[BicCherry]

Medishield-life: Rich people ROB poor people's life savings in Singapore.

Rich Singaporeans are competing to claim 2.03786x more than middle class, yet medishield-life is supposed to be pre-funded by all, INCLUDING the poor; why do the poor subsidise the rich in the medishield-life insurance scheme?

According to MOH stats, [url='https://www.todayonline.com/singapore/5-co-payment-required-all-new-integrated-shield-plans-full-riders-moh']"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. "[/url]

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 [url='https://m.facebook.com/goh.gilbert/posts/10157361126798975?pnref=story']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.[/url]

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, [url='https://www.moh.gov.sg/content/moh_web/home/pressRoom/Media_Forums/2013/role-of-pre-funding-.html']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.[/url] 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.

Ultimately, no medishield-life nor associated integrated plans should be valid at any private hospital because those Singaporeans who wish to have private insurance coverage are like those who buy/ invest property in foreign jurisdictions: they still have to serve NS in Singapore. But if they have robbers inside their foreign properties, they will call the police of that foreign country in which their home is burgled; the Singapore police force cannot help them with anything that happens on foreign soil. Likewise, all medishield-life related insurance policies shall ONLY apply in PUBLIC hospitals. Those who want private healthcare, they have to buy SEPARATE insurance coverage and only AFTER they have paid up their annual basic medishield-life premiums.

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. Ultimately, the poor are suffering excessively under this PAP raw deal.

The original source URL of this thread is at https://forums.hardwarezone.com.sg/eat- ... t117893855

[BicCherry]

There’s some merit in this argument. I think there are two additional, relatively easy fixes that’d go a long way to temper private hospital inflation:

1. For policyholders who choose private hospital care, just set the MediShield Life payout to be equal to what MediShield Life would pay for an equivalent stay in public hospital B2 ward. Right now it has the same proration factor as public hospital A ward, which seems much too generous. I don’t think there should be a proration factor at all since private hospital pricing can be wild, and a percentage of wild is still wild. So just cap the MSL reimbursement at whatever dollar amount would apply to a public hospital B2 ward stay.

This adjustment might need to be phased in over a period of, say, 3 years since it’d be something of a shock to the private hospital insurance market.

2. When somebody pays for a private hospital Integrated Shield base plan, put another limit on the amount of MediSave that can be used to pay the premiums for that plan. The limit should be equal to the cost of the public hospital A ward Integrated Shield base plan (on a market average basis probably) or the Annual Withdrawal Limit (which already applies), whichever is lower.

I would add that better controlling MediShield Life costs means that coverage can be improved. I’d like to see some coverage expansion into chronic diseases (and medicines), for example. And into prenatal and maternity care, in part because it’s long past time the government got much more aggressive in trying to boost Singapore’s birth rate. Try throwing the kitchen sink at the problem, in policy terms.

About your point 1: "set the MediShield Life payout to be equal to what MediShield Life would pay for an equivalent stay in public hospital B2 ward". I say wild is still wild. Just because they don't pay 1¢, some integrated plan with rider holders demand (or their docs offer) investigation for every small thing, many unnecessary to begin with.

Thus no matter how u look at it, the current over claims situation of 2-3x average will still persists simply because one group (poor) has to pay a % out of pocket but the rich take advantage of the poor in this shared scheme because they treat health care like a buffet with a free hotel stay thrown in.

Maybe one simple way to prorate would be grossly by on a median per day of admission basis.

For those with riders, the proration to insurer would be 50% or less of the equavalent basic medishield-life pay out to a class C patient because it is shown that people with riders have the habit of claiming 2.04 times as much as those with integrated plans but without riders.

Those with integrated plans should have insurer compensated at 80% of the equivalent public hospital C class daily charges because only more wealthy people can afford integrated plans and the 20% will be an implicit subsidy to the poor in Singapore.

No integrated plan or private medical insurance user should receive any form of medishield-life premium subsidy at all because they have obviously more expensive taste and thus should fail the means test for medishield-life subsidies in this regard.

Ultimately, medishield-life should be governed just like public transportation or NS. Everyone must serve the NS even if they should subsequently migrate away from Singapore and everyone has to pay taxes to subsidise public transportation even if they solely travel by PMD or private cars. Likewise, everyone should contribute to medishield-life regardless of whether they use public hospitals (those who want to extend cover to higher class wards in public hospitals can opt for integrated shield plans but all medishield-life plans will have same deductable and co-insurance payment %).

Private hospital insurance plans will be available to non- Singaporeans/PR and only Singaporeans whose medishield-life premiums are not in arrears will be able to participate in any private healthcare insurance plan. All Singaporeans with integrated shield plans and/or private healthcare insurance will also not be eligible for any medishield-life subsidies unless except on a case by case basis (e.g. if they have a rare congenital disease which cannot be treated at a public hospital).

[BicCherry]

OK, you could limit MSL private hospital claims to one per year. How about that?

Could MediShield Life coverage of private hospitals be eliminated completely? Sure, it could. But that's a little too aggressive for my tastes. Besides, some abuse in the public hospitals is possible, too.

One claim per year, might as well DON'T ALLOW ANY AT ALL (e.g. medishield-life is like public transportation or public service like police and fire; if u want to go private, pls buy extra and SEPARATE insurance. However, u will still receive benefits if u decided to get warded at a PUBLIC hospital).

As mentioned, it is because rich Singaporeans are robbing the poorer ones which is the problem due to their selfish/ self-serving mentality to begin with. Thus this is about justice and not about your tastes (u might not agree with national service (NS) as well but I know of someone who is very strongly enthusiastic about it on edmw).

https://forums.hardwarezone.com.sg/eat- ... t117894184 will inform you that part of the overconsumption/ over-stay problem in public hospitals is caused by private medishield-life integrated plan policies as well.

Well, the elimination of "zero dollar" riders should go a long way to help fix that particular problem. We should also keep in mind that poor citizens get free MediShield Life. It's really the middle class, and particularly the middle class that's just barely above the limit for the big MSL discounts and waivers, that's most impacted.

Hypothetically, you could cut down on these distortions by making MSL premiums progressive (wealth-based, ideally). Another possible approach would be to require foreign residents to buy into MSL, at higher premiums of course. That'd tend to improve the risk pool.

Reduction of zero dollar is not a sufficient solution unless u also agree to allow people to be excused from NS just because they pay a certain fee to be excused. The deductible and co-payment is there for a very FUNDAMENTAL reason to make medishield-life an insurance against extremes in healthcare costs and not against ALL healthcare costs. Likewise, for NS, and I shan't repeat myself about the comparison once more. In short, riders to avoid deductable and co-insurance should NOT be allowed for all medishield-life related insurance plans. Patients fearing high medical costs should either invest in keeping fit and strong or else downgrade themselves to an affordable ward. Quality of health care in public hospitals is regardless of ward class (see pict at bottom).

As for foreigners paying into medishield-life, that may be a hard sell because even in terms of worker levies, PAP government is rolling out the red carpet, so wide, some special pass holders receive faked high salaries just so that their employers could enjoy this benefit of zero/low worker levies and also evade corporate income taxes as well. Medishield-life has a pre-funded component. Ostensibly, these rich folks will live longer because to afford pte healthcare, obviously nutrition isn't an issue unlike poor Singaporeans, many if whom live shorter lives due to hardship and malnutrition. Thus, richer Singaporeans shouldn't complain about the medishield-life insurance schemes being cut off completely from private healthcare useage.