Streamlining Public Hospitals' Admission Process

12 Mr Saktiandi Supaat asked the Minister for Health (a) whether the public hospitals' admission process can be streamlined to enable the frontline and medical staff to ascertain the patient's financial status at the time of treatment, admission or prior to bill issuance; and (b) what is the current process for patients to be referred to the hospital's social service officers for financial assistance.

The Senior Minister of State for Health and Law (Mr Edwin Tong Chun Fai) (for the Minister for Health): Mr Speaker, all hospitals are required to financially counsel a patient receiving inpatient care or day surgery.

For planned admissions and surgeries in public hospitals, financial counselling is done prior to admission or surgery. For emergency cases, however, the priority is on quick diagnosis and intervention, and so, in those cases, patients are counselled as soon as possible after admission. If there is a significant increase in estimated bill size during the course of the inpatient’s stay, which could occur for reasons such as complications that were not anticipated prior, the patient would be provided with an updated estimate as quickly as possible.

Patients are counselled based on their financial status and the subsidies they are eligible for, as well as the expected MediShield Life payouts and the available MediSave withdrawals for their specific treatment and their condition. Information is presented in an easy to understand way, such as graphical way to explain the estimated bill size and out-of-pocket payments that they will be expected to incur.

Patients are also advised to choose the appropriate ward type based on their own circumstances. For example, patients who have concerns over their bill size would be advised to choose a ward type that would give them access to higher Government subsidies. If they indicate a financial difficulty, they will then be asked whether they wish to be referred to a Medical Social Worker to explore additional financial assistance.

Finally, patients may approach hospital staff to request for financial assistance at any point in their healthcare journey at any stage, and they will be referred to a Medical Social Worker for assistance. Patients’ medical needs will be prioritised and no one will be denied appropriate care because of financial constraints.

Mr Saktiandi Supaat (Bishan-Toa Payoh): Mr Speaker, I would like to thank the Senior Minister of State for the answers he gave. I am asking two supplementary questions, or probably just one, because I am getting quite a number of my residents coming to my Meet-the-People Sessions with regard to post-treatment, out of hospital. My question is whether there can be further streamlined or maybe enhanced processes at the payment counters to assess them and refer them to the Medical Social Workers, instead of waiting for them to request for referrals themselves. I wonder if that can be enhanced even further, following up from the question that I have already asked in my Parliamentary Question (PQ).

Secondly, in terms of referral to the Medical Social Workers at the hospitals, how is the process? Can the Senior Minister of State share how the process can be refined and enhanced further for elderly patients or patients who are there alone and may not be able to converse or understand properly what the bill means and entails, in terms of their financial circumstances and whether there can be any help from the counter staff and nurses.

Mr Edwin Tong Chun Fai: Sir, there is a framework for trying to estimate as close as possible upfront, prior to the admission and prior to the procedure itself. As far as possible to estimate what it will cost, and likely out-of-pocket expenses. And then to right-size the kind of stay in the ward choice and so on, appropriate to the particular patient's own financial means and circumstances. Obviously, the way in which it is conveyed would also depend to a large extent on the patient himself or herself, and whether this person is conversant in one language or another.

As I mentioned earlier, steps are also taken beyond just verbal counselling to also present the information in easy-to-understand ways – in graphics, in charts, using those as aids to explain to the patient. So, I understand the Member's point that, ultimately what we want to achieve is a greater understanding upfront of the likely expenses and so on, as far as possible so that there is no big surprise at the end.

On the Member's first point, we do have a process where there is proactive intervention in terms of trying to give information proactively, especially for patients who might be identified to as someone who is not able to understand the treatment processes and also may not even know what questions to ask. I would like to let the Member know that in 2014, MOH introduced Proactive Financial Assistance (PFA) to alert patient service associates who deal with the patients, about patients who might require financial assistance. This is drawn proactively from information stored in the National Electronic Financial Records (NEFR) and it is obviously available to help patients who have, prior to that, given consent for their information to be accessed.

So, looking at the nature of the procedure the likely cost of the expenses will be incurred, matched up with what we know from the NEFR, the counsellors will be able to more proactively manage the cost upfront for the patient and provide the advice upfront, even if it is not asked for.

This plus a series of other measures on the ground will be taken. But I understand the Member's point that, ultimately, it is about awareness upfront and to try to anticipate, as far as possible and as accurately as possible, the likely expenses that will be incurred. We will endeavour to do so.