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Wednesday November 26th 2014

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Can you afford to pay $12,000 for three stents in a C-class ward from our public restructured hospital when you have a heart attack?

Latest: Hear Mark speaks about his near-death heart attack experience at our entrepreneurial event on 26 Nov (Mon) at NVPC seminar room one. Registration is required via gilbert@transitioning.org.

Yesterday, I visited a cabbie friend of mine Mark at a public restructured hospital -  he suffered  a serious heart attack last Sunday. Three of the arteries were blocked with one at 100%.

It was a long while since I last visited a hospital and I was impressed with the modern facilities and pleasing decoration of the public restructured hospital.

One can even mistaken our restructured hospital as a private one as the facilities and professionalism are almost similar.

You even have to register yourself at the counter now before you can visit the patients and there is this high-tech gate which you need to scan in your identity card before you can be admiited into the ward.

Most of the nurses and hospital aides are  foreigners but they all look so professional and customer-orientated.

Many Singaporeans must have a few rather unpleasant incidents with our stoic local nurses when they visited their friends or loved ones at our public hospitals.

They are strict and discharged their duties well but often grudgingly and without any courtesy.

Anyway, I was nevertheless glad that my friend was well and resting at a high dependency ward a day after the heart attack with a stent inserted into the blocked artery.

He experienced cold sweat till his shirt was all wet and extreme dizziness – sysmptons of an impending heart attack.

Fortunately, he has the good sense to drive his cab home early in the morning and his wife dictating that something was wrong with him decided to sent him to the A & E.

He has three blocked arteries and required three stents so that his heart could function properly again.

What shocked me was the cost of the stent insertion – each stent costs around $4000 and he could only pay $1000 plus from his medisave savings.

He needs to cough up $12, 000 for the three stents and after minusing the medisave deductible, he needs to pay close to $8000 plus in cash – not a small sum when he could not work for at least a few weeks and has two young teenagers to feed.

The amount was also calculated based on him staying in the lowest C class ward!

Though the admission has assured the family that a social worker can look into their finances after his discharge, one wonders what their criterion will be when the family decides to apply for a waiver of the exhorbitant medical fee.

Will the hospital then decides to do a means testing exercise and asks for all the payslips and tax returns of the siblings and loved ones to look for someone weathier within the family tree to pay up?

Will the hospital also plans out a instalment plan so that the family has to work two jobs to pay up hospital debts or worse force the heart attack patient to over-worry and prematurely return to the workforce further jeopardising his recovery schedule?

Already during the short visit yesterday at my friend’s ward, I could sense the anxiety on the family’s faces as they go over the high medical cost.

Having worked in a voluntary welfare organisation before, I knew that it is very difficult for someone to apply for subsidy for medical services rendered as they will go through your whole family’s finances thoroughly and even look into the kind of home you stay.

Its also a exhaustive exercise which will sap you emotionally dry until you give up applying for the state subsidy and probably forfeit the medical services that your loved ones require.

Proponenets of our modern medical facilities will point out that there is the national medishield insurance scheme which will  cover most medical disasters which strike a large majority of our population.

Medishield coverage also has a deductible  sum i.e your medical bill must exceeds a certain amount before the insurance scheme kicks in and they only pay a certain percentage of the toal medical cost incurred.

It is all very complicated  and many Singaporeans are probably clueless as to how Medishield works.

The weathier Singaporeans will try to cover themselves with private medical insurance such as  the dreaded critical illnesses – a premium-based insurance scheme which pays out a large sum when you are hit with one of the 30-plus list of critical illnesses.

However, there will always be this group of Singaporeans who forego paying insurance premiums especially if they have lost their jobs during the 2008/9 downturn.

Personally, I have lapsed all my insurance policies as I could not fork out any cash to pay for the premiums during the long 18-month unemployment period.

How can you pay insurance premiums when you could not even pay your PUB  and town council bills?

For most lower middle-income Singaporeans, going to the hospital can be an expensive exercise as they are not too poor to apply for medifund – a medical provision for those who are the very poor here and not too well off to comfortably pay for a 5-figure hospital bill in a C class ward.

I am unsure how the family can cough up the $12, 000 bill but one thing is for sure – Singaporeans who say that they prefer to pass on than visit our public restructured hospital may have some truth there.

Many Singaporeans have confessed that our public medical cost is just too expensive especially for those who are in the lower middle income group – people who generally earn between $2500 – $3500 and probably don’t have much left over  for savings.

Moreover, I have heard from a close friend  how her dad preferred not to accept medical treatment for cancer and eventually he passed away.

Her dad  was uncomfortable of being a financial burden to his family and preferred not to accept medical treatment as someone has to act as a guarantor for him in order for the hospital to proceed further with the treatment plan.

For someone who earns less than $2000 a month, acting as a guarantor for a medical bill of more than $20, 000 in a C class public hospital ward can be a frightening thing – even though the person you are standing  for is your father or mother.

I wondered if such incident is a cmmon daily  occurrence in the highest GDP country of the world?

Finally, did I also hear that our health minister was only charged $8 for his recent heart-related hospitalisation at our public restructured hospital?

All this mindless propaganda only made my blood boils…

Written by: Gilbert Goh

Editor’s Note: The $12,000 bill does not include the patient’s ward charges and other hospitalisation cost. The bill is inclusive of  all other C-class ward subsidy. B-class ward patients pay more than $6000 for one stent. If you suffered from the high cost of staying in our public restructured hospitals before, please email me at gilbert@transitioning.org or goh_gilbert@yahoo.com, we like to hear from you. All correspondences will be treated with the strictest confidence.

Reader Feedback

28 Responses to “Can you afford to pay $12,000 for three stents in a C-class ward from our public restructured hospital when you have a heart attack?”

  1. jj@39 says:

    We the citizens of Singapore can die but cannot afford to fall sick bcoz we are paupers. We don’t have that kind of money to seek treatment.

    In PRC, some parents with financial difficulties just dumped their seriously ill children in hospitals & ran away. That’s the only way their children can get treatment.

    Some hospitals will watch over the movement of their patients in case they ran away without paying the bills. The hospitals refuse to let the patients discharge, they must stay in the hospital until the bills are clear. The patient’s family members will perform all kind of acts in order to get the patients out of the hospitals.

    I always wonder how would i die when my time is up. Will it be some illness or accident? If i am diagnosed with some illness e.g. cancer, i maybe also won’t seek chemotherapy treatment. I will go enjoy my last days while i can.

  2. SG in China. says:

    In PRC, Patients are require to deposit a certain amount of money before they can be admitted to the hospital. The hospital will inform you to top up when the money is not enough to cover your fees. If you or your family members are unable to top up, then the doctors will simply ignore you and stop all form of mdeication.

    • jj@39 says:

      “In PRC, Patients are require to deposit a certain amount of money before they can be admitted to the hospital. The hospital will inform you to top up when the money is not enough to cover your fees. If you or your family members are unable to top up, then the doctors will simply ignore you and stop all form of mdeication.” – I believe that.

      But if the patients die or health deteriorate or became more seriously ill in the hospital then family members, relatives or maybe all the villagers will come protest outside the hospital. There are many medical disputes in PRC.

      In PRC, you also have to give hongbao money (red packet) to the docs & nurses if not no good medical service will be given to you. The rich & powerful will always receive the best medical service.

  3. Tim says:

    Hi Gilbert, how much do you expect to pay for a triple heart bypass surgery? Price of an iPad? $12,000 is very reasonable for this complicated life saving procedure and the standard of care given. Save $400 every month for 2.5 years and you can have this amount of money. My low income neighbour who works odd jobs blows at least $400 a month on cigarettes and pet grooming. My subordinate drives a flashy car while I take public transport. He ends up borrowing money every month to pay his car installments. If he falls ill, he would have no money to pay for his medical treatment.

    It is about personal financial responsibility.

    However I do agree that our insurance sector needs improvement. Insurance is too expensive and the government allow the insurance companies to make huge profits by selecting only healthy customers. Everyone should have the right to basic medical insurance.

    • jj@39 says:

      If save $400 every month for 2.5 years and you can have this amount of money. But if can only save $200 every month then it would takes 5 years to save enough amount of money for a triple heart bypass surgery.

      Don’t forget about the inflation factors during these 2.5 yrs – 5 years. Now maybe we only need to pay $12,000 for the treatment but after a few years, $12,000 is no longer enough for that kind of treatment. Unless we have great medical technology breakthru to help us save cost.

      Pay money to seek treatment is one thing but during the treatment & after treatment, patient usually can’t go work so no income for him. $12,000 is just only for the treatment. If you add in the lose of income, that’s definitely more than $12,000.

      Medical treatment & surgery is definitely expensive for the poor. it’s a great misfortune for low income earners or paupers like us to fall sick.

      • Tim says:

        So you are saying since inflation will diminish your $400 monthly savings, might as well live for today and buy those packs of cigarettes, car, iPad, etc today.

        Good luck to you then.

    • Eastman01 says:

      Your reply sounds cold and heartless. Like the Ministers and Civil Servants.

      One day if you/ family members fall very sick – you will feel differently.

      When you are sick, job stability/ security is even more at stake. And you will never know how much is enough as the $12,000 medical fee is only the beginning…..

      • Tim says:

        You don’t have to worry about my family. I work hard, save money, and don’t spend on frivolous things so that I can one day when they fall ill, I will have enough money to save them.

        Fact of life is that everyone will fall sick eventually and we need to be prepared for it. If you can’t be responsible for yourself and your family members, then who will?

    • Dico says:

      Hehe, Tim must be one of those medical people who charge his patient with the Mary Lim style. That is why $12,000 to him is peanuts because he charged more.

      • Tim says:

        Just a working class average joe who lives in HDB and BMW (Bus, MRT, Walk). I don’t think the likes of Mary Lim will visit this site.

  4. Seraphim says:

    Singapore is a non-welfare state and has one of the lowest taxes in the world. (Even though there are alot of hidden taxes) So subsidization cannot be expected to be good. In short, prepare to pay a huge sum for medical treatment from your own pockets. Is 12k a lot? I would say yes, if you have a housing loan to pay and family to feed.

    The medical services in Singapore seems to be heading the American model of healthcare. In other words, healthcare expenditures are going to be insanely expensive in time to come and can potentially bankrupt a person without healthcare insurances.

    Insurance companies are profit making companies, so I am not surprised by the fact they choose healthy young people with no medical history as their clients. What I suggest though is to buy health insurance even though you are healthy. Family and future plannings starts at a very young age, especially in a non-welfare and unforgiving country like Singapore…

  5. J Y says:

    If anything happens to me and I end up in A&E in hospital, I will choose euthanasia. It is very true that poor people would rather die than to suffer the pain on top of astronomical bills even after subsidy.

    I hope that Singapore can legalise euthanasia. If anything happens to me, I do not want to prolong my pain and sufferring. It is also unfair for my family to foot the bills for me. They also need the $$ for their own bills in their old age.

    It is just unjustified that our hard-earned $$ got “eaten up” by hospital bills. Only the rich can afford it. The poor will need to work much harder or longer after recovery to earn the amount back. It is not that the poor are spendthrifts, but they can hardly survive with the meagre wage that they are getting. A major illness would most probably deplete their life-long savings.

    Many people worked too hard with little rest and got sick. The problem is that the living costs here are just too high for the poor. It is a vicious cycle of working harder to recoup the lost in earnings and falling sick again.

    • jj@39 says:

      I support euthanasia.

      In ROC, many signed up some sort of legal forms instructing hospital to stop giving them medical treatment to prolong their lives if they ever suffer serious illness or injury so that they can end their suffering & pain soon. They want euthanasia.

    • Seraphim says:

      Sign yourself up for the Advance Medical Directive (AMD), its the closest thing to euthanasia in Singapore.

      For more info, please go:
      http://www.moh.gov.sg/content/moh_web/home/policies-and-issues/advance_medical_directiveamd.html

      • jj@39 says:

        Thank you, Seraphim. But it’s not suitable for me yet.

        I now not suffering from any terminally illness and unconscious and where death is imminent. Doctor also won’t be my witness.

        • Seraphim says:

          Hey jj,

          The AMD is meant to be signed when you are healthy and ‘sound of mind’. You will not be able to sign it once you have a terminal illness and things like that due to the ‘psychological effects’ of the illness.

          • jj@39 says:

            “An Advance Medical Directive (AMD) is a legal document you sign in advance to inform your doctor that you do not want the use of any life-sustaining treatment to be used to prolong your life in the event you become terminally ill and unconscious and where death is imminent.

            The AMD can be made by any person, aged 21 years and above, and of sound mind. The AMD form is a legal document which must be completed and signed in the presence of two witnesses before it is returned to the Registrar of AMDs. The patient’s doctor must be one of the two witnesses, while the other witness must be at least 21 years old. In addition, both witnesses must not have any vested interests in the patient’s death.”

            I am not ill now, i not seeing any doctor now. i am not a patient. How do get a doctor to be my witness?

          • Seraphim says:

            Hey jj,

            It can be made in any polyclinic. But u need to pay the consultation fees though.

            You would be asked if you want your AMD to take effect when you are critically ill. Please take note that if you are unable to communicate your wishes (Coma), your family will retain the rights to uphold the AMD or revoke it on the spot.

            When you get a terminal illness or met an accident, it will be too late to sign the AMD as they will perceive you are not of sound mind due to illness, etc.

            More info at:
            http://www.lawsociety.org.sg/forPublic/YoutheLaw/AdvanceMedicalDirective.aspx

            AMD and euthanasia is different in many ways.

            AMD still gives you the basic treatment you need. Such as food, water, antibiotic. But should you require CPR, advance life support or cyto-toxic treatments, they will be withheld.

  6. Thomas says:

    Remember “Family allowed to pay $130,000 hospital bill in monthly installment over 42 years” (New Paper, Oct 16)

    It just crazy!!

  7. Tongkol says:

    Just buy hospital and medical insurance… Not the critical illness Insurance. It’s not expensive. Get everyone in your family especially your parents covered. It’s peace of mind.

    • Tim says:

      I think some people would rather buy the latest gadgets than buy medical insurance for their family.

      Then later complain on how $1000 is too much to pay to save their lives.

  8. jj@39 says:

    There’re quite a few high class private hospitals operating here now. Their target customers are local or regional rich people. PAP also supported the idea of making S’pore as a high class medical treatment hub for the rich.

    Many less income earners from Europe, USA, Spore went to seek cheaper treatment in India & other asia countries. I think Thailand is one of them too. They also want their countries to become high class medical treatment hubs for the rich or anyone who earned more than its locals.

    It’s a great misfortune for low income earners or paupers like us to fall sick. Nothing will change the fact for this.

  9. junior says:

    If I’m not wrong, Medishield should be allowed in this case.. My father has the same incident just few mths back.. The final bill to be paid in cash is less than $1k..

    Nevertheless, I hope that our government can do more for us.. Medical fee should not be a burden or worry by any singaporean.. Bear in mind that money cannot buy back life..

  10. chillax says:

    12k is reasonable for 3 stents!what is not reasonable is the way subsidy is given. i believed taxi drivers do need to contribute medisave. if it has not been wiped out before, this bill will easily be covered by medisave.

    Take comfort that the bill is manageable. it is those cases with extended stay in ICU that runs to six figure which is a real nightmare.

    My uncle blew 450k on a transplant in a private hospital. that was mind blowing for me at least.

  11. anon says:

    Those who want to stay in private hospital — let them blow as much money as they like — $1 million for panadol also can.

    But C-class ward in govt restructured hospital is another story.

    The Hard Truth is that ALL restructured hospitals are now forced to operate as profit-making private institutions. Do you know that all our govt hospitals are under various Private Limited companies? E.g. SingHealth Pte Ltd, National Healthcare Group Pte Ltd, Jurong Health Pte Ltd, Alexandra Health Pte Ltd, Eastern Health Alliance Pte Ltd.

    All these Pte Ltd companies are fully owned by Ministry of Health. All the CEOs of the govt hospitals are mandated and forced to show profits on their hospital accounting records.

    As for that $12K being taken care of by Medishield. NO WAY!! Medishield has very low payment limits — it definitely will not even cover 50% of the $12K. Most probably only cover at most 35% — you still need to cough up $7,800.

    Don’t believe, you can scrutinise all the Medishield details in CPF website. BTW, They make it very hard to search for the info. You can also call the CPF insurance dept to find out the Hard Truth. But they will try to give you BS and talk cock first.

  12. Colin says:

    Nobody can afford housing or medical care in singapore.. We might as well die if we are terminally ill to save cost. Harsh to say but its the reality.

  13. jj@39 says:

    @Tim

    I presume you have no problem in saving $400 per month. But not everyone can do that.

    You presume other can’t afford saving $400 per month or buy medical insurance for themselves & their family bcoz they spend the money on gadgets, cigarettes, car. I don’t think that’s right.

    Why not let us do a test? You quit your manager job now.

    Let’s see whether or not the employer/HR mgr will condemn your education & experience as out-dated & irrelevant to the position you applied for?
    Let’s see how much the new employer is willing to pay you?
    Let’s see how long you will take to find the next mgr job?
    Let’s see how much you can save per month?

    Tim, ppl like you have to go thru the suffering of others only then you will know & understand why & how.

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