Wednesday, June 22, 2016

Adequacy of Basic MediShield if you keep to the side of the deal

If you are Singaporean, and stayed in Ward B2 or C, without any upgrade, how adequate would your shield plan be?

It is enough, it seems (if you are not "choy suay" - super unlucky). Lets go through them one by one.

First, operations/ procedures
https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/hospital-charges/Total-Operation-Fees-By-procedure.html


I went through all the procedures listed, the highest Subsidized cost of operations is for Vitreous, at 75% it is $1976. $2K surgery claim is enough. The rest are well below 2K at 75 percentile. Only operations with more than 30 case studies are published. 

Verdict:
Passed, and adequate, as long as you dun "chow suay" and dun belong to the above 75% percentile.


Next Average bill test.


Above illustration for Public hospital-surgical specialties. With the exception of KKH and NHC, all are covered by $700 room and board insurance provided by Medishield. By average, I assume it is 50 percentile. Average total bill would include surgical costs, it is rather blurry here as it would depend on the number of stays in the hospital. I would think using 90% percentile would be quite a safe bet. Assume 3 days inpatient stay and 1 day in ICU, insurance would cover up to 5K, assume 4 days inpatient and 2 days ICU it would cover up to 6K. I would go through the procedures that required longer days and most operations take only 1 -4 days. So looking at the 90 percentile, you would be safe at long as you dun go SGH. 

Verdict:
Passed, and adequate, as long as you dun "chow suay" and dun belong to the above 95% percentile.

Next long stay treatment with stays above 7 days.

They are:
1)Back problems (Serious)
2) Diabetics with serious implications
3) Stroke with and without serious implications
4) Lungs infections/ cancer
5) Kidney and urinary infections
6) Hip replacement
7) Heart Surgery 

You can down the excel form this website  The following conditions will be inadequate as subsidized surgery would already exceed 2K : 

Condition:
Heart angiography (Coronary angiography) - overnight stay
Condition Description:
Admission for heart angiography procedure (with no occurrence of Heart Attack in this admission) and without cardiac ablation; no serious complications
Ward B2
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
CGH
69
3.0
2,001
3,119
KTPH
69
3.3
1,713
3,163
NHC
256
2.7
2,448
3,484
NUH
111
2.9
1,818
2,653
TTSH
113
2.9
1,488
2,470
Ward C
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
CGH
104
2.5
1,358
2,554
KTPH
77
3.2
1,460
2,683
NHC
227
3.0
1,729
3,229
NUH
199
3.0
1,345
2,070
TTSH
140
2.8
1,075
2,839
Day Surgery (Subsidised)
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
NHC
114
1.0
1,989
3,935



Condition:
Heart angioplasty (Coronary angioplasty)
Condition Description:
Percutaneous Transluminal Coronary Angioplasty (PTCA); procedure to enlarge a narrowing in a heart vessel with a stent; no serious complications
Ward B2
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
CGH
87
1.8
5,222
7,105
KTPH
38
1.9
6,288
7,757
NHC
174
2.3
7,570
11,871
NUH
79
2.2
5,157
8,039
TTSH
80
2.2
8,383
14,423
Ward C
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
CGH
175
1.5
4,050
5,914
KTPH
85
1.7
5,768
10,486
NHC
195
2.5
6,309
10,526
NUH
185
1.8
3,425
5,163
TTSH
106
1.9
7,986
12,463
Day Surgery (Subsidised)
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
NHC
551
1.0
7,708
12,173
This would be a nightmare for those under Medishield


Condition:
Stroke with serious complications
Condition Description:
Admission for stroke, with serious complications and/or comorbidities
Ward B2
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
CGH
85
15.4
3,917
10,728
KTPH
82
13.8
4,364
8,366
NUH
91
11.8
3,761
8,971
SGH
107
13.3
4,627
11,936
TTSH
197
18.9
6,323
13,733
Ward C
Hospital
Volume1
Average Length Of Stay (days)2
50th Percentile Bill Size ($)3
90th Percentile Bill Size ($)4
CGH
336
17.2
3,602
8,152
KTPH
324
17.2
3,972
8,004
NUH
204
16.0
3,798
11,025
SGH
164
18.2
6,041
13,786
TTSH
446
22.8
4,251
10,254
The Expenses look scary but it should be covered by the room and charge, 10 days of ICU care would already allow you to claim up to 12K

Verdict:
I looked through all 81 excel sheets and only found 1 condition that would bust the mediashield coverage, however, do note that some conditions state the surgery costs are not reflected.

Conclusion:
I believed Mediashield is meant to cover as much people at a as low possible cost as possible, so some outlayers are excluded. 

So, the biggest item that could throw your plan to disarray is surgery, so if money is really not too much of an issue to you, go for the lowest IP plan that covers surgery as "per charged", and you get a upgrade to B1 ward.

Please note that I am excluding private care totally as an option here. 



29 comments:

  1. Sillyinvestor,

    Come, I give you a bear hug!

    Now that's what I call verifying for ourselves and making an informed decision based on facts :)


    Medishield Life is like flying economy class - good for the majority of the people; and that's where big daddy should focus subsidies on. And they did.

    If we want extras, we can "upgrade" ourselves to economy plus or business class within public hospitals.

    Prefer First Class stay at private hospitals? Well, if we can afford it, why not?

    No one stopping anyone, just as long we pay our own way. Just don't expect others to subsidise you ;)



    Chris' post was a gentle reminder to not treat our Medisave account as "funny money".

    They are those who are ill-equipped to afford Integrated Policies but went ahead anyway. Only to find out they can't keep up the premiums when they retired...

    It's a bit like that young man at his early 20s who bought a car with $2K salary and found out he can't afford to maintain it.

    Imagine downgrading your health insurance policies at 60 due to insufficient CPF Medisave funds - just when you probably need it the most?


    That's the main thrust of Chris' post - all these segregation of accounts like Skills Future, Edufund, Medisave; etc - may lull people into making frivolous decisions since we can't "see" the money anyway...

    And that's where snake oils like to lurk. Spend it all before big daddy moved the goal posts again.

    ReplyDelete
    Replies
    1. Hi SMOL,

      Ya, I apologized to CHris... A bit agaited, as I am a strong believer of IP. Regarding you analogy:

      "Medishield Life is like flying economy class - good for the majority of the people; and that's where big daddy should focus subsidies on. And they did."

      It is not the same. Budget or First Class, they get you to your destination. NO way they send you somewhere else unless you super duper chow suay and meet with air flight accident.

      We want insurance to pay our bills. If I tell you, you fly budget there is one out of 81 chance that it will not get your destination, and there is a 5% probability everytime too, that the flight might not get you to your destination.

      Will you still fly budget??

      Delete
    2. Sillyinvestor,

      Chris wrote a thought provoking post and you zeroed in on one insignificant mention of "wards". Glad you apologized to Chris.

      Now you swinging your bat at me?

      ........

      Still agitated? Is "budget airline" the trigger word? I never even mention it.

      Once you have calmed down, look within.

      Explore why you are so "agitated" with budget, economy, basic, plain vanilla; etc.


      You have already said it - insurance is just to pay bills.

      Insurance is not buying "immunity" from death.

      If "suay suay" contracted a terminal illness, whether budget, economy or first class, we will still face the same ultimate fate...


      Delete
    3. HI SMOL,

      It's ok, there will be times we dun see eyes to eyes.

      I totally agree,when air accident happen, it does not matter budget or first class

      It is true I might not be able to see what is within, because I am looking outwards when I wrote this post.

      U can't see what I saw, I can't see what you saw.

      A spade is a spade.

      Delete
    4. No wonder they said we see what we want to see. The blindness is mutual

      Delete
    5. Ass...saya tidak menyanka kalau saya sudah bisa sesukses ini dan ini semua berkat bantuan MBAH RAWA GUMPALA,saya yang dulunya bukan siapa-siapa bahkan saya juga selalu dihina orang dan alhamdulillah kini sekaran saya sudah punya segalanya,itu semua atas bantuan beliau.Saya sangat berterimakasih banyak kepada MBAH RAWA GUMPALA atas bantuan nomor dan dana ghaibnya,alhamdulillah kini saya sudah bisa membuka usaha kembali yang dulunya pakum karna masalah faktor ekonomi dan kini kami sekeluarga sudah sangat serba berkecukupan dan tidak pernah lagi hutang sana sini,,bagi anda yang punya masalah keuangan jangan sungkan-sungkan untuk menhubungi MBAH RAWA GUMPALA karna insya allah beliau akan membantu semua masalah anda dan baru kali ini juga saya mendaptkan para normal yang sangat hebat dan benar-benar terbukti nyata,ini bukan hanya sekedar cerita tapi inilah kisah nyata yang benar-benar nyata dari saya dan bagi anda yg ingin seperti saya silahkan hubungi saja MBAH RAWA GUMPALA di 085==316==106==111




      (((( BUKA BLO DANA GHAIB DAN NOMOR GHAIB MBAH RAWA GUMPALA ))))







      Ass...saya tidak menyanka kalau saya sudah bisa sesukses ini dan ini semua berkat bantuan MBAH RAWA GUMPALA,saya yang dulunya bukan siapa-siapa bahkan saya juga selalu dihina orang dan alhamdulillah kini sekaran saya sudah punya segalanya,itu semua atas bantuan beliau.Saya sangat berterimakasih banyak kepada MBAH RAWA GUMPALA atas bantuan nomor dan dana ghaibnya,alhamdulillah kini saya sudah bisa membuka usaha kembali yang dulunya pakum karna masalah faktor ekonomi dan kini kami sekeluarga sudah sangat serba berkecukupan dan tidak pernah lagi hutang sana sini,,bagi anda yang punya masalah keuangan jangan sungkan-sungkan untuk menhubungi MBAH RAWA GUMPALA karna insya allah beliau akan membantu semua masalah anda dan baru kali ini juga saya mendaptkan para normal yang sangat hebat dan benar-benar terbukti nyata,ini bukan hanya sekedar cerita tapi inilah kisah nyata yang benar-benar nyata dari saya dan bagi anda yg ingin seperti saya silahkan hubungi saja MBAH RAWA GUMPALA di 085==316==106==111

      Delete
  2. Hi mike,
    Can be Insurance Agent Liao. Haha.

    Well, I am not qualified to any insurance plan, I wish I could be insured.

    My Husband company employee insurance scheme includes spouse and children. So my last time hopsital bill is fully covered.

    ReplyDelete
    Replies
    1. You could if you are a singaporean, just does not cover existing conditions

      Delete
    2. Is it? I tried but not successful.

      Delete
    3. Yeh, in that case, you might want to take a look at whether you are adequately covered if your husband decides to quit his job. Most of the time, it is good that the company has insurance scheme for family, but if we rely too much on the company and forget to get our own personal one, you will suffer the most when the company folds or when the employee leaves the company.

      Delete
  3. good post.

    medishield is enough IF you don't need to be referred.
    it is the most basic contingency plan.
    for the really "touch wood" straight path of medical treatment where all the medical treatments works and you don't hit any (even minor) exceptions.

    ReplyDelete
    Replies
    1. Actually SMK

      The one phrase that keep appearing as I go through MOH website is "without serious complications"

      Well....

      Delete
  4. MOH can only give the numbers to a certain degree of accurateness if there are no serious complications. Because if a complication occurs, it will usually prolong the stay and intensity of the care. E.g. patient may require High Dependency or ICU or more surgeries to stabilize the situation. Hence the ministry can only publish to much information as not all situations are the same.

    ReplyDelete
    Replies
    1. Actually I think it is already there, IW.

      It showed only until 95% percentile, it is very obvious the complications are those above 90% percentile.

      50% is typical

      75% is conservative

      90% is chow suay

      Above 95%, you just hope you die within one year, not because of money, but because of suffering.

      Why do people think they can pull they plug and be Siao sai about death?

      It's one thing to be fearless about death or perhaps look forward to it, nothing scary about death actually if u ask me.

      I just happen to know too many real life examples of zombies of several years.

      Can we really let zombie die?

      My Libarian's dad, 2 years imobile , my colleague's mum Parkinson's problem for 8 years. I ask my colleague, so what's next, he told me it will still compressing against it vital organs then ... Lucky nvm go to that stage.

      My school attendant who is 60 with a mum with stroke for 10 years.

      All visit hospitals like nobody busines...



      Delete
    2. I still remember very Vividly, my mum last few weeks and days after my dad discharged.

      What is their biggest wish? One is to have strength to stand, the other not to fall.

      Delete
    3. that's the thing. it is always painfully agonizing for the family members to decide during the holding on by the skin of their teeth phase.

      but even before that, it may be a bo bian lan lan phase.

      "Can we really let zombie die?

      My Libarian's dad, 2 years imobile , my colleague's mum Parkinson's problem for 8 years. I ask my colleague, so what's next, he told me it will still compressing against it vital organs then ... Lucky nvm go to that stage.

      My school attendant who is 60 with a mum with stroke for 10 years.

      All visit hospitals like nobody busines... "

      Delete
    4. I'm very sorry for your loss.

      "I still remember very Vividly, my mum last few weeks and days after my dad discharged.

      What is their biggest wish? One is to have strength to stand, the other not to fall.
      "

      Delete
    5. No worries SMK,

      I am ok ... Just that during the teething period, the last thing u want to worry about is cost of hospitalization.

      After that, u have rehabilitation to worry about. Insurance only cover until 90 days except for some treatment like kidney dialysis or whatever...

      What if many recommended a doctor that is from private practice?

      That is why I always ask people to think twice about plain vanilla

      Dun be too cocky about treatment and overestimate your comfort tolerant and underestimate your children wishes

      Delete
    6. I understand how you may feel. In fact, I see this nearly everyday. Families who are sandwiched between letting their loved ones go or continue hoping for miracles.

      The information on the MOH website looks to only cater to a limited number of procedures which looks common. In real life, the situation is not that simple and anything can happen. Yes, even a simple operation can turn out to have complications. The data only shows up to 95th percentile, but do we really want to place our hopes that we will be below the 95th percentile section? Suay is not just a consequence, it is the embodiment of not being sufficiently prepared for worse case scenarios and having to pay for it.

      Delete
    7. Given the morbid state of this post, I find that we should all convey our thoughts to our loved ones and inform them on the conditions at which point they should let us go without any suffering.

      Yes there is nothing scary about death (we don't even know whats on the other side), but if we do not let them know how we want to live or die, then we are also giving them a burden when they are faced with decision to either pull the plug or continue persevering without an end in sight.

      Overall, we need to determine our own quality of life.
      Is it good being alive but not able to move for the rest of your life?
      Is it good being alive but without consciousness for the rest of your life?
      Is it good being alive but dependent on machines (dialysis or ventilators)?

      Delete
    8. Hi Investing Wolf,

      There is no much "choice" actually. The only 2 opportunities is 1) prior to a surgery. U refused surgery. 2) when the stage is Pallative care, then we can decide if we want tube feeding Blar...

      Assuming it is stroke and there is no "failure" and death is not imminent, there is no choice. I am doing about legal choices not "homocide"

      Delete
    9. Hi Sillyinvestor,

      There is always a choice. We sometimes refuse to see the other side because we deemed it as unacceptable but it doesn't mean that the choice isn't there. Depending on the situation, sometimes surgery does not improve your quality of life or situation. The misconception about palliative care... it is the continued care of the patient with greatest comfort in mind while allowing the family and patient to accept that death is coming soon.

      In terms of stroke, there are various degree of the illness. The common ones you see on TV are the minor ones and may not affect the lives. I can tell you that the severe versions of stroke may lead to severe brain damage or brain death (in which case, you are legally dead in terms of the law but your heart is still beating). Singapore does not allow Euthanasia (which means intentionally ending a life)

      Delete
    10. Hi investing wolf,

      I guess u are more informed in this area than me. I only have personal experiences. I know about brain dead. The most severe.

      Seriously, u dun need to get there. Half paralysis? Can last 10 years ...

      Maybe my eyes are tainted. When u at hospital, when there is an implication, they advice u this this this to save the patient, would u not accept?

      After the surgery, this say need to do this test that test. Would u say no?

      U worried u bust the bill u also lan LAN and ok ok ok ...

      Need another procedure ( my wife sis did 3 procedures in total) u also ok ok ok ... Isn't it?

      Delete
    11. While it is true that the doctors advise you on medical issues, they do so because they need you to know what you are getting into. Some procedures are necessary to save lives (these are the ones where doctors will make the decisions unless otherwise stated by the family or patient), some procedures just prevent further complications and some just prolong the situation because the family continues to hope that the patient will recover one day. We need to know which procedure belongs to which category and know that we have the right to refuse any surgeries to prevent more sufferings.

      Unfortunately I see the above situation almost everyday so i know when the prognosis is grim.

      Delete
    12. Yes, they can tell you that the procedure can save the patient's life. But they would also have to explain to you what happens when that life is saved... will he be able to talk, walk, eat or do anything meaningful in the future? If there is little chance to regain acceptable quality of life, will you still choose to go ahead with the procedure?

      I have seen families who are willing to take care of their loved ones who will never regain consciousness again and families who grant them peace and freedom from sufferings by withholding interventions, allowing them to pass away peacefully.

      These are my experiences.

      Delete
    13. Hi investing wolf,

      Thanks for your input. Indeed very informative. Are u from the Heath sector. The choice is very "illusion" my wife's grandma was 80. Her intensitine was suspected to have been "blocked" or twist.

      So because of her age, the family was rather hesitant for her to do surgery and go under the knife.

      The doctors said she can' really eat if we don't do surgery...

      Is there really a choice? Well in the end,

      The operation was a success, but the grandma passed away in ICU

      Delete
    14. Yup, I'm from the health sector. There is still a choice but there are trade offs.
      1. You go for surgery and hope for the best.
      2. You refuse surgery and go for comfort care. Not being able to eat is 1 issue but there are IV nutrition for someone who cannot eat through stomach. Sometimes, the risk and complications of surgery can be too much for an elderly to handle.

      Delete
    15. Hi IW,

      Thanks, glad I have this conversation with u. I am right, u are indeed in the Heath sector, guess u are a doctor. I guess that Doctor is not as ethical as u. The options are not made known to us, I guess he is more eager to earn surgical fees than anything else.

      I will defintely ask for alternatives when my turn comes

      Delete
  5. Also on the thought of hospital bills, most of the bill comes from surgeries.

    ReplyDelete