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Get set for means test
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Tue, Jan 08, 2008
The Straits Times
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TH | E likely shape of means testing in public hospitals, as sketched by the Health Minister yesterday, will be reassuring to most. Patients will be free to choose the subsidised ward class, with no ban placed on the well-off for, say, stays in C class which is subsidised at 80 per cent. A prohibition could divert resources more efficiently to the needy, but it cannot be defended on grounds of equity and fairness. Income will almost certainly be the sole criterion to test means, not patients' property category and liquid assets such as deposit savings and portfolio investments. This is being practical. A convoluted system of including all asset classes will be hard to administer, besides incurring the risk of encouraging fraudulent behaviour.
But Minister Khaw Boon Wan made no mention of the five-day rule, floated last year as a probable cutoff after which means testing will be triggered. This is not so good news, but sensible. Discharge of patients should be made on clinical considerations, not financial cost to the patient or cost to the hospital in that demand for subsidised beds frequently exceeds supply. In any case, the Health Ministry will continually build more subsidised facilities and of a better quality than is available now. The most pleasing aspect of the likely implementation model is the possibility that retirees, besides the long-term unemployed, will not be subject to any other measure of the means test. They will enjoy full subsidy of whichever ward class they choose. This is just, a necessary concession in an ageing society. The retired elderly are the most vulnerable in health, and their dread of medical bills will grow with advancing years. As for the complaint that the wealthy can access subsidies like the needy and the poor, the fact is that the rich elderly sick are more likely to choose treatment in private hospitals.
Two exogenous features arise from Mr Khaw's preview. First, the 'poorest' of middle-income earners who are barely able to make ends meet - the squeezed group with families which earns moderate income, pays taxes and receives no welfare benefits - will expect fair treatment when the quantum of subsidies relative to income is decided. Mr Khaw's assurance that the present profile of B2 and C patients fits the target beneficiaries is not to be taken as a static situation. Second, Singaporeans should consider private hospitalisation insurance to supplement MediShield and employer-provided cover. This is the appropriate response to the coming of the means-test age, the better to prepare for the grey years. Those with spare income would even want to take out disability or critical illness plans to protect themselves against prolonged loss of employment income.
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