1. Singapore – Healthcare Policies Tan Yu Yang (23) Terre Chua (24) Zou Xiangyu (31)

2. ‘The 3M system’ M edisave (1984) M edishield (1990) M edifund (1993)

3. Medisave Implemented in April 1984 Similar to America’s ‘health savings account’ Every month, 6.5%-9%* of salary is deposited into Medisave Money deposited can be used to pay for personal or immediate family’s hospitalization, day surgery and certain outpatient expenses bills Compulsory * depends on age group

4. Medisave Contributions to the Medisave account has a limit of $34,500 Medisave can be claimed only if the patient stays in the hospital for at least 8 hours (unless the patient is admitted for day surgery)

5. Medisave – Claim limits Medical / surgical inpatient cases S$450 per day for daily hospital charges for patients admitted on or after 1 May 2007. S$400 per day for daily hospital charges for patients admitted before 1 May 2007. This includes a maximum of S$50 for doctor's daily attendance fees. Approved day surgeries Up to S$300 per day for daily hospital charges for surgeries done on or after 1 May 2007. Up to S$200 per day for surgeries done before 1 May 2007. Surgical operations (inpatient and day surgery) A fixed limit - depending on the complexity of the operation

6. Medisave – Claim limits A list of claim limits and table of surgical operation is available on our wikispace: http://s3-health1.wikispaces.com A list of approved outpatient treatments which can be paid by Medisave is also available on our wikispace

7. Medisave for the self-employed Only self-employed persons who earn more than $6,000 a year would need to contribute to Medisave The amount of Medisave they are required to contribute is capped based on an annual income ceiling of $60,000 for income earned in 2005 and $54,000 for income earned in 2006. Details of Medisave contribution for the self- employed can be found in CPF Board's websiteCPF Board's website

8. Use of Medisave MOH will allow the use of Medisave to help pay part of the outpatient cost, and reduce out of pocket payment for patients For each bill, patients will only need to pay the first $30 of the bill (as the deductible) as well as 15 per cent of the balance of the bill. Medisave can be used to pay for the remaining amount. This is regardless of whether the bill is for a one-off visit or a package.

9. Why is it a good policy?

10. Medisheild Implemented in 1990 Acts like a medical insurance: helps pay part of the large hospitalisation bills for treatment of serious illnesses or prolonged hospitalisations (even after Medisave coverage) From 1 December 2007, it has been restructured to be provided to all newborns and SPRs Only claimable for approved medical services performed in Singapore

11. Medisheild Medishield will cover up to 80% of your large medical bill at the Class B2/C level Medishield covers hospitalization expenses, surgery/day surgery and certain approved outpatient treatments, such as kidney dialysis, chemotherapy and radiotherapy for cancer treatment

12. Medisheild Medishield is designed for Class B2/C wards, so for hospital stays in higher class wards/private hospitals  Medishield claim will be calculated based on a percentage of your hospital bill Similarly, if you go for unsubsidised day surgery, your Medishield claim will be calculated based on a percentage of your bill

13. Table showing difference in % of claim btw. Singapore citizen and SPR Ward Class Percentage of charges incurred for non-Singaporeans SPRForeigners 1 January 20081 July 20081 January 2008 C80%67%20% B287%78%35% Subsidised Day Surgery 87%78%Not Eligible Subsidised Specialist Outpatient 90%83% Not Eligible

14. Medisheild claims based on… Citizenship: Singapore citizen, Permanent Resident, Foreigner Age group: e.g. “30 and under”, “51-60”, “84-85” etc. Class of wards/type of hospitals: Class B2/C, higher class wards (e.g. A/B), government/private hospital Length of medical procedure/hospitalization: e.g. “54 days incl. 2 days in ICU” Type of medical procedure: e.g. pancreas and gall bladder operation, implants, colonoscopy etc.

15. Why is it a good policy? Gives benefits to both Singapore citizens and non-citizens (SPRs and foreigners) ensure the harmony between the different groups in the society and even foreigners are given this benefit, thus ensuring that everyone in Singapore is given the same benefit, while giving Singaporeans more subsidy in their healthcare prices encourages Singaporeans to continue staying in Singapore to receive such benefits and also to encourage foreign talents in Singapore to become Singaporeans so as to receive more benefits.

16. Why is it a good policy? Policy is an opt-out* one, thus government is actually providing citizens and non-citizens  in times of economic crises, they will still have enough money to pay for hospital bills Ensures that regardless of religion and race, everyone will receive the same amount of benefit, ensuring social stability Only applies to certain government hospitals, which in turn will encourage citizens to visit government hospitals rather than private ones, thereby helping to contribute to Singapore’s economy *An opt-out policy means that it is not compulsory; however, you must opt- out of it if you do not wish to participate in it.

17. Medifund Implemented in 1993 Endowment fund set up by the Government as a safety net to help poor and indigent Singaporeans pay for their medical care Acts as a last resort for patients who, despite heavy Government subsidies, Medisave and Medishield, are unable to pay for their medical expenses Patients receiving inpatient treatment in Class B2/C wards or subsidised outpatient treatment in the public hospitals may apply for help from Medifund

18. Medifund - Criteria Medifund is not an entitlement!, only for Singapore citizens facing hardship Patients have to fulfil certain income criteria before their applications can be approved. The amount of help from Medifund will depend on individual circumstances and the patient's financial background. Hospital Medifund Committee considers the application The applicant must exhaust all other funds (e.g. Medisave) first before the balance is being considered for Medifund

19. Medifund - Limitations No limitations to age, gender, race, religion Limited to Singapore citizens only Limited to certain hospitals, specialist centres and voluntary welfare organisations Limited to patients in Class B2 and C wards, subsidised outpatient treatments Available to all medical and healthcare services (including day surgery, hospitalisation etc.) EXCEPT respite care and delivery

20. Why is it a good policy? Eases financial burden of less well-to-do families (esp. in times of economic crises) Not limited to race or religion: thus making it fair for all Singapore citizens who meet the other criterias to apply Gives more support to elderly Singaporeans with no Medisave or who did not accumulate enough Medisave because the Scheme was implemented too late for them

21. Why is it a good policy? Provides good welfare for all Singaporean citizens, regardless of gender, race, religion or age (ensures social stability), thus making it a sound and fair policy Equal racial treatment and consideration for Singapore’s ageing population