Relief after $180,000 bill worry

SINGAPORE - When her daughter-in-law gave birth to quadruplets last month, she worried about how the family was going to pay the staggering medical bills ($180,000 and counting) incurred as a result of the births.

But there is some relief after the Ministry of Health (MOH) made an exception and allowed Madam Lily Lim, 52, and her husband to use their Medisave savings to help pay their grandchildren's bills.

Madam Lim's daughter-in-law, Ms Jennifer Pan, 28 (pictured), gave birth by caesarean section at Gleneagles Hospital last month to what is believed to be Singapore's first set of quadruplets since 2008.

Ms Pan,an assistant treasury manager at acommodities trading company here, had taken fertility medication, but did not undergo in-vitro fertilisation, The Straits Times reported.

Janessa, Joelle, Jovianne and Kingsley (the only boy) were born on July 19.

In a letter to The Straits Times forum, published last Wednesday, Madam Lim said: "Having quadruplets was a joyous occasion, but it was marred by the financial hole it created."

She said the hospital bill totalled some $180,000 and explained that the babies were born premature and have to stay in the hospital for almost two months in the intensive care unit (ICU).

The ICU charges alone were reported as $1,000 for each baby a day.

The bills also include an estimated $25,000 for Ms Pan's month-long hospital stay and an obstetrician fee of $23,000.

Madam Lim added: "My husband and I wanted to help them by dipping into our Medisave account, but the Central Provident Fund blocked it with the reply that grandchildren could not use their grandparents' Medisave."

Unique circumstances

Madam Lim is the founder of a confinement nanny agency.

She and her husband have about $90,000 in their Medisave savings, Chinese newspaper Shin Min Daily News reported. The babies' father, Mr Phua Jiun Wei, 28, runs the agency.

In response to media queries, an MOH spokesman said it has "agreed to allow the grandparents to use their Medisave to help with the bills, considering their family's unique circumstances".

The spokesman said parents can use their Medisave to pay for their child's hospitalisation expenses.

But as elderly persons tend to incur more medical expenses than younger persons, grandparents cannot use their Medisave to help pay for their grandchildren's medical bills.

This is to ensure that the grandparents themselves have sufficient Medisave savings for their own hospitalisation needs, especially after retirement.

The spokesman said: "In circumstances such as in Madam Lim's case, where the grandparents have requested for their Medisave to be used, we will assess such requests on a case-by-case basis.

"We understand that the family has also appealed to Gleneagles Hospital for assistance for the babies' hospital and doctor charges."

The spokesman said that all hospitals are required to provide financial advice to their patients regarding their treatment.

"Patients are encouraged to choose a care setting most appropriate to their financial situation.

"In the restructured hospitals, Singaporeans can receive subsidies of up to 80 per cent of their total bill, and can also be assisted by Medifund or other hospital assistance schemes if they still face difficulties in settling their bill."

Ministry in touch with family

MOH understands the concerns faced by Madam Lim and her family, and has been in touch with them, the spokesman said.

When contacted, Madam Lim declined comment.

Dr Lam Pin Min, chairman of the Government Parliamentary Committee for Health, told The New Paper that he was glad to know that MOH has exercised flexibility according to the special circumstance in this particular case.

"I do understand the anxiety caused in cases where hospitalisation bills can be hefty and the helplessness in relieving the financial burden although there are significant amounts in the Medisave accounts," he said.

"The restriction on the use of Medisave needs to be reviewed regularly to commensurate with the medical needs of Singaporeans.

"However, we need to exercise caution as a too rapid liberalisation may result in premature depletion of members' Medisave savings," he said.

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.

She's sick but hasn't seen doctor in 10 years

People like housewife Tan Miu Muay could well be who Deputy Prime Minister Tharman Shanmugaratnam had in mind when he spoke about the Government's emphasis on a fair and inclusive society.

She's poor. She's sick. She has five school-going children.

And because she hasn't seen a doctor in 10 years - she fears she cannot pay her medical bills - she has only a vague idea of what ails her.

The 41-year-old is a needy Singaporean who hasn't been forgotten in this year's Budget, which was announced yesterday.

She will benefit from a new GST voucher scheme, a permanent system of offsets to help lower-income Singaporean households.

Her children will also benefit indirectly from top-ups to various funds which help with education and social support.

Madam Tan has been living in a two-room rental flat on Lorong Lew Lian for the last 10 years.

She has five sons, aged seven to 17. Her husband, Mr Chua Chue Po, 40, is a Malaysian who is a permanent resident here. He earns $1,200 a month moulding cornices.

Their monthly rent is under $200.

Madam Tan, who left school after Primary 6 and can't read or write, has been having trouble with her liver since she was 28.

She said: "The last time I went to see a doctor 10 years ago he said that there were some levels in my liver which were very high."

Liver operation 

She said she had an operation on her liver in 1998, and was in and out of hospital for three years after that.

She eventually discharged herself even though she needed further treatment because she was afraid of incurring further medical costs.

"I had help from a medical social worker. But I was afraid that I could not pay if I continued to seek treatment.

"So now I just tong ('endure' in Hokkien)."

Since then, Madam Tan has foregone medication. She often breaks into cold sweat and feels cold even when the room temperature is normal.

She suspects she also has low blood pressure because she often feels weak and tired, and cannot stand for more than 30 minutes at a stretch.

"I thought of getting a job, but all the jobs I qualify for are strenuous and I cannot do them."

Her days are spent doing household chores - mostly while she is seated - and looking after her children.

Yesterday, the new measures brought some relief. She was especially pleased with the Government's moves to make health care more affordable.

"I hope health care will be cheaper, so I can find out what is wrong with me.

"Right now, the thought of hospitals and clinics scares me. I don't know who can help me."

What are the health care changes under Budget 2012?

By 2020...

>> Number of beds in acute-care hospitals to increase by 1,900 – or about 30 per cent.
>>  Number of beds in community hospitals to increase by 1,800 – more than 100 per cent.
>>  Two more community hospitals in Outram and Seng Kang.

Enhanced subsidies
>> In community hospitals, low-income patients will receive 75 per cent government subsidy. Patients above the median income to receive 20 to 50 per cent subsidy. They did not qualify for subsidies previously.
>>  Subsidies for nursing homes, day care and rehabilitation facilities, and home-based care packages will be raised. About 80 per cent of elderly will qualify.
GST will be fully absorbed for subsidised patients under long-term care.

Enhanced Medishield
>> Coverage extended from age 85 to 90.
>>  One-off Medisave top-up to meet increase in premiums. Those aged under 40 will receive $50; aged 41 to 50, $100; aged 51 to 60, $200; aged 61 to 75, $300; and those aged above 76 will receive $400.

Help for Mrs Tan

New moves to offset GST

1. Cash component
Given to Singaporeans whose incomes fall within the bottom 40 per cent, and who live in HDB flats, or the bottom 15 per cent of private properties, based on assessable income and the annual value of their homes. They can expect to receive this from August.

2. MEDISAVE Top-up

Up to $450. This will go to about 85 per cent of Singaporeans aged 65 and above from August.

3. U-SAVE
Between $180 and $260 for all HDB households to help directly offset their monthly utilities bills. To be given out in January and July each year, from July this year. Those who qualify for this scheme will receive a letter in July.

How Madam Tan's family will benefit from the GST VOUCHERS

Estimated GST they pay in a year: $810

But Madam Tan will get:
Cash: $250
Medisave: $0
U-Save: $260

Effect: The GST voucher scheme will offset more than half of the GST incurred by her family in a year.

Other ways she may benefit:
>> More affordable health care
>>  More affordability in long-term care
>>  Top-ups to Medifund, an endowment fund set up by the Government to help needy Singaporeans who can’t pay for their medical expenses.

Help for Madam Tan's children

More support for children from low-income families:

>> Pre-school subsidies will be extended. A family of five, with three children, will now pay $20 for each child in child care compared to $110 previously.

>>  More students will benefit from the Education Ministry’s financial assistance scheme. The qualifying household income ceiling will be raised to $2,500 a month from $1,500.

>>  About 40,000 more students will be subsidised for school fees, uniforms and textbooks, and receive a 75 per cent subsidy on their exam fees.

Top-ups for school advisory and management committees:

>> To help them introduce new schemes in school, like transport assistance for students.

Enhanced student-care fee assistance scheme:

>> Subsidies for student care will be extended to families with up to $3,500 in monthly household income. Currently, only families earning $2,500 or less qualify. A family under this scheme will typically see the amount they pay for student care reduced from $200 to $80 per month.

Top-ups:

>> $200 million to EduSave Endowment Fund to let children enjoy meaningful enrichment programmes.

>>  $200 million to ComCare Endowment Fund to support needy families.

>>  $5 million to self-help groups and $5 million the CCC ComCare Fund.

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.

Govt looking at allowing Medisave for home care services

SINGAPORE : The government is looking at allowing the use Medisave for home care services and reviewing current subsidies to make home care options more affordable.

This was announced by Minister of State for Health, Dr Amy Khor, at the opening of the TOUCH Home Care Centre in Jurong on Wednesday.

78-year-old Sapri Amat suffers from hypertension and cataract, and some months ago, a gout attack left him almost bed-bound.

His wife Madam Piah has cancer.

Their only caregiver - son Mohamad Sapri - left his job about two years ago to care for his elderly parents.

The new TOUCH Home Care Centre in Jurong now provides transport for Madam Piah for her hospital appointment visits.

A nurse and therapist also visit Mr Sapri to monitor his condition and provide home-rehabilitation.

After subsidies, the family pays about S$60 a month for the services - 10 per cent of the total cost.

Madam Piah said: "I feel better. There are now people to look after me. If not, there is only me taking care of my husband, along with my son."

TOUCH Home Care is only the second voluntary welfare organisation (VWO) to provide home care services in the West, an area it said has been under-served, till now. But in just two months, its staff of 10 are now catering to the needs of 30 clients, a number it hopes to expand to some 300 within the next two years.

Besides VWOs providing these services, needy Singaporeans can soon also tap on Medifund for home care services. Some 1,000 Singaporeans are expected to benefit.

But the government acknowledges that cost is still a big factor, and it may also allow the use of Medisave for such services.

Dr Khor said: "Home care will play a substantive role in future as one of the care options for the elderly. The issue of accessibility and affordability of elder care services is critical and we need to address that, so we are looking at ways to grow the home care sector.

"Some of the areas we are looking at include reviewing our subsidies as well as the use of Medisave."

The government is also looking at leave options to alleviate the stress faced by caregivers.

The Agency for Integrated Care and the Centre for Enabled Living will provide TOUCH with a funding of S$700,000 over two years.