Portion of Average Bill for Surgical Procedure Paid Via MediShield Life and Via Out-of-pocket Payments

15 Mr Xie Yao Quan asked the Minister for Health (a) what portion of an average bill for a surgical procedure in each Table for Surgical Procedures, including pre-operation scans, medical tests and other work-ups as well as post-operation rehabilitation, is paid through MediSave; (b) what portion of this average bill is paid out-of-pocket; and (c) whether MediShield Life coverage for surgical procedures can be further enhanced for a member above 80 years old, beyond the present recommended deductibles for day surgeries.

The Senior Minister of State for Health (Dr Koh Poh Koon) (for the Minister for Health): Sir, surgical procedures may be undertaken as part of an inpatient or day surgery episode. The Government provides significant subsidies of up to 80% for both the surgical procedure and the daily hospital charges, which include any number of tests, scans and rehabilitative services which may be required as part of the treatment episode.

MediShield Life is targeted at helping patients with more costly bills. For hospitalisations involving a more complex surgical procedure, it will cover about 15% to 20% of the total bill in a subsidised ward on average, while MediSave pays for about 5% to 10%. About 3% of the bill is then paid for in cash.

For example, an average subsidised bill for a heart artery bypass surgery, a much more complex surgery, would cost probably about $33,000 before subsidies, where MediShield Life pays for about $7,300, MediSave covers about $1,600, and the patient pays the remainder of about $200 in cash. The bulk of it is still taken care by subsidies and the remaining by the other components I just illustrated.

Overall, for all treatments, including less complex surgeries, eight in 10 of all subsidised hospitalisation bills incurred by Singaporeans were paid $100 in cash or less. So, eight in 10 Singaporean subsidised bills cost less than $100 in cash.

The MediShield Life and MediSave claim limits for surgical procedures are pegged to the complexity of the surgery required, as indicated in the Table of Surgical Procedures. The MediShield Life claim limits for surgical procedures were recently increased in January this year to keep pace with rising healthcare costs and provide better coverage for more complex surgical procedures. The MediShield Life Council has recommended further adjustments to the claim limits for daily ward and treatment charges as part of the ongoing MediShield Life Review. And we will also review MediSave limits in tandem with this. These adjustments will help to cover more of the inpatient or day surgery bill. In addition, the Council has also recommended to raise the policy year claim limit from the current $100,000 to $150,000 for that year. This will help older patients with exceptionally large bills due to long or multiple periods of hospitalisation within that same year. We will continue to review the MediShield Life and the MediSave limits regularly, to ensure they remain adequate in protecting Singaporeans, while keeping the premiums affordable.

MediFund, as I said earlier in a previous reply, is available for needy Singaporeans who require additional financial assistance to pay for their healthcare bills after subsidies, after MediSave and after MediShield Life. No Singaporean will be denied appropriate healthcare due to their inability to pay. So, I want to emphasise that point again – no Singaporean will be denied appropriate healthcare.

Mr Speaker: Mr Xie Yao Quan.

Mr Xie Yao Quan (Jurong): Mr Speaker, I thank the Senior Minister of State for his reply. I have one supplementary question. I recently saw an estimated bill for a procedure in the highest surgical table, table 7, and assuming a C class ward stay, the out-of-pocket expense, meaning the cash outlay after MediSave and MediShield Life claim was estimated to be $9,000.

My question is: were outlier surgical bills in the scope of the Council's review? And, if so, what were the conclusions of this review regarding the adequacy of MediShield Life coverage for such outlier bills?

Dr Koh Poh Koon: Sir, I think such outlier bills will be unusual and I think it is useful if the Member can perhaps share the information through an email with the data. Because the policyholder has a deductible a year and the deductible, usually, is in range of $3,000. Anything beyond that, MediShield Life kicks in. So, for the policyholder to have to pay $9,000 in cash, I think it is quite unusual. So, we do need to take out a look at the specifics of the case whether they have required very esoteric or specialised treatment even though they may be a C Class patient where certain treatments would not fall within the scope of the usual subsidies, for example. I think that is something we can do.

And if the person does have difficulties paying the bill with cash, then this is where we need to get a medical social worker involved and see if MediFund can be a way to help defray the cost and help this person to settle the hospital bills and continue the treatment.