Health Insurance

Health Insurance provides you and your family with financial benefits which will help you recover partly or fully the financial loss you may
suffer as a result of an accident, illness or disability. It can provide an income while you are disabled or in hospital, or cover the cost of your medical treatment or nursing care.

There’s no need to strain your cash reserves. Simply put your Medisave funds to work and enjoy comprehensive cover for yourself and your family, enjoying the following benefits as well with
no extra costs.

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Top 10 healthcare changes to note for 2013

The new year is beginning and the changes announced by the Government in 2012 will soon be rolled out.

Keep abreast of the latest developments by reading on the top 10 upcoming health care changes that all Singaporeans should know about:

Improvements to MediShield  

IN A NUTSHELL: From March, the Ministry of Health will introduce sweeping changes to the MediShield insurance scheme, the low-cost catastrophic illness insurance plan covering 92 per cent of the population which was introduced in 1990.

The maximum age covered by MediShield will be raised from 85 to 90 years, to ensure people will get health coverage even as they live longer.

The current maximum entry age of 75 will also be scrapped so that more healthy elderly people who are uninsured can join the scheme.

The maximum amount claimable each year as well as the lifetime claim limit will also be raised so that more exceptionally large bills are are covered.

Acute psychiatric hospital care and short stays in emergency departments will also be covered, so people do not miss out on timely and appropriate treatment of mental illnesses.

The changes followed public consultation in July and August last year.

SIGNIFICANCE: The enhanced MediShield covers more people for more types of illnesses for a longer time span. It offers a lifeline to those worried about hefty medical bills even as they live longer.

It is also good news to those who have difficulty upgrading to a more comprehensive insurance plan due to health reasons or because they had almost reached the benefit limits, as they should be able to enjoy improvements to their current plans.

But broader coverage means premiums will have to rise to meet the increased claim amounts and number of claims.

The premiums will increase by less than $10 per month for those aged 65 and below and up to $21 per month for those aged above 65.

To help with higher premiums and deductibles, the Government will give a one-off Medisave top-up of up to $400 to all Singaporeans insured under MediShield or Medisave-approved integrated shield plans. The money will be credited to the accounts from March.

In addition, 85 per cent of Singaporeans aged 66 and older will get a Medisave top-up of $250 to $450 every year under the Goods and Services Tax Voucher scheme. The scheme helps lower- and middle-income Singaporeans with their expenses.

With the top-ups, people aged 60 years and older, and those 20 years and younger, will pay lower premiums for the next two years.

New medical school 

IN A NUTSHELL: The new Lee Kong Chian School of Medicine will open this year with 54 students. The school, which will focus on "treating the patient and not the illness", is jointly run by the Nanyang Technological University and Imperial College London in Britain.

Tan Tock Seng Hospital will be the main training hospital for the students. They will start interacting with patients from the first year and track patients' progress from their time of hospital admission to their stays in a nursing home and outpatient rehabilitation.

SIGNIFICANCE: It will be the third medical school here, after the Yong Loo Lin School of Medicine at National University of Singapore and the Duke- NUS Graduate Medical School.

The three schools will eventually produce 500 medical graduates a year.

This would improve the ratio of doctors to patients here.

With 10,057 doctors on the registry in 2011, Singapore has one doctor for every 537 people. This is a far better ratio than the one doctor to 700 people in 2001, but it is still behind that of most developed countries.

The United States has one doctor for every 390 people, while Australia has one per 334 people. The need for doctors will continue to grow, given the new hospitals that are set to open in the next few years.

These include the 700-bed Ng Teng Fong Hospital in Jurong and the Integrated Building for Changi General Hospital and St Andrew's Community Hospital, both slated to open next year. By 2015, new community hospitals will also be built next to Ng Teng Fong Hospital and Khoo Teck Puat Hospital in Yishun.

A third community hospital will be set up next to the 700-bed Sengkang General Hospital, both of which are to be completed by 2018.

Ban on unhealthy food ads 

IN A NUTSHELL: Advertisements which make unhealthy food and drink appealing to children will be banned from early this year as part of Singapore's battle against obesity.

Topping the list of ads likely to be affected are those for sweet drinks and fast food which contain high amounts of oil and salt.

Announcing this last October, Health Minister Gan Kim Yong said the action is not targeted at specific brands, but at unhealthy food.

In the same month, 14 major food and beverage firms belonging to industry association Food Industry Asia pledged to cut back on advertising on unhealthy food to children.

The firms include Coca-Cola, Nestle, Ferrero and McDonald's.

The pledge covers products high in saturated fat, trans fat, sugar and salt.

Under this voluntary framework, firms will not advertise on television, in print and on websites where 35 per cent or more of the audience are aged below 12.

SIGNIFICANCE: The move is an important initiative because eating habits are formed at a relatively young age and Singapore is seeing a steady rise in obesity rates.

These rates have risen by 1per cent a year over the past three years. In Singapore today, 11 per cent of adults and 9 per cent of children are obese.

Half of these children will grow up to be adults with diabetes, which increases a person's risk of serious illness, including blindness, stroke and heart attack.

The proportion of adults aged 18 to 69 suffering from diabetes has grown from 8.2 per cent in 2004 to 11.3 per cent in 2010.

The experience in the West indicates that there will be a tipping point - when obesity affects 17 per cent to 18 per cent of the population - beyond which the rate rises even faster.

Hence, it is important to act now to prevent obesity from becoming a real epidemic.

S'pore to host first regional World Health Summit 

IN A NUTSHELL:  Singapore will host the first regional conference of the prestigious World Health Summit in April.

Its theme is health for sustainable development in Asia. The three-day event will be hosted by the National University of Singapore and MOH Holdings, the holding company for public health-care assets.

About 500 to 600 participants - including leaders in health care, policy and research - are expected.
The topics discussed will include health issues in the region, ranging from an ageing population to illnesses related to rising pollution levels.

SIGNIFICANCE:  This will be the first time that a regional version of the annual World Health Summit will be held outside Berlin, Germany, since the summit started in 2009.

Regional meetings have tended to be planning sessions for the Berlin event.

The regional summit will offer opportunities for Asian countries to take stock of the health challenges ahead and outline strategies to counter these threats.

IVF guidelines tightened 

IN A NUTSHELL:  By Tuesday, all assisted reproduction centres have to conform with standards established by Australia's Reproductive Technology Accreditation Committee.

Fertility centres now have to be recertified every two years.

There are 10 assisted reproduction clinics in public hospitals and in the private sector.

SIGNIFICANCE:  This latest measure follows revised guidelines on licensing terms and conditions of assisted reproduction centres implemented by the Ministry of Health last April.

They were aimed at boosting standards in clinical practices and workflow processes after an in-vitro fertilisation (IVF) botch-up at Thomson Fertility Centre in 2010.

A mix-up in sperm samples led to a woman having a baby, now two years old, with a stranger's sperm. Key additions include a list of proper laboratory practices and stringent counter-checking of specimen identification.

New ward at KTPH to ease bed crunch 

IN A NUTSHELL: A new 32-bed ward is expected to be ready early this year at Khoo Teck Puat Hospital (KTPH) in Yishun.

The 980 sq m area is being converted from a rooftop garden.

A new lift will also be added, since the current ones in Tower B, where the new ward will be, are already operating at optimum capacity. Construction started last July.

SIGNIFICANCE: The building of a new ward at KTPH will mean more beds for patients.

The need for the newest public hospital in Singapore, which opened in 2010, to expand, highlights how critical the public hospital bed crunch situation is. Alexandra Health group chief executive
Liak Teng Lit said he had expected to add more wards only after the hospital had functioned for five to 10 years.

KTPH is facing occupancy rates of more than 80 per cent, which is considered very high. Private hospitals prefer to keep occupancy rates in the low 70 per cent for a comfortable turnover of patients.

Changi General Hospital, Tan Tock Seng Hospital and, occasionally, National University Hospital, are experiencing an even bigger squeeze, with bed occupancy rates of more than 90 per cent.

The continued high demand for hospital beds has come as a surprise to many, since the opening of
KTPH added 550 more beds, bringing the total number of beds in public general hospitals to more than 5,800.

Part of the problem, it seems, is that families are often reluctant to take home elderly relatives who are recovering from illnesses.

Faster approval for high-risk medical devices 

IN A NUTSHELL: From this month, doctors and hospitals will be able to bring in many high-risk medical devices more quickly and cheaply.

These devices are categorised as Class C devices, such as X-ray machines and ventilators, and Class D devices, such as breast implants and intra-uterine devices. They account for roughly 40 per cent of all medical device applications.

Class C devices are now expected to be approved by the Health Sciences Authority (HSA) within 120 working days, at an evaluation fee of $3,000, down from 220 working days, at an evaluation fee of $5,700.

They have to be first approved by at least one foreign health authority recognised by the HSA.
The turnaround time for class D devices is now 180 working days, at an evaluation fee of $5,400, significantly less than the previous 310 working days, at an evaluation fee of $11,400 for the full evaluation route.

They have to be first approved by two or more foreign health authorities.

SIGNIFICANCE: These changes should make for speedier delivery of health care. Since 2010, the HSA has mandated that high-risk medical devices must be registered before they can be used here.

Last January, it extended this rule to include medium- and low-risk devices.

The move drew much criticism from doctors and importers. They questioned whether it was necessary for the HSA to assess devices which have been approved in other countries.

They argued that the high cost and complexity of registration and the time taken to process applications would push up health-care costs and reduce the number of devices in use here.

Within two weeks of these problems being highlighted last April, the HSA scrapped registration for about 4,700 class A or low-risk devices, such as wheelchairs, and cut the application time and fees for about 3,650 class B or low- to medium-risk devices devices, such as catheters.

Last August, the HSA cut the costs for devices brought in through the special authorisation route - items needed in a hurry, or for specific patients, exhibitions or training - from $500 to between $150 and $350.

Blueprint of genes linked to myopia mapped 

IN A NUTSHELL: A blueprint of the main genes linked to myopia will be unveiled by researchers here by the end of this year.

The project combined the results of three large studies on 5,000 myopic adults and children here, comparing their genetic make-up to that of those without the condition.

It has identified several genes associated with high myopia of 600 degrees and above.

The researchers hope to fine-tune, in a few years' time, a test to identify such sufferers for early treatment, before they become severely myopic and face the risk of going blind.

The massive research effort to uncover the genetic basis of myopia involves researchers from the Yong Loo Lin School of Medicine at National University of Singapore, the Duke-NUS Graduate Medical School, Singapore Eye Research Institute and the Genome Institute of Singapore.

SIGNIFICANCE: Short-sightedness or myopia, typically caused by an elongated eyeball, is the result of both genes and the environment.

A blueprint of the main genetic variants of myopia will allow researchers to develop predictive tools that combine gene tests with environmental factors, and recommend treatment for those who need it the most.

One of the leading causes of visual impairment and blindness, myopia poses a significant public health burden in Singapore and the region.

Asia is experiencing a myopia epidemic, particularly in its big cities. Rates of the visual defect have been rising over the past two decades.

In Singapore, the myopia capital of the world, eight in 10 people are short-sighted by the time they are 18.

New medical complex at Farrer Park 

IN A NUTSHELL: Connexion at Farrer Park (right), a development which includes a hospital, hotel and medical suites, is expected to open this year.

Built directly above the Farrer Park MRT Station, the six-storey podium with two 20-storey high-rise wings will have a medical centre housing more than 200 medical specialists in 189 consultation suites. It will also have a 83-bed private hospital with a luxury hotel and a shopping mall.

It is run by the Farrer Park Company, comprising private medical and hospitality specialists as well as foreign investors.

SIGNIFICANCE: Connexion at Farrer Park will open on the heels of Mount Elizabeth Novena Hospital, run by regional private health-care provider Parkway Pantai, and Fortis Colorectal Hospital, run by Indian private health-care group Fortis Healthcare. Both opened last July.

They could strengthen Singapore's position as a destination for medical tourism.

Already, foreign patients make up a significant number in some private hospitals here. For instance, at Mount Elizabeth Hospital, about half of its patients hailed from overseas, The Business Times reported last March.

Despite the economic boon of medical tourism, some experts have warned that excessive growth of the industry may put more stress on the health-care system and squeeze the supply of doctors here even further.

Heart centre moves to new home 

IN A NUTSHELL: The National Heart Centre Singapore will move into a new 12-storey, $266million building at the end of this year.

The new 8,800 sq m site will be just down the road - about 400m away - from the present four-storey building on the Singapore General Hospital campus.

The centre will operate on a new concept that wraps services around the patient. For instance, patients, who are often the elderly, can see a doctor and have a blood test and an electrocardiogram on the same floor, instead of having to walk from place to place for these services.

Other features designed with the elderly in mind include distinctly coloured signs with large font, non-slip vinyl floors and motion-sensor lights.

SIGNIFICANCE: The new building is designed with the growing number of patients at the centre - one in three of whom are aged 65 and above - in mind.

The centre treated 108,000 patients last year, a figure that is set to rise by 60 per cent in the next decade.

The number of first-time elderly patients has shot up by 44 per cent since 2002. There will be 38 consultation rooms - more than double the current 18.

MediShield to be tweaked from March next year

SINGAPORE: The national medical insurance scheme, MediShield, will be tweaked from March next year to provide better coverage for the elderly.

The Ministry of Health (MOH) said on Friday that it is raising the limit on the amount that can be withdrawn from Medisave, a national medical savings scheme, to fully cover the premiums for basic MediShield schemes.

Those who are between 76 and 80 years old can withdraw a higher amount of S$1,000, compared with the current S$800; while those who are above 80 years old can withdraw up to S$1,200, compared with S$1,150 currently.

The age limit for MediShield will also be changed.

The government will scrap the maximum entry age of 75 so that more elderly people who are healthy but not insured can get insurance coverage.

At the same time, it will raise the maximum coverage age to 90 years, from the current 85.

Coverage will be extended to inpatient psychiatric treatment at S$100 per day, up to 35 days per year.

The coverage limit per policy year will be raised from S$50,000 to S$70,000, and the lifetime limit will be higher at S$300,000, compared with the current S$200,000.

In addition, coverage will be extended to short-stay wards in Emergency Departments.

Other adjustments include increasing the deductibles for Class C bills from S$1,000 to S$1500, and S$1,500 to S$2,000 for Class B2 bills.

The deductible is the amount of a hospital bill that patients have to pay before claiming insurance.

MOH decided on these changes after it consulted the public in July and August on ways to make MediShield more inclusive.

It is still looking into another suggestion on using MediShield to cover outpatient treatment, saying this involves a major shift in MediShield's focus and could have significant impact on the premiums.

$14k bill shock for retiree after operation

SINGAPORE - Retired businessman Steven Choo, 60, underwent angioplasty at the Singapore General Hospital (SGH) to unclog blood vessels in his legs last November.
 
Mr Choo, who is diabetic, underwent the procedure - with "balloons" and stents used to unblock the arteries - which prevented gangrene from spreading from his toes.

But the successful operation marked the start of another round of problems for him. On the day he was discharged from hospital, he received a shock: His medical bill came up to $14,501, but Medisave and MediShield would cover only $900 and $810, respectively, or $1,710 combined.

SGH also told him he would not get his $6,620 deposit back, and that he still owed it $5,381, Mr Choo told my paper in an interview. The remaining $790 was covered by a government grant.

The Central Provident Fund (CPF) Board told him that the Medisave claim submitted by the hospital did not indicate a surgical procedure.

This meant he could not claim the full amount he should have been entitled to: $3,050.

Insurance company AIA, which handles his MediShield account, told him likewise.

Mr Choo then hand-delivered a four-page report from his doctor to the CPF Board, explaining that angioplasty is a surgical procedure. But then he got another shock.

He said: "CPF Board wrote to tell me that they're not paying because (the angioplasty) was not done in a 'proper' place."

The CPF Board's letter, dated Feb 8, read: "Only surgical procedures performed in a properly equipped operating theatre... are Medisave claimable."

The head of SGH's diagnostic radiology department, Associate Professor Tay Kiang Hiong, told my paper that Mr Choo's angioplasty had been planned to take place in an operating theatre. But his operation was moved to an angiography suite - where angioplasty is also typically conducted.

Unhappy

This was because "there were urgent and complicated cases that needed to be performed in the operating theatre", said Prof Tay.

Mr Choo then sent an e-mail message to the CPF Board arguing that he had been penalised because of where his operation was conducted.

The case remained in limbo for three months, said Mr Choo, who wrote to the CPF Board repeatedly, only to receive the same reply each time that his appeal was under review.

In May, the Ministry of Health (MOH) sent him an e-mail message informing him that his appeal had been successful.

Not long after, Mr Choo's MediShield claim was also approved.

AIA told my paper that the claim was reviewed twice because there were inaccuracies in the initial claim.

Late last month, SGH called Mr Choo to tell him that both Medisave and MediShield amounts due to him had been paid out fully.

He was also entitled to a $638 refund from his deposit.

Six months later, the problem has been resolved but it has left Mr Choo irate. He said: "If I did not fight for it, where would I get the money from?"

Mr Choo added that he hopes that others would not have to be put through the same ordeal.

An MOH spokesman told my paper that angioplasty typically takes place in operating theatres.

As Mr Choo's angioplasty took place in an angiography suite, it "was not deemed a surgical procedure".

This is why SGH did not submit a Medisave claim for the procedure, said the spokesman.

The spokesman added: "We have since clarified with SGH that an angioplasty procedure... can be submitted for Medisave claims, even if it took place in the angiography suite."

Health Minister Gan on MediShield enhancements

SINGAPORE: Health Minister Gan Kim Yong has stressed the importance of insurance in a country's healthcare financing.

He said the government wants to encourage lower-income families to be covered by its insurance scheme, MediShield.

Mr Gan said this in response to questions from reporters, on his ministry's plan to provide wider coverage from the first quarter of next year.

He said it has to calibrate MediShield enhancements very carefully, including extending coverage for congenital and neo-natal conditions.

"We also are concerned that, whether by introducing this additional insurance, we will actually increase the cost of treatment. Because once it is covered by insurance, parents and doctors may pursue more expensive treatment and overall, this may raise the cost of healthcare for children in Singapore," said Mr Gan.

"We need to calibrate it so that there is a balance between benefits covered by the insurance, as well as the cost of the insurance premium, to ensure that the benefits remain relevant and effective and at the same time, the premium remains affordable," he added.

Mr Gan was speaking to the media at the end of his Ministerial walkabout to the Bukit Timah division of the Holland-Bukit Timah GRC.

With the enhancements, patients will be able to claim more - up to S$70,000 for their hospital bills annually, compared with the current S$50,000.

The lifetime limit will be increased from S$200,000 to S$300,000 to help policyholders who face exceptionally large bills, such as undergoing multiple surgeries after an accident.

The Health Ministry said MediShield deductibles will also be adjusted accordingly, as medical bills have become more expensive over the years.

With the extended coverage and payouts, MediShield premiums will have to be raised.

But the Health Ministry said for the vast majority of policyholders, the increase in premiums will be less than S$10 a month.

And with the additional government support given at this year's Budget, Singaporeans aged 65 and below will have to fork out no more than S$5 per month in the next two years.

For the elderly, their premiums will be largely offset by the annual and one-time Medisave top-ups.

They will, in fact, see a decrease in premiums payable.

MediShield revamp: Premiums to rise but better coverage for S'poreans

The national health insurance scheme, MediShield, will soon be expanded to cover Singaporeans and permanent residents who are currently excluded.

The limits on how much can be claimed from MediShield will also be raised.

To support the enhancements, premiums for MediShield will be increased.

The majority of policyholders - those aged 65 and below - can expect to pay an additional $10 or less per month.

Yesterday, the Ministry of Health (MOH) announced these changes, which are set to take effect in the first quarter of next year.

Speaking on the sidelines of an event at Tan Tock Seng Hospital yesterday, Health Minister Gan Kim Yong said of the changes: "We (are taking) the opportunity to see where we can enhance the coverage, especially for those who are more vulnerable."

With the expanded coverage, MediShield will provide financial relief to older seniors, along with newly diagnosed mental patients who require inpatient psychiatric treatment.

The maximum age for MediShield coverage will be raised from the current limit of 85 to 90.

An Institute of Mental Health (IMH) spokesman called the expanded MediShield a "positive step" that will help relieve the financial burden of patients.

He explained: "Currently, patients have to rely on their own or their family's Medisave. Those who require prolonged or repeated hospitalisation will find it a drain on their resources."

MOH is also looking into the coverage of newborn babies with congenital conditions, or medical problems that exist at birth.

As there are mixed views on the issue, MOH is seeking public feedback.

Of the 40,000 babies born every year in Singapore, about 860 reportedly have a serious birth defect.
Mrs Sylvia Mun, KK Women's and Children's Hospital's chief medical social worker, said: "One of the frustrations (that parents of such children) face is that when they try to buy health insurance for their newborn baby, they are often rejected and they worry about how they can continue to manage the cost of treating their baby."

She revealed that for a smaller number of "more-serious premature (birth) cases", the average medical bills can range from $10,000 to $60,000.

Medical expenses may even exceed $100,000, in the rare cases of babies with severe complications, as well as for those who need multi-stage operations and treatment.

To help patients with large medical bills, MOH will bump up the total amount one can claim, in a policy year and for life, from MediShield.

The policy-year limit for claims will be raised from $50,000 to $70,000, and the lifetime limit will be raised from $200,000 to $300,000.

Patients staying in Class C and Class B2 hospital wards will have to pay a greater initial amount before they are able to make claims from MediShield.

This amount forked out by patients, known as a deductible, will be raised from $1,000 to $1,500 for Class C wards, and from $1,500 to $2,000 for Class B2 wards.

On concerns over higher premiums and deductibles, Mr Gan assured Singaporeans that financial aid is in place, such as a one-time Medisave top-up of up to $400.

84-year-old man dies 2 weeks after fall

A fall at home last month landed 84-year-old Chiu Cho Tak at the emergency department of the Changi General Hospital.

Although his X-ray did not show any breaks, Mr Chiu was hospitalised.

Things went downhill after that.

After two weeks of being shuttled in and out of the intensive care unit (ICU) and the geriatric ward, Mr Chiu died from what was diagnosed to be a lung infection.

The episode left the family shaken.

"What I want to know is how this could happen and whether there was an over-treatment of my father's condition," said Mr Chiu's daughter, Mung Hing, 47, a businesswoman.

She had written in to The New Paper to share her story.

Relating the harrowing two weeks, Ms Chiu said her father slipped and fell at home when he was going to the toilet in the middle of the night.

He was rushed to CGH by Ms Chiu the next day after he complained of pain in his left leg.

On arrival, Mr Chiu was assessed by a doctor and sent to the X-ray department.

"Although the X-ray did not show any fractures, the doctors wanted to keep him for observation, in case he had a stroke," Ms Chiu said.

The family had wanted to take him home so they could get a second opinion, but was advised against it, she claimed.

Mr Chiu was warded.

During her father's first few days in the geriatric ward, a subsequent scan showed a small hip fracture.

Once again, the family expressed its wishes that the hospital discharge him so he could recover at home, but "the ward doctor insisted he should stay longer," Ms Chiu claimed.

The hospital, however, said that as Mr Chiu had suffered a fracture, his family's maid required caregiver training.

It added that doctors had made plans for Mr Chiu's discharge "together with his family". (See report on facing page.)

A week into his stay at CGH, Mr Chiu suffered a heart attack and was sent to the ICU.

Puzzled

"I was puzzled as to why the doctors at ICU insisted on putting a respiratory tube through my father when he could breathe normally on his own," Ms Chiu asked.

Four days later, Mr Chiu was transferred back to the geriatric ward, but started running a high fever.

He died on May 31 from lung infection.

"During his stay there, I saw at least seven doctors and every one of them gave me different information about my father's condition," said Ms Chiu.

She said she was asked at least six times if the family wanted to resuscitate her father should he collapse.

Ms Chiu said her father, despite his age, was still very alert, even though he "walked rather slowly".

Explaining her initial decision to take her father to the hospital, she said: "I wanted to make sure he was okay and there was no internal injury."

Ms Chiu said she later received a bill of $16,000 for her father's stay and treatment at CGH.

The hospital management and the doctors met with Mr Chiu's family for two hours on Thursday to explain his treatment.

Speaking to The New Paper after, Ms Chiu said CGH was sympathetic to her grief and during the discussion, "realised that there could have been a gap in communication".

Although she does not want to pursue the matter further, Ms Chiu hoped her father's experience would create awareness among the public and medical professionals alike.

What the hospital says

IN A written reply to The New Paper, Changi General Hospital said that Mr Chiu Cho Tak, 84, was admitted on May 17 through its Accident & Emergency department after his fall at home.

Its spokesman said that during Mr Chiu's stay at the geriatric ward, he was found to suffer from giddiness due to low blood pressure from lying down, and the hospital suspected it might have caused the fall.

He also had pain at the left side of his hip due to a fracture sustained from his fall. This was confirmed by a CT scan.

Doctors adjusted his medications to reduce giddiness and treated his pain, the spokesman said.

Mr Chiu was advised not to stand on the affected leg and to use a wheelchair instead.

As Mr Chiu had a fracture, he needed full assistance of a caregiver to move around.

Said the spokesman: "As such, the family's maid required caregiver training to enable her to look after Mr Chiu at home while the doctors made plans for his discharge together with the family.

"His daughter had requested for an early discharge on May 21 and it was planned for within a week of his admission but (as) his caregiver needed time to be trained, his daughter agreed with our plan to discharge him on May 25 instead," she added.

Throughout that period, Mr Chiu's vital signs were stable and he did not have any symptoms of chest pain, shortness of breath or palpitations.

But on May 24, he became acutely unwell and had a heart attack.

He was treated and referred immediately for further investigation and supportive treatment.

Procedures explained

The spokesman said Mr Chiu's daughter was present and the procedures were explained to her in the ward.

In light of his instability and decreased consciousness, Mr Chiu was intubated and sent to the Medical Intensive Care Unit (MICU).

The doctor spoke to the family about the option of not subjecting Mr Chiu to CPR (cardiopulmonary resuscitation) or advanced cardiac life support should his heart stop.

"This topic was broached respectfully and sensitively when the doctors assessed that further interventions are unlikely to produce any significant benefit for the patient. Mr Chiu's family was given time to discuss and consider, and his daughter signed the Do Not Resuscitate (DNR) form four days later," the spokesman said.

"Although the form was signed, our doctors will still check with the family on their wishes thereafter as we understand the sensitivity of a DNR," she added.

Mr Chiu was transferred to the general ward after four days at the MICU, when his condition improved and he was able to breathe without ventilatory support.

"Our doctors remained guarded in their prognosis and this was conveyed to his daughter.

"Mr Chiu was also receiving treatment for an ongoing infection after having fever, and subsequent X-rays revealed a pneumonia which progressed rapidly despite maximal medical therapy," she said.

Unfortunately, Mr Chiu's condition deteriorated o nMay29 and he died two days later.

"Throughout his stay, our doctors had constantly kept his family, especially his daughter, informed of his condition. Our doctors work in a team and although different membersof the team have spoken to the family throughout the admission, the medical team was always clear about the medical management plan," the CGH spokesman said.

She added that the Geriatric Medicine Consultant in-charge, who is the primary doctor, managed MrChiu with his colleagues and updated his daughter.

Other specialists included the bone specialists and cardiologists.

On the meeting with the family on Thursday, the spokesman said the hospital "has given her (Ms Chiu) a clearer understanding of the treatment provided for her father and addressed all her concerns in detail".

"We assured her of the commitment of our medical team and the specialists who took care of her father," she said.

Government cuts healthcare subsidies for PRs

SINGAPORE - The Government announced today through a press release that the healthcare subsidies for Permanent Residents are to be reduced, starting from the third quarter of this year.

The Ministry of Health said that the changes mean that most PRs will soon enjoy only about half the subsidies citizens enjoy.

This is to draw a further distinction in the privileges offered to citizens as compared to PRs.

The adjustments will apply to inpatient services of Class B2 and C wards, day surgery and specialist outpatient clinics in restructured hospitals, and intermediate and long-term care services.

For example, a patient of an average monthly income of $3,200 and below staying in a Class C ward can currently receive a subsidy rate of 60 per cent.

Under the changes, the subsidy rate will be reduced to 55 per cent. The subsidy rate for citizens is 80 per cent.

PRs in the same income band staying under a Class B2 ward will see decrease of subsidy rates from 45 per cent to 40 per cent.

For day surgery, the subsidy rate for PRs is to be lowered to 40 per cent, down from 45 per cent.

For specialised outpatient clinics, the subsidy rate for PRs will be lowered to 25 per cent, down from 30 per cent.

The ministry said that the subsidy adjustments are different for lower income PRs, as it is mindful of the impact of the changes.

The changes in restructured hospitals will be implemented in two phases, one in October this year and the next in April 2013, while that for the intermediate and long-term care sector will see the changes implemented in the third quarter of 2012.

Other changes include the lowering of subsidies for PRs for Community Hospitals and Residential Services and the fixing of subsidy rates of citizens for these services at 75 per cent.

This fixed subsidy rate will kick in from the third quarter of the year.

More got Medifund aid in 2010

SINGAPORE - More than $78 million of Medifund aid was given to needy Singaporean patients in 2010, $14 million more than in the previous year.

The biggest chunk of that sum, amounting to about $68.2 million, was disbursed to patients with acute needs. The remaining $10.5 million went to those who required intermediate and long-term care.

The Ministry of Health (MOH) said in a statement yesterday that there were 480,869 successful applications for Medifund in 2010, from 393,980 successful applications in 2009, an increase of 86,889 or 22.1 per cent.

The number of successful applications does not represent the actual number of patients who received the grants, as a patient can make multiple applications.

The MOH added that it distributed $81 million of Medifund and Medifund Silver - meant for needy patients aged 65 and above - to Medifund- approved institutions such as restructured hospitals, and care facilities such as hospices and nursing homes.

There are 37 Medifund- approved institutions, according to MOH.

Of these, 13 are restructured hospitals and institutions while the rest are facilities that provide intermediate and long-term care (ILTC).

Up to 473,033 successful applications were made via restructured hospitals and institutions in 2010, while those from ILTC facilities, such as hospices and nursing homes, amounted to 7,836.

The Medifund scheme was introduced in 1993 to help needy Singaporeans who are unable to finance their medical expenses, even with funds from Medisave and MediShield.

It is meant mainly to provide a safety net for lower-income Singaporeans but it can also be tapped by better-off Singaporeans who need help with exorbitant medical bills.

Out of the total number of successful applicants in 2010, more than 92 per cent had their bills fully subsidised.

Outpatient treatment accounted for 96 per cent of the applications made via restructured hospitals and institutions.

On average, the sum given to help patients cope with their medical bills ranged from $1,321 for inpatient admission to $94 for outpatient treatment.

Grants given to needy elderly patients rose by 22.8 per cent in 2010, from about $18.9 million in 2009 to $23.2 million in 2010.

MediShield premiums to be raised: Health Minister

SINGAPORE - Medishield premiums must be raised to keep up with the rise in pay-outs, said Health Minister Gan Kim Yong in Parliament today.

The amount in which the premiums will be raised will be according to the policy holder's age, he explained.

For example, a 76-year-old policy holder is likely to see an increase of $25 a month, while a 45-year-old may see a lower premium increase of $7 a month.

The premium increase will be less for those in the younger age groups.

This is inevitable in order to keep MediShield sustainable, said Mr Gan.

MediShield paid out 21 per cent more in claims each year between 2008 and 2011. However, premiums only grew by 10 per cent each year, said Mr Gan.

According to Mr Gan, the last increase was in 2008, and Medishield premiums are calculated to be sustainable for a five-year period.

However, to help Singaporeans deal with the rising premiums, the government will be disbursing a one-time Medisave top-up of up to $400 for all Singaporean policy holders.

In addition, most older policyholders who are beyond the re-employment age of 65 will receive direct and long-term assistance via Medisave top-ups under the GST Voucher scheme.

This means they will receive up to $450 a year, or $37.50 per month, which can offset the premium increase in full.

Those aged 50 to 60 will also see a higher contribution to their Medisave accounts due to the higher CPF contribution rates, Mr Gan added.

In response to Hougang MP Mr Gerald Giam's query on whether some of the MediShield reserves can help to offset these premium increases, Mr Gan said that the reserves are to ensure that MediShield will be able to honour policyholders’ future claims and are crucial in ensuring the long-term sustainability and viability of the MediShield Fund.

During the Parliamentary session, several MPs also called for the extension of Medishield to cover more conditions, such as congenital conditions in newborn babies, and psychiatric and mental care.

Mr Gan said the Government will look into the suggestions, but warned that a wider coverage will also mean higher premiums.

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Better to get medical insurance while young and healthy

Some people say they fear sickness and disability more than death, as the former will drain their wealth.

But you can easily avoid this problem by buying health insurance, and by buying it early when you are healthy.

Do not think that you need insurance only when you are old, as the risk of illness goes up as you age.

Once illnesses develop, insurers may slap on an extra charge, or choose not to cover your pre-existing conditions. A pre-existing medical condition is a condition, disability or illness that you have before you apply for health cover.

Apart from basic medical expense insurance or hospitalisation plans, which pay for hospital and surgical expenses, there are hospital cash insurance plans which pay a fixed amount of cash should you be warded. You can also choose a critical illness plan or a disability income insurance. Then, there is long-term care insurance, which gives you a regular cash payout if you are too ill to look after yourself.

The common mistake many people make is to hold off on taking out a basic hospital plan as they are already covered under their company's insurance plan.

Most companies do not offer portable group health insurance plans. So the coverage ceases once the employee leaves the company. Those who have an existing illness may then realise too late that they are no longer insurable, or that the insurer will not cover their illness.

Singapore's health-care financing system offers three tiers of protection - through heavy subsidies in acute public hospital wards; Medisave; and MediShield and the private Integrated Shield plans.

Medisave

This is a national medical savings scheme whereby individuals put aside part of their income into their accounts with the Central Provident Fund. It can be used for the co-payment of their personal or immediate family members' health- care bills. All employees, as well as self-employed persons earning more than $6,000 a year, have to contribute to Medisave.

Medisave can be used to pay for the premiums of Integrated Shield plans, subject to a limit of $800 per policy per year. The limit for those aged 81 and above is $1,150 per policy per year.

Medisave can also be used to pay for treatments that are not covered by insurance, such as outpatient treatment of chronic diseases.

It is important to maintain your Medisave account and to use it prudently. Note that the cash will run out fairly quickly when you stop working. This is why it is important to have health insurance, as it can cover major medical expenses.

MediShield

This is a low-cost catastrophic medical insurance scheme that helps meet medical expenses incurred for class C or B2 wards in government restructured hospitals.

All Medisave account holders who are Singaporeans or permanent residents will be automatically covered unless they opt out of it.

Because it is a catastrophic policy, which covers extended hospital stays, you may find that you have to fork out a large sum for short stays after all the limits are applied.

Also, the subsidies for class B2 and C wards are subject to means-testing, where lower-income patients will get more subsidy than higher-income patients.

Therefore, higher-income patients or those who want to use higher ward classes or private hospitals should go for Integrated Shield plans on top of their MediShield.

Integrated Shield plans

These are Medisave-approved private health insurance plans currently offered by NTUC Income, Great Eastern Life, Aviva, Prudential Assurance and American International Assurance.

They do not usually cover pre-existing health conditions. But the good news is you can use your Medisave to pay the premiums.

Also, the premiums are kept affordable because the plans are designed with deductible and co-insurance components which promote individual responsibility for one's health-care needs.

Deductible refers to the first layer of costs that you have to pay before the insurance kicks in. Co-insurance is the share of the insured portion of the bill that you must pay. It is typically set at 10 per cent.

You can get a rider to cover these components or extend coverage to medical expenses incurred abroad but the premium has to be paid in cash.

Many Integrated Shield plans offer lifetime cover, or up to age 100, which is something you are unlikely to find among private insurers outside the Integrated Shield plans.

Key things you should know about Integrated Shield plans

· Claim limits: Plans may vary in terms of the maximum claim that you can make per policy year. Some plans may also stipulate a lifetime claim limit; other plans may not set a cap on lifetime claims.

· Pro-ration factor: If you stay in a higher-class ward than what your plan entitles you to, a pro-ration factor will be applied. It reduces the sum that can be claimed.

· Last entry age: For most plans, the latest age you can apply for coverage is 75. The maximum coverage age is the length of coverage.

Some plans offer lifetime coverage, while others may extend cover until age 80 or 85. Note that the riders attached to a plan with lifetime coverage might offer coverage up to a certain age (for example, 100).

· Premiums: All plans can be renewed as long as the premium is paid. But the rates, which rise with age, are not guaranteed. They can rise on renewal depending on the claims experience of the portfolio.

· Pre-existing conditions: These are not usually covered. You have to disclose all pre-existing conditions at the time of application as insurers may declare the policy void if you misrepresent or fail to disclose them.

Some plans may cover a pre-existing condition following a waiting period of, say, five years, provided the insured does not experience any symptoms or receive treatment or medication for the conditions during this time.

· Coverage: The inpatient benefits commonly include daily room and board, and treatment costs. Outpatient benefits can include kidney dialysis and cancer treatment. All these may be subject to a claimable limit or covered on an 'as charged' basis, which means that you can claim for what has been billed for all eligible expenses.

· Final expenses benefit: With this, the deductible and co-insurance portions of the bill - up to a limit of say $5,000 - will be waived if the insured dies during hospitalisation or within a stipulated period after discharge from the hospital. Not all plans provide this benefit.

· If you are warded: Your insurer may provide a letter of guarantee - an assurance of payment for the portion of the bill covered by the insurer. It can help to reduce the upfront payment to the hospital.

But the sum indicated in the letter may not be sufficient for the entire bill. To better plan for the cost, ask the hospital for an estimated billing amount, and also query the insurer on the basis for the sum indicated in its letter of guarantee.

To compare benefits, coverage, policy features and the premiums for the different Integrated Shield plans here, go to the health care financing section of the Health Ministry's website (www.moh.gov. sg).

You can contact me if you wish to know more about the  Integrated Shield plans.

Medifund to be extended to home nursing services in 2012

Coming April this year, Medifund subsidies will be available for home-based healthcare services, said the Minister of Health Mr Gan Kim Yong.

Mr Yong was responding to a question asked by Mr Patrick Tay Teck Guan, MP of Nee Soon GRC, in today's Parliamentary session.

Mr Tay asked if Medisave and Medishield schemes can be extended to home palliative care and home nursing services.

To that, Mr Yong said that the Government provides subsidies of up to 75 per cent for lower and middle income patients who require home palliative and home nursing services.

Patients can also use cash payouts from ElderShield to further defray the cost of such services.
For home palliative care, the Government has allowed use of Medisave funds since 2010.

However, as MediShield is designed as a basic insurance scheme for catastrophic hospitalisation expenses to keep premiums affordable, it is therefore unable to cover home-based services.

Nevertheless, needy patients who require additional financial assistance for home-based healthcare services beyond the subsidies they are receiving will be able to apply for Medifund subsidies soon.

The Government will be extending Medifund subsidies to such home-based services from April 2012, Mr Yong said.

Medifund is an endowment fund set by the Government.

The interest income from the capital sum of Medifund is allocated to approved hospitals and medical institutions in the form of grants, which are then used to help needy Singaporeans pay for the medical bills which they cannot afford.

Mr Yong added that the voluntary welfare organisations (VWOs) that provide home-based services also provide additional financial help for their patients if necessary.

Mr Yong said the ministry will continue to review government subsidies and the use of ElderShield and Medisave to ensure affordability of such home-based services for the elderly, while balancing against the adequacy of Medisave and the impact on ElderShield premiums.

More financial help with medical bills: Health Minister

More patients can expect financial help with their medical bills in the coming years as the Ministry of Health (MOH) beefs up its subsidies and other helplines, said Health Minister Gan Kim Yong in his addenda to the President's Address.

Already, recent changes meant that half of all Singaporeans aged 40 and over will be able to enjoy subsidies when they get treated by their family doctor.

The Government will also increase subsidies for those needing step-down care, such as nursing homes or rehabilitation care, he said when setting out the health social safety net.

MediShield and Eldershield insurance will also be enhanced.

The broad-stroke objectives for the MOH is to provide better health, better care, better value and better support for ageing so all Singaporeans can 'live well, live long and enjoy peace of mind'.