On 12 September, a security guard working at Gleneagles Hospital, Thomas Lukose, suffered a heart attack while on night shift. He was taken to Gleneagles’ intensive care unit (ICU) immediately, and was put on a ventilator. On the next day, his family wanted to transfer him to a public hospital – but, there were no beds available at the time.

Hence, Dr Sriram Shankar, a cardiothoracic surgeon at Gleneagles’ treated Lukose with an open-heart surgery and three coronary artery bypass grafts. Dr Shankar waived the fee for his service, knowing his family’s financial concerns; yet, he was billed SGD78,000 by the private hospital while recovering at home.

Lukose’s family had made a crowdfunding appeal to raise funds for his hospital bills, as the MediShield Life and his employer insurance (covers only SGD13,500) would not be enough to cover his hospital bills.

Subsidised treatment, limited hospital beds for emergency patients

MediShield Life was created in 2015 to provide general medical coverage for all Singaporeans including permanent residents, from birth till death. It targets Class B2/C wards to reduce burdens of hefty medical bills among patients – if they opt for subsidised treatment.

In case of emergencies, patients are taken immediately to the nearest public hospital, where subsidised treatment under MediShield Life would be an option. For Lukose who needed emergency medical attention, he had no choice but to be admitted into the nearest private hospital.

There is a limited number of hospital beds to accommodate a possible surge of emergency patients, but subsidised treatments can only be claimable at public hospitals.
There is a limited number of hospital beds to accommodate a possible surge of emergency patients, but subsidised treatments can only be claimable at public hospitals.

This brings forward two main concerns within the Singapore healthcare system. Firstly, the lack of hospital beds in the emergency department of public hospitals; and next, the limited financial protection for these patients with a basic insurance coverage at times of need.

Statistics under the Ministry of Health (MOH) showed the total number of hospital beds in Singapore was 11,936 in 2001 and only increased by about 2.8% to 12,268 in 2016. However, the national population has increased by 37% from 4.1 million in 2001 to 5.61 million in 2016, according to the Department of Statistics Singapore.

This translates to a disparity where there is a limited number of hospital beds to accommodate a possible surge of emergency patients.

Additionally, Singapore’s public healthcare spending is just about 2.4% of GDP (SGD 9.8 million out of SGD 400 billion) – which is probably one of the lowest in the world. Limited budget allocated to the healthcare sector fetches limited subsidies available for patients.

Limited government subsidies on healthcare sector; financial burden for patients

Looking at Singapore’s healthcare system – the national health scheme comes with a key principle where no medical service is provided free of charge (regardless of subsidised amount). It is a hybrid model of health care system, combining government subsidies with patient co-payments. This makes Singapore healthcare system being ranked as one of the world’s best, with a relatively low cost to the government.

Even with the government subsidy, hefty medical bills can cause financial strain among patients, especially those with basic insurance coverage only.
Even with the government subsidy, hefty medical bills can cause financial strain among patients, especially those with basic insurance coverage only.

Yet, more than 60% of healthcare costs are paid by patients out-of-pocket, with less than one-third of all healthcare costs are paid by the government. The health insurance provided may not pay for the full hospital bill. As follows, patients will need to pay an initial amount (called a “deductible”) based on a subsidised class, as well as co-pay the rest of the bill. Aside from that, they will have to pay 10% of the rest of the bill for Integrated Plans.

Workers are contributing up to 10.5% of their wages to mandated savings accounts (Medisave account), for health care and insurance. This is much higher than the average of 14% in high income countries, according to World Health Organisation (WHO), and may be one of the highest national health insurance contribution (pre-pay basis) globally.

Even with the government subsidy, hefty medical bills can cause financial strain among patients, especially those without add-on integrated plans for more expensive hospital treatments. Thus, those who need urgent medical attention might not be able to afford them – especially among those who are dependent on basic insurance coverage only.

With the well-receiving media attention, Lukose’s family managed to raise about SGD16,000 on the crowdfunding website, according to the Straits Times. As of recent updates, Gleneagles Hospital waived Lukose’ medical bills, and the funds raised would be donated to those in need. MIMS

Read more:
Healthcare subsidies: Do we need more or less of these?
Understanding the concerns of Singaporeans on critical illness
Singapore healthcare subsidies: Lots more room to improve, as compared to Asian Tiger counterparts

Sources:
http://www.straitstimes.com/singapore/health/patient-could-not-get-place-in-sgh-hit-with-78k-bill
http://www.businessinsider.sg/brother-of-security-guard-who-suffered-heart-attack-says-gleneagles-has-waived-his-s78000-medical-bill/
http://www.straitstimes.com/singapore/health/allow-subsidised-rates-for-patients-who-opt-for-but-cant-get-such-care?login=true
http://www.theindependent.sg/security-officer-suffers-heart-attack-while-on-duty-forced-to-go-private-after-lack-of-space-in-sgh/