Saturday, July 16, 2011

Govt should review subsidy for implants

Jul 16, 2011

50% subsidy for lenses, stents and replacement joints may be too low
By Salma Khalik

PATIENTS in C-class wards in public sector hospitals, the most subsidised of wards, generally get about 80 per cent of their bills paid by the Government - except when it comes to implants.

The subsidy for any implant at a public hospital is 50 per cent of the cost of the implant. This subsidy is capped at $1,000, regardless of the subsidised patient's ward class.

Until April this year, the subsidy was still 50 per cent, but the cap was even lower, at only $500 for all subsidised patients.

The rest has to come from the patient's insurance, Medisave account, or his own pocket.

In announcing the higher cap, the Ministry of Health (MOH) said 90 per cent of implants cost less than $2,000, which means only 10 per cent of subsidised patients will need to pay more than 50 per cent of the cost of their implants.

The raised cap is expected to cost the ministry $3 million more annually. The total amount in implant subsidies the Government hands out yearly is not available.

The move to increase the subsidies on implants, which can range from lenses following cataract surgery to stents to keep blocked arteries open, is commendable.

But is it enough?

Two questions come immediately to mind.

The first: What about the 10 per cent of subsidised patients for whom the cap means they have to pay more than 50 per cent of their implant's cost?

The second, and perhaps more important, question is: Why is the subsidy for implants capped at 50 per cent?

Poor patients in C-class wards get 80 per cent of their hospital bills subsidised by the Government. If they opt for B2 class, 65 per cent of their bills will be picked up.

This is obviously not the case when it comes to paying for the implants they need, which makes one wonder about the rationale for the lower subsidy.

In a reply to this query, the ministry said that government subsidies are formulated based on several factors, such as 'the cost of care, patient needs and long-term sustainability'.

Said the spokesman: 'By and large, an 80 per cent subsidy applies across the various services and treatment received by inpatients in Class C. However, a different subsidy framework applies for implants, similar to certain other items such as drugs.'

The ministry added that patients in need can turn to Medifund, the health safety net for the very poor.

But that doesn't explain why implant subsidies are pegged at no more than 50 per cent - unless the worry is the long-term sustainability in giving out such subsidies.

But one can argue that implants such as stents to prevent heart attacks can be as crucial as chemotherapy for cancer patients.

As the population ages, more implants will be used. Some, like heart stents, will save lives, while others, like knee replacements or eye lenses, will improve a person's quality of life.

These are all basic medical needs, which should enjoy the maximum 80 per cent subsidy for C class and 65 per cent for B2 class.

It would be a pity if older people suffer from pain and are unable to enjoy a better quality of life in their twilight years simply because of the cost of such implants.

While there are no figures on the number of implants used by patients here, a check indicates that tens of thousands of such operations are performed annually.

Four of the more common implants used, said MOH, are lenses following cataract operations, artificial knees, stents to hold arteries open, and parts for hip surgery following a fracture.

A check with the Singapore General Hospital (SGH), which replaced 1,500 knees last year, showed that the implants cost between $2,500 and $3,500.

This means that a C-class patient would still have to pay from $1,500 to $2,500 for the implant. That is no small sum.

Those who are insured can rely on insurance to take care of the bill. But not all C-class patients are insured. In 2009, one in three elderly subsidised patients warded in public hospitals did not have any insurance coverage.

Furthermore, those needing such implants tend to be older, and MediShield currently stops coverage once the insured person turns 85.

Nationally, more than 2,000 knee replacements are done per year.

SGH surgeons also did 150 hip replacements, with the cost of the implants needed ranging from $3,000 to $6,000. Regardless of their ward class category, subsidised patients would have to fork out between $2,000 and $5,000 for them.

The 550 SGH patients who had hip fractures paid less for their implants, with costs ranging from $3,500 to $4,500. But again, subsidised patients needed to fork out from $2,500 to $3,500 for their implants.

In all cases, the higher government subsidy of $1,000 didn't cover half the cost of the hip implant.

These are three of the four most commonly used implants. The most common are lenses following cataract operations - with about 25,000 such operations a year.

If the 80 per cent subsidy for C-class patients applied to implants, such patients would need to pay a maximum of only $1,200 for a $6,000 hip replacement - a far cry from $5,000, which could easily deplete their Medisave accounts.

In 2009, the average Medisave balance of members aged above 65 was $9,369, said the MOH spokesman.

She added that 'this is enough to pay for six Class C hospitalisations and five Class B2 hospitalisations'.

But not if the patient has to pay $5,000 for the implant, plus 20 per cent of the cost of surgery and hospital stay, under the 80 per cent subsidy on hospital bills he enjoys.

One hopes that in his review of the health-care system, new Health Minister Gan Kim Yong will look into the subsidy of implants, as this will have a big impact on the lives of Singapore's rapidly ageing population.

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