. minimal invasive robotic surgery) justified only by the small scar. Unfortunately, MOH isn't privy to the investigation findings nor operation details and would rather just pay up because the surgery has already been done and the surgeon can always say that he was just being cautious or that he only does robotic surgery because all his patients demand small (minute) scars.

Some patients may also treat the private hospital like a hotel and demand investigation about every minor problem just to prevent discharge. Private hospitals are much more likely to acquiescence as opposed to public hospitals who face a bed crunch and are closely monitored by MOH.

MOH basic medishield-life are thus unable to examine every single claim made and may have to pay penalties for payment delay or even pay fees to multiple medical specialists to get details about the hospitalization episode. Patient confidentiality issues also mandate that MOH needs patient consent to apply for more information regarding the hospitalization episode.

Given the large volume of claims being made and the spot on diagnosis that buffet syndrome by doctors and patients is the reason for excessively high claims by rider holders as well as the fact that the core pillar protecting medishield-life from abuse are the co-payment and deductible features, then these features should be STRICTLY ENFORCED across the board and patients need to either buy their own separate insurance cover and claim zero from medishield-life for a particular hospitalization episode (just like they choose to claim from company hospitalization insurance or personal health insurance but not from both)...

All Singaporeans serve NS and SAF is only obliged to defend them/their physical properties located on Singapore soil. All Singaporeans serve NS even if they have foreign properties / citizenship / depend on foreign government to protect their foreign properties/ live abroad ... likewise, ALL MEDISHIELD-LIFE based insurance plans need to have the same co-payment % and deductible amounts as strictly enforced as NS for 2yrs, even if some Singaporeans have their own private insurance schemes.
#14926255
teaserteam (SGtalk) wrote:So the Gov protects the insurers from losing money at the expense of citizens just because there are a few black sheeps who misused the insurance to pay many unnecessary hospital bills? Why the bulk of us have to suffer because of this?


Doctors like the following (Dr Lim Wee Kiak) also equate high earnings with dignity, they are medical specialist in private practice and also sitting as MP in parliament. As mentioned, medishield-life insurance MAIN PURPOSE is to protect against HIGH hospitalization bills, not ALL hospital bills. The design of medishield-life makes the patient one important safety check that treatments are cost effective and not merely cosmetic or to bankroll doctor's path to get filthy rich.

Law is law...gahmen says no drugs/private gambling, do doesn't mean that within confines of private residence can do drugs or operate gambling den.

Likewise, medishield-life basic and all its other permutations are like NATIONAL SERVICE , non-negotiable even if later u wan to drop Singapore citizenship, serve first, talk later... Ditto medishield-life, u can choose to claim private, foreign or company health insurance cover but U still have to pay medishield-life basic premiums because it is a form of National Service and deserters whether AWOL from medishield-life or National Service all have to serve time in PRISON.

Thus, whilst the current case is that of the tail wagging the dog, where MOH is behaving like the Public Relations manager of the Singapore Private Health Insurance Business Federation, there are actually genuinely important reasons why private riders are INCOMPATIBLE with the original design and purpose of medishield-life to begin (and should NEVER have been allowed to be sold beginning since 1994).
Normally, two wrongs do not make one right, but in this case it does. As egged on by insurers, MOH is now making amends for the mistake it made in 1994, to allow private insurers to begin to sell medishield-life with the option of adding on riders. [url='https://forums.hardwarezone.com.sg/eat-drink-man-woman-16/pap-gahmen-squandering-tax-payers-%24%24%24-irresponsible-medishield-life-fund-5848930.html']This 'rider business' has all along been INCOMPATIBLE with medishield-life being designed to insure ONLY against high medical bills, however the flaw of the 1994 decision has only with audit come to recently to light, that claims by rich Singaporeans (using riders) were 2.04 times that by middle class Singaporeans (with none/partial riders) meaning that ironically , poor were subsidising the rich which is antithetical to Singapore's status as an egalitarian nation state.[/url]

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"If the annual salary of the Minister of Information, Communication and Arts is only $500,000, it may pose some problems when he discuss policies with media CEOs who earn millions of dollars because they need not listen to the minister's ideas and proposals. Hence, a reasonable payout will help to maintain a bit of dignity."
- [url='https://sg.news.yahoo.com/blogs/singaporescene/reasonable-pay-help-maintain-bit-dignity-084833549.html']MP Lim Wee Kiak apologises for comments on pay[/url]
Image[[url='http://asingaporeanson.blogspot.sg/2012/02/khaw-beh-khaw-bu.html']IMG URL[/url]]
#14926270
Chromesthlesia(HWZ) wrote:Erm, I kind of think it is a chicken and eggs problem though. Poorer people try to claim as minimally as possible because they can't afford the ip riders premiums.

But rich people claim frequently since their rider covers 100%, even with the new inclusions of 5% co-insurances.

My point is: even if you changed the premiums revision, which is a good thing, you can't exactly solve the bigger underlying problem which motivates a rich/poor person's claims;

Poverty.


Which is why all these stupid tag-on integrated shield plans should either be scrapped (dissociate themselves from basic medishield-life) or else MUST conform to the basic principles that enshrine medishield-life: universally enforced deductible and co-payment % amount, pro-rated for hospital type and class: same philosophy as for NATIONAL SERVICE : 2yrs at 18yrs age to be served without delay regardless if person wants to later change citizenship or if family is influential/ rich because its a national security issue.

If the individual wants to have other alternative private insurance plans, he can have whatever he wants from anywhere in the world; however, he must first pay his dues to basic medishield-life and thereafter buy whatever he wants. Just as for NS all have to serve when called to do so and all defaulters are immediately sent to jail.

Technically PAP planned medishield-life it this way (it is self-explainatory by its design), however in between, they chose the populist path, wanted to please the rich and also profit the insurance companies ... this time bomb could be hidden by the then youthful and healthy population, juvenile(inexpensive) medical technology and facile audits of medishield-life claims since riders were sold starting 1994... ends up, with today's high costs medicine and aging population, the cat is now out of the bag with evidence that the system is broken with the poor having to subsidise the healthcare costs of the rich- which is a grave injustice and the antithesis of a modern egalitarian cosmopolitan society.
#14926504
Medishield-life is a betrayal of Singaporeans to foreigners who become new citizens.

Isn't it blatant DOUBLE STANDARDS when Singaporeans have "to pay the accumulated sum of premiums not paid previously, with compound interest" i.e., any payments unpaid since 2015 (year of start of medishield-life) but New Singapore Citizens and Permanent Residents don't have to pay medishield-life premiums since their birth year or 2015 (whichever later), but just since "within 1 month of attaining permanent residence" .

The reason why Singaporeans living abroad have to back pay ALL unpaid medishield-life premiums is premised upon the concept of 'pre-funding' https://www.moh.gov.sg/content/moh_web/home/pressRoom/Media_Forums/2013/role-of-pre-funding-.html that MOH used to justify high premiums collected when a citizen is young so as to accumulate sufficient cohort linked reserves in the medishield-life fund so that premiums can be reduced for the same cohort in old age. Thus the need for previously exempt Singapore citizens "to pay the accumulated sum of premiums not paid previously, with compound interest" even though zero claims were made against medishield-life (owing to the very rigorous exemption qualifying criteria such as not being allowed to stay in Singapore for more than 140days over 5 years).

However, MOH is only too eager to give NEW citizens and foreigners a FREE LUNCH by saying:
https://www.moh.gov.sg/content/moh_web/medishield-life/resources---faqs/faqs.html#7
UNIVERSAL COVERAGE FOR ALL:
Will new Singapore Citizens and Permanent Residents be required to join MediShield Life?
New Singapore Citizens and Permanent Residents will be required to join MediShield Life, in line with the principle of universal coverage.
- New Singapore Citizens and Permanent Residents with serious pre-existing conditions may have to pay Additional Premiums upon joining MediShield Life. They will be eligible for Government subsidies for their MediShield Life premiums if they meet the eligibility criteria and will receive premium rebates in line with their age of entry.
They will be notified of their MediShield Life cover by Central Provident Fund Board when their covers have been issued, generally within 1 month of attaining permanent residence.


Thus, nothing is mentioned about new citizens having "to pay the accumulated sum of premiums not paid previously, with compound interest" i.e. blatant DOUBLE STANDARDS.

MOH is also being DISHONEST to retain the 'prefunded' portion of medishield-life of PRs who relinquish their PR status to return home.

The fact that MOH treats new citizens better than old ones and swindles PR returning home shows that the Singapore government is corrupt and is a crafty and wicked organization.

See also:
PAP gahmen is SQUANDERING tax payers $$$ and IRRESPONSIBLE with Medishield-life fund
===============
MediShield Life Coverage for Overseas Singaporeans
The MediShield Life Council’s Review and Recommendations
The MediShield Life Council has reviewed the issue of MediShield Life coverage for overseas Singaporeans.

The MediShield Life Council recognises that there is a small and distinct group of overseas Singaporeans who have chosen to live outside Singapore permanently, have no intention to reside in Singapore, and feel that they will not benefit from MediShield Life. The MediShield Life Council has recommended an administrative arrangement for this group of overseas Singaporeans where they can apply for suspension of MediShield Life premium collection.

The Ministry of Health has accepted the Council’s recommendations. Please click here for the press release.

Administrative Arrangement for Overseas Singaporeans who have Permanently Relocated Abroad
Overseas Singaporeans who live outside Singapore permanently with no intention to reside in Singapore can apply for and be granted the suspension of MediShield Life premium collection, if they meet the eligibility criteria. The suspension will continue for each person as long as he continues to fulfil all the criteria. Any outstanding premiums prior to the start of the Suspension Period1 must still be paid.

Cessation of the Suspension of Premium Collection
Should a successful applicant (a) choose to relocate back to Singapore or (b) no longer meet the eligibility criteria for suspension of premium collection, the arrangement will cease. He will have to pay the accumulated sum of premiums not paid previously, with compound interest2. He would not need to pay additional premiums for health conditions developed during the Suspension Period1.

Similar to all Singaporeans, Overseas Singaporeans who choose to return may be eligible for premium subsidies if they apply for subsidy assessment and provide sufficient timely documentation prior to each policy year during suspension. Besides subsidies, financial assistance may be available upon return and members may apply for assessment on a case by case basis.

Seeking MediShield Life Coverage for Treatment in Singapore
If a successful applicant seeks medical treatment in Singapore during suspension of MediShield Life premium collection (e.g. while visiting), he can choose to claim and benefit from MediShield Life payouts. Once he does so, his suspension of MediShield Life premium collection will cease and he will have to pay the full sum of the premiums not paid previously, with compound interest2.

1 The Suspension Period will start on a date specified by the Board when your application is approved and will end when the Insured’s MediShield Life Scheme cover ends or the suspension of premium collection is earlier ceased by the Board.
2 The interest rate is currently 4% per year and will be subject to applicable laws as may be amended from time to time. Interest will be imposed and computed on a compounded basis on full policy years that have passed.

Eligibility Criteria
Those who meet all of the following criteria are eligible to apply for the suspension of premium collection:
a) Singapore Citizen
b) Live outside Singapore permanently with no intention to reside in Singapore, based on the following supporting indicators:
i. Possess a valid permanent residency permit in their country of residence;
ii. Resided outside Singapore for at least five years immediately preceding the date of receipt of the application by the CPF Board, except for short visits3;
iii. Have completed their full-time National Service obligation, or are not required to serve full-time National Service; and
iv. Able to afford healthcare treatment in their country of residence, and declare that they do not need to rely on MediShield Life in Singapore.4

3 Visits to Singapore during the five years should not exceed 140 days in total.
4 Applicant should not have benefitted from MediShield or MediShield Life payouts in the five years prior to the start of the suspension of premium collection.

For more information on the detailed eligibility criteria for specific groups, e.g., for minors, please click here.

If you meet the eligibility criteria and wish to apply for the suspension of MediShield Life premium collection, please click here.

Frequently Asked Questions and Further Information
For frequently asked questions for MediShield Life coverage for overseas Singaporeans, please click here.
For further information on MediShield Life, you may:
a) Call us at 1800-222 3399 (or +65 6222 3399 if calling from overseas) from Monday to Friday, 8.30am to 5.30pm, Singapore time; or
b) Email us at contactus@medishieldlife.gov.sg

https://www.moh.gov.sg/content/moh_web/medishield-life/about-medishield-life/medishield-life-coverage-for-overseas-singaporeans0.html
#14929896
24yrs MOH Mistake to use Public Insurance System to fund Private Hospitalization costs.

And the expansion of medishield into medishield-life (2015) just magnified and aggravated these mistakes...

Isn't medishield-life like a form of National Service / income tax, with fixed parameters (e.g. 2yrs duration)/ universally applied income tax scale designed to be fair and equitable to all citizens?

Imagesource : https://www.moh.gov.sg/content/moh_web/medishield-life/about-medishield-life/medishield-life-benefits.html

Medishield-life by definition and reason for conception, is as an insurance against extremes of PUBLIC hospitalization costs and intrinsic to its design is the need to pay deductible and co-insurance (3-10%) as a deterrent against people living unhealthy lifestyles and thus requiring AVOIDABLE hospitalization for AVOIDABLE lifestyle diseases.

This deterrence effect against unhealthy lifestyles should apply across the board and like NS, cannot be shortened/ waived with the payment of a bribe/fee.

Whether officer or private rank in NS, all NSF serve the same 2yrs. NS also applies to all Singapore citizens even if they reside/study abroad/ plan to migrate in future.

Ditto income tax for all income earned in the world (except for the case where Singapore has mutual agreements with foreign governments to tax based on earned income location).

In the case of BOTH medishield-life AND NS, non-compliance will result in a jail term as well as compensation payment to the government in lieu of default.

As such, Medishield-life ought operate upon the same universal principles as NS, which means all integrated medishield-life plans should adhere to the same deductible and co-insurance requirements as basic medishield-life, meaning that anyone who wants to enjoy the blank cheque/buffet style benefits of 100% cover (free from deductible /co-insurance)/ private hospitalization cover should buy their own separate private hospitalization policy but first pay medishield-life basic premiums.

Integrated medishield-life plans should only be used to cover A and B1 ('private') wards in PUBLIC hospitals (deductible and co-insurance rates unchanged across all medishield-life based plans) and should NOT apply to private hospital use.

Just as all national taxes are pooled to support public transport, police/ fire service, people have the option of using private car transport/ attend private schools /home school/ private security at their own personal costs but that doesn't discount their national duty to pay personal income tax etc to fund these public goods.

Likewise, those who want private hospital (or 100% as charged public hospital A/B1 ward) cover should buy their own private health insurance at own costs and medishield-life should be treated like a form of income tax/national service which they have to contribute to (even if medishield-life only covered PUBLIC healthcare costs) because it is classified as a public insurance / necessity /public good. Claims from private insurers or medishield-life should be mutually exclusive: i.e. a bill can be claimed vz either process but not both (just like home schooling/ pte transport use doesn't afford one discounts from NS/ income tax payment).

The consequence of MOH policy mistake is seen today in the fact that rich people with riders are exploiting the poor by making double (approx 2.04 times* or even more ) as much as is claimed by the average medishield-life policy holder: akin to broad daylight robbery of poor Singaporeans.

Riders providing a blank cheque/ promoting buffet syndrome amongst private sector doctors and patients respectively only causes more public sector doctors to abandon public hospital patients for the lucrative private sector because the MOH (PAP gahmen) is complicit in robbing the poor to make private sector doctors rich by allowing rich people (exploiting the rider and ABSENCE of public healthcare limitation loophole), to evade fundamental location, co-insurance and deductible rules which are a main pillar in the design of medishield originally and its subsequent expansion into compulsory medishield-life- i.e. to misuse/ exploit a highly structured and focused national PUBLIC hospitalization insurance program into one that offers blank cheques and buffet style PRIVATE healthcare consumption for the privileged few who exploit glaring loopholes of a public hospitalization insurance plan for their limitless private hospitalization buffet syndrome demands.

PAP thus needs to admit its 24yrs old MISTAKE of allowing an essentially public hospitalization cover to be misused/ misdirected for private hospitalization use in order to make medishield-life sustainable and affordable for the common man on the street.
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References:
Medishield was started in 1990 and integrated plans with riders allowed in 1994 https://www.todayonline.com/singapore/5-co-payment-required-all-new-integrated-shield-plans-full-riders-moh

"rich people with riders are exploiting the poor by making double (approx 2.04 times* or even more ) as much as is claimed by the average medishield-life policy holder" see article 'PAP gahmen is SQUANDERING tax payers $$$ and IRRESPONSIBLE with Medishield-life funds.'

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