BHS increase to $52K from 1 Jan 2017

BBCWatcher

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I think u are not getting his point.
I think I am. Let's hope everyone age 88 doesn't have to stay more than 5 days in the hospital, or have any other procedures done, than the specific reimbursement example in that illustration. But that's not reality, of course.

MediShield Life does have an actual payout cap, but it's $100,000 per year per person.
 

BBCWatcher

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is the garmen trying to sucker our money?
Nope, at least not on this occasion.

Singaporeans want and need medical care. Medical care requires financing. That financing can be all public (out of general tax revenues for example), all private, or a combination of both. It can be pay-as-you-go, which (with an aging population) results in faster spending increases than general inflation even if you maintain equal covered services with equal productivity (both not givens). Or it can be with a build-up of surpluses to then pay for those future, greater needs -- and with lower rates of premium increases. Singapore has adopted the latter approach. It's planning ahead.

Medical care needs really do peak toward end of life. If you have private medical financing, then that financing must be geared toward that reality, too. Which means you have a Medisave Account, and it needs to grow. Because, on average, you get old and need more medical care when you're old. Medical needs are demographically different than, say, Zouk cover charges.

Which is why I asked the question I did. If you don't like the current system, then what you're really saying is you don't like the heavily private financing nature of the current medical system in Singapore. Singapore is rather different than other developed countries in this "personal responsibility" sort of philosophy when it comes to medical care. More American and Swiss, less French and British. So do you want something closer to what France has? It's possible. Singapore and her taxpayers can easily afford it.

Regardless, go have some more babies, and the government won't have to plan ahead as much. ;)
 

akwl88

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your unused money in medisave can be passed down to your children as cash

1.  How do I know if my loved one has any CPF money and if they had made a valid nomination?

The money from the Central Provident Fund (CPF) of a person who has died will be distributed in line with the nomination they made during their lifetime.

You will need to check with the CPF Board whether the person who has died had made a valid nomination for their CPF money. If they had, the CPF Board will pay the money direct to the person or people they nominated (if those people are older than 18).

If the person who has died did not make a valid nomination, the CPF Board will send their CPF money to us, as required by law.

The CPF Board will also send us the CPF money of a person who has died if the person chosen to receive that money is under 18 years old (unless she is a widow).
 

akwl88

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A CPF nomination provides CPF members with the option to specify who will receive their CPF savings, and how much each nominee should receive, upon their demise.*

You should make a CPF nomination if you want your CPF savings to be distributed according to your wishes. If you do not make a CPF nomination, your CPF savings will be transferred to the Public Trustee’s Office (PTO) for distribution to your family members under the Intestate Succession Act or the Inheritance Certificate (for Muslims). The PTO charges the beneficiaries an administration fee for the distribution of your CPF savings.

What does a CPF Nomination cover?

Covered under CPF Nomination
CPF savings* in your Ordinary, Special, Medisave and Retirement Accounts
Unused CPF LIFE premiums,
Discounted SingTel shares
** CPF savings cannot be included in your Will. They also do not form your estate and are protected from creditor claims on any outstanding debts.
 

akwl88

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Q

Are my Medisave Account savings covered under CPF Nomination?

A
Yes, CPF Nomination covers all savings in your Medisave Account, including those in your Ordinary, Special and Retirement Accounts.
 

antonpoh

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Which is the correct MediShield Life math for the 5 day hospital stay of that nature in that specific example. It's not the correct math for a 6 day stay.

So is your proposed alternative that the government increase general tax rates, or expand the personal income tax to cover passive income, or some of both, in order to fund a single payer, universal (citizens and PRs) program that pays all medical expenses for all medically necessary care, with modest co-pays that are partially or fully waived for Singaporeans of modest means? Then we wouldn't need Medisave Accounts and MediShield Life. There'd be a different, more globally typical medical financing system.

What do you think?

MediSave-01_17Jun_zpsed33f06c.jpg


I propose to let us use our 52k for any medical expenses. When that amount drop below 15k then gahmen subsidies and medishit life kicks in.

For those who have 15k or less in their MediSave Account, they with be auto covered by the existing gahmen subsidies and medishit life.

Of cause everyone still pays a lower MSL premium. Maybe lower than current rate by 20%.
 

BBCWatcher

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I propose to let us use our 52k for any medical expenses. When that amount drop below 15k then gahmen subsidies and medishit life kicks in.
You can call MediShield Life by its real name, or you can be childish. ;)

Of cause everyone still pays a lower MSL premium. Maybe lower than current rate by 20%.
OK, so fundamentally you're proposing to shift more of the burden for medical funding away from a near-universal insurance pool and more toward individuals and a smaller pool of (on average) sicker people. And to provide greater tax advantages (especially to those in the highest tax brackets) for a much broader range of medical services, beyond the current Medisave scope.

In practice what wealthy/high income Singaporeans would rationally do is to keep topping up their MA (for the tax savings) and consume more medical care that's less medically necessary (since it's tax subsidized). And never fall to $15K, and never pay MediShield Life premiums, probably. They'd self-insure.

So your plan is terrific if you're rich/high income in Singapore, even better than the current system. It's bad if you're not. Wealthy/high income Singaporeans would put more pressure on the medical system and add to medical inflation. Both the MA cap and the various Medisave withdrawal limits (scope of services, etc.) are expressly designed and intended to curtail tax-advantaged medical demand pressures and associated medical inflation, and they do that. Your proposal would uncork that champagne bottle.

Everyone else would have to face that problem of the tax system (especially for the highest income Singaporeans) turbocharging their consumption of medical services, and with a sicker MediShield Life pool. The current MediShield Life premium schedule is not fully age adjusted, and that would have to change under your proposal. Members (some) would pay some premiums while young, fall to zero in productive working years, then come back onto MediShield Life when their Medisave accounts are drained enough. And since MediShield Life would lose its universality (or near-universality), it'd have to give up on its partial age rating, too. So you'd have extremely sharp increases in elder MediShield Life premiums. And currently those premiums are only slightly subsidized for the poorest, and that in turn would have to change -- and that would really, really whack middle class Singaporeans, hard.

Bad plan, sorry, and I say that as somebody who would personally financially benefit from your proposal. Your proposal would result in a toxic death spiral for the medical financing system in Singapore. You'd make the insured pool much sicker, and you'd lavish tax advantages on the highest income Singaporeans to go spend more on medical care. Bad, bad idea.
 

antonpoh

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I propose to let us use our 52k for any medical expenses. When that amount drop below 15k then gahmen subsidies and medishit life kicks in.

For those who have 15k or less in their MediSave Account, they with be auto covered by the existing gahmen subsidies and medishit life.

Of cause everyone still pays a lower MSL premium. Maybe lower than current rate by 20%.

Let me elaborate it more because BBCWatcher try to read it as 3 different part.

Firstly the rich that already have enough amount 52k in their MA will pay with their own medical bills from their MediSave. MSL will only kick in when their MA drops below 15k. Everyone including the rich still pays MSL.

The poor will get the existing gahmen subsidies and medishield life claim. They too pay for the MSL.

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My main point is let us use the money that we saved in MA for any medical expenses. For those who don't know about CPF MediSave:

If you're unlucky and get critical illness from the 'can claim list' of CPF then you can use your MediSave. But if you're lucky like my dad whose skin condition is not in that list, you can't use a single cent from it. Btw, he is 70+ with 28k inside his MA.
 

BBCWatcher

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So what would you call an insurance that you pay $600 every year but you can only claim back $530?
Not MediShield Life. MediShield Life pays up to $100,000 per year per policyholder.

Please run the numbers for a 10 day hospital stay, other things being equal, and then get back to us.
 

OngHuatHuat

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Medisave is a protection net. If you have critical medical condition, it may wipe out your whole savings plus whatever asset you have.

This happen frequently in China due to lack of social protection system and huge population base.

It can happen to anybody, the person who replied here are fortunate ones that do not have any medical condition at all. A simple surgical operation is enough to wipe out quite a substantial amount in medisave(assume no medical insurance coverage).
Cancer treatment can cost even more, up to few hundred thousands. So having sufficient protection at reasonable cost is important.

Medisave can be used to pay medishield life and that channel back to a commom pool to be used. It is a social safety net.
 

OngHuatHuat

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Compare with other countries if possible.

By introducing medishield life, the government has effectively solving the problem from the root.
Next time the frequency people asking for donation due to medical condition will be reduced significantly.
 

BBCWatcher

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Do you feel that it may be more equitable to have a year-end exercise where excess premiums paid are refunded to the individual Medisave accounts in proportionate amounts including potentially immense amounts of interest that would have otherwise been incurred (and could have been incurred on compounding basis in future) had these funds not been withdrawn?
First of all, who said the premium surplus isn't collecting interest?

OK, stepping back for a moment here, Medisave alone -- especially but not only for less affluent Singaporeans -- cannot possibly cover catastrophic medical needs. If nothing else, insurance must cover those needs, the needs individuals themselves cannot bear alone. In the modern world, with modern medicine, and the reasonable medical expectations of a now developed society, $10 and an aspirin simply isn't enough. A program with individual savings alone, spent individually, can't work. There has to be at least a catastrophic insurance component.

So the government (rightly) juiced up the catastrophic medical insurance component, primarily with MediShield Life. But that wasn't/isn't free. So it mandated premiums, made those premiums only partially age and preexisting condition rated (young, healthy adults subsidize everyone else, including their older selves), subsidized premiums for certain groups (e.g. poorer Singaporeans), and required participation (to avoid adverse selection and "death spiral" problems). All of that makes public policy sense. We can quibble about levels -- I think MSL ought to be more generous, with a higher average premium, and with more progressive tax financing -- but the core principles are perfectly sound.

Another decision the government made was to set the premiums conservatively, with a forecast surplus, partly because they couldn't fully predict how medical consumers and providers would react and partly because of demographic destiny. That, too, seems prudent. If the government had mandated that you buy MSL (the base plan) from one of three designated private insurance carriers, then (more or less) you would have had the new U.S. system in basic construction. The private carriers expect profits, so that (and more) is where surpluses would go. But more importantly you'd get wild price fluctuations as the underwriters try to gain experience in the market, with associated difficulties especially for people on fixed incomes. And that's exactly what happened in the U.S., although the U.S. has more generous subsidies for lower income households in order to soften the sharp premium increases. (Insurers underpriced due to white hot competition, and now they're correcting. Much more turmoil is likely with the new Republican/Trump Administration since they're utterly fanatical and non-reality-based, but that's another topic.)

Anyway, Singapore didn't do that. Singapore set MSL premiums conservatively, and now a surplus is accumulating. It's accumulating in public hands, not in corporate profits eventually returned to private shareholders. Or, to borrow an earlier remark, the surpluses aren't going into a black hole. Once the government gains some more MSL actuarial experience, in order to get a more precise handle on the magnitude of the surplus, they have two basic options. One is simply to hold premiums to smaller price increases than realities would normally require. Indeed, that was planned all along, to do some of that. So instead of 7% average annual premium increases they might be 2%, or whatever. That's good for every MSL participant, but it's particularly good for elderly Singaporeans of more modest (but unsubsidized) needs, those who pay the highest premiums. Another possibility is to reduce that surplus in the form of more generous coverage benefits. And, I suspect, that was/is the plan, too. As people discover the ins and outs of MSL they're discovering where the gaps are, where benefits aren't generous enough. I expect some gap filling over time.

To summarize, if you value relative premium and benefit stability amidst a graying population (and most people do, especially the elderly), then having some premium surplus to start is a great way to start. I can't disagree with that. The U.S. analogy is instructive again, with U.S. Medicare. Medicare is enormously popular in part because it's more stable. Currently the Medicare trust fund has enough surplus to hold the whole program steady for another decade plus, with no benefit or premium changes (beyond what's already baked in). So participants can set their household budgets and live their lives without extra worry. The next administration threatens to upend that stability, but that's also another topic.
 
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BBCWatcher

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I do not understand the need for us to compare our systems with other countries that are facing even worse problems.
It is unreasonable and unrealistic to expect any government to outperform all 200 other governments on a sustained basis and by a large amount. Context is important.

And it's not necessarily true that other countries have worse problems. Singapore is facing enormous challenges, most especially in its globally lowest (or nearly so) birth rate. Singapore is going to have an extremely old population, and medical needs will rise rapidly. It's Singapore's demographic destiny. If Singapore is doing better than countries that don't have this demographic problem, that's important perspective.

As an analogy, no, I don't think Singaporeans should be disappointed that their government hasn't built Changi Spaceport yet, with daily Singapore Spacelines two hour nonstop service to London, New York, and Paris. Strive for improvements, sure, but also be realistic.
 
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OngHuatHuat

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Actually government already started to tackle supply end cost for government hospitals and this can be seen from only mild increase in medical cost over the last 3 years. The problem actually lies with private hospitals. The cost has been spiraling up for the past few years. They can charge high and lure experienced doctors to join private sector by offering shorter working hour and more holidays.
 

OngHuatHuat

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The reason why I quoted other countries are simply because I feel that Singapore system is already one of the best: doesn't overburden public fund and adequate protection for residents.

It is already much better than neighboring countries imo.

I do not understand the need for us to compare our systems with other countries that are facing even worse problems. In constantly doing such comparisons, we end up patting ourselves on the backs for just average (and sometimes sub-par based on absolute terms) performance and consequently there is no hunger for further improvement.

Why don't we just focus on the fundamentals and get our systems to function better progressively instead of telling ourselves that we are much better than our neighbours and peers?

This applies not just to our healthcare systems.
 
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