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Calculation: Medishield-life is a Swindle of Singaporean Poor.

bic_cherry

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#1
Calculation: Medishield-life is a Swindle of Singaporean Poor.

Rich Singaporeans claim 2.03786x more then middle class, what more the poor?

According to MOH stats, "Nine per cent of full rider policyholders made claims in 2016, compared to 7 per cent of those without riders"

"According to MOH, the average bill claimed by a full rider policyholder cost S$9,093 in 2016, about 58.5 per cent higher than that of an average IP holder (S$5,738). Patients with riders were more likely to visit private hospitals than those without riders, contributing to a bulk of this differential. "


Calculation:
Since hospitalization claims rate for rider holder is 9% as opposed to 7% for non-rider holders and also 1.585X more for rider holders,
Increase payout value to rider holders= 9/7 X 1.585= 2.03786 times that of average IP holders.

Since private insurers selling IP plans make claims from (and basic premium payments) to MOH wrt medishield-life, it can be said that those with full riders make in excess of 2X claims from the common medishield-life insurance pool.

Pls note that the actual multiple may actually be even higher than 2.03786 times, since MOH own definition of the 'average IP' holder is likely to also include BOTH partial and full rider holders, the latter of whom make up 30% of the IP pool which in itself is constituted by the more wealthy 68% of Singaporeans.

It was also reported that poorer Singaporeans are unable to receive proper public healthcare cancer treatments because even the public transport costs to and from hospital may turn out to be a hindrance in itself.

It is also noted that the MOH is subsidising many wealthy Singaporeans indiscriminately just based on their declared household address and income levels even though by the fact that these Singaporeans can afford not just IP plans or worse, even very expensive full rider add-on plans, remains prima facie evidence that (MOH is squandering state funds to buy votes given that) by their expensive taste for expensive insurance products, these same wealthy folks are indeed very well to do.

In its inception, MOH explained the huge jump in compulsory medishield-life premiums over the old optional medishield plans by using 'prefunding' (with the option of future premium discounts and refunds) as the reason why basic medishield-life premiums for the young increased so much. Yet, short of doing IP plan insurance companies a business favour and helping them mediate amongst themselves an agreement to cease the sale of loss making full rider for medishield-life IP plans (and coincidentally reducing the population of (double value claims) full rider holders in the process), MOH is doing precious little independently to lead in reducing the raw deal that medishield-life especially gives to the poor ('prefunding') and the SQUANDERING OF STATE FUNDS, aka increase in GST. Perhaps, for a start, all basic medishield-life subsidies to anybody with an IP rider should be REMOVED with immediate effect and those with IPs, 1year later. Only those on BASIC medishield-life compulsory insurance (and no other hospitalization insurance plans) can qualify for medishield-life premium subsidies of any form.

In short, medishield-life and its subsidy structure is a raw deal for poorer Singaporeans and a big extravagance of government funds with the consequence that GST has to be unnecessarily raised for all.
 
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bic_cherry

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#3
01asdf (HWZ) said:
*Yawns* Reposting again after admitting that caps and claims limits mean people with riders are actually paying for their so-called inflated claims through insurance instead of "cheating the poor"?
There is ZERO lifetime limit where basic medishield-life claims is concerned. Also, caps and claims limit on the basic medishield-life portion apply EQUALLY across the board whether or not the citizen has private shield plan (insurance) or not, just that all costs are pro-rated to C/B2 class costs when private insurers attempt to back claim from gahmen for the basic medishield-life compensation portion of actual private etc hospitalization costs.

There is presently no discrimination by condition; as such, a 2.04X over-serviced wealthy patient cohort will also translate to private insurers making 2.04X higher claims to MOH for prorated basic medishield-life compensation for a same patient demographic cohort (because rich patient cohorts don't feel any concern about costs because their riders cover everything 100%)... inadvertently, the poor suffer because basic medishield-life has to pay out 2.04X higher claims to the private rider owning medishield-life cohort despite both cohorts paying the exact same annual premiums into the basic medishield-life insurance fund pool.

Whilst caps and limits exists, they are of MINIMAL RELEVANCE to the fact that rich Singaporeans are exploiting the poor. By the time claim caps/ limits are reached, the situation is totally out of control already.

Therefore, please do not attempt to evade the fact that rich Singaporeans do claim DIRECTLY 2.04X more than average /poor Singaporeans from the common basic medishield-life fund pool by using the minimal effect of caps and claims limits which is of almost zero significance to begin with.

Perhaps due to rich Singaporean cohorts claiming 2.04X the average poor cohort payouts from medishield-life, MOH should DOUBLE the basic medishield-life premiums of integrated shield plan holders, with private insurers paying MOH double in basic medishield-life insurance premiums... That way, the historically doubled payouts demanded by wealthy integrated plan holders (with riders) can be fairly balanced by their appropriately doubled (2.04X) contributions to the compulsory (prefunded) common medishield-life public insurance fund pot.
 

bic_cherry

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#4
SGuy1976(HWZ) said:
TS should spend some time trying to understand how MediShield and isp works.
Patient goes for operation, if patient is on full rider. The patient claims from insurance company and insurance company claims the normal class C operation fee from the MediShield base plan. The rest have to be absorbed by the insurance company, which is why they are screaming to change the terms.
The only problem is that those on full riders are more likely to visit a doctor and a private one.
So now moh has declared that they are going after private doctors who were naughty with unnecessary procedures and inflated bills.
Moh is getting the data ready for publishing fees guidance which will most probably be used by insurance companies to cap the payout. So supposedly full riders will no longer cover the full bill if the doctor’s bill is outside of the guidance range. So no more business for Susan Lim from the insured.
Read more at the old appleyum thread.
Cancel my cheesepie Prudential insurance policy !!! At last can sleep well at night !!!
Of course MOH/ insurers can publish fee guidelines, however there exists many ways to skin a cat and unless a charge is a definite outlier or very egregious, MOH is unlikely to quibble and just pay the prorated C/B2 class amount.
However, one must consider also that because private specialists are more experienced and have fewer patients to see than public hospital specialist, they can easily over service the patient on full rider who also may have less reason to suppress hypochondriac behavior because rider covers all costs and either repeatedly makes the same complaint or else goes doctor hoping resulting in duplicate tests being done (e.g. 12 nose scopes in 1 year) or seeking out the latest, most expensive treatments (e.g. minimal invasive robotic surgery) justified only by the small scar. Unfortunately, MOH isn't privy to the investigation findings nor operation details and would rather just pay up because the surgery has already been done and the surgeon can always say that he was just being cautious or that he only does robotic surgery because all his patients demand small (minute) scars.

Some patients may also treat the private hospital like a hotel and demand investigation about every minor problem just to prevent discharge. Private hospitals are much more likely to acquiescence as opposed to public hospitals who face a bed crunch and are closely monitored by MOH.

MOH basic medishield-life are thus unable to examine every single claim made and may have to pay penalties for payment delay or even pay fees to multiple medical specialists to get details about the hospitalization episode. Patient confidentiality issues also mandate that MOH needs patient consent to apply for more information regarding the hospitalization episode.

Given the large volume of claims being made and the spot on diagnosis that buffet syndrome by doctors and patients is the reason for excessively high claims by rider holders as well as the fact that the core pillar protecting medishield-life from abuse are the co-payment and deductible features, then these features should be STRICTLY ENFORCED across the board and patients need to either buy their own separate insurance cover and claim zero from medishield-life for a particular hospitalization episode (just like they choose to claim from company hospitalization insurance or personal health insurance but not from both)...

All Singaporeans serve NS and SAF is only obliged to defend them/their physical properties located on Singapore soil. All Singaporeans serve NS even if they have foreign properties / citizenship / depend on foreign government to protect their foreign properties/ live abroad ... likewise, ALL MEDISHIELD-LIFE based insurance plans need to have the same co-payment % and deductible amounts as strictly enforced as NS for 2yrs, even if some Singaporeans have their own private insurance schemes.
 

bic_cherry

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#5
teaserteam (SGtalk) said:
So the Gov protects the insurers from losing money at the expense of citizens just because there are a few black sheeps who misused the insurance to pay many unnecessary hospital bills? Why the bulk of us have to suffer because of this?


Doctors like the following (Dr Lim Wee Kiak) also equate high earnings with dignity, they are medical specialist in private practice and also sitting as MP in parliament. As mentioned, medishield-life insurance MAIN PURPOSE is to protect against HIGH hospitalization bills, not ALL hospital bills. The design of medishield-life makes the patient one important safety check that treatments are cost effective and not merely cosmetic or to bankroll doctor's path to get filthy rich.

Law is law...gahmen says no drugs/private gambling, do doesn't mean that within confines of private residence can do drugs or operate gambling den.

Likewise, medishield-life basic and all its other permutations are like NATIONAL SERVICE , non-negotiable even if later u wan to drop Singapore citizenship, serve first, talk later... Ditto medishield-life, u can choose to claim private, foreign or company health insurance cover but U still have to pay medishield-life basic premiums because it is a form of National Service and deserters whether AWOL from medishield-life or National Service all have to serve time in PRISON.

Thus, whilst MOH is no doubt behaving like the Singapore Private Health Insurance Business Federation Public Relations manager, actually there are good important reasons why private riders are INCOMPATIBLE with the original design and purpose of medishield-life to begin.
Normally, two wrongs do not make one right, but in this case it does, as egged on by insurers, MOH is now making amends for the mistake it made in 1997, to allow private insurers to sell medishield-life with riders to begin with. This 'rider business' has all along been INCOMPATIBLE with medishield-life being designed to insure ONLY against high medical bills: as a result, claims by rich Singaporeans were 2.04 times that by middle class Singaporeans meaning that ironically , poor were subsidising the rich which the recent audit of medishield-life detected.

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"If the annual salary of the Minister of Information, Communication and Arts is only $500,000, it may pose some problems when he discuss policies with media CEOs who earn millions of dollars because they need not listen to the minister's ideas and proposals. Hence, a reasonable payout will help to maintain a bit of dignity."
- MP Lim Wee Kiak apologises for comments on pay
[IMG URL]
 

bic_cherry

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#6
Chromesthlesia(HWZ) said:
Erm, I kind of think it is a chicken and eggs problem though. Poorer people try to claim as minimally as possible because they can't afford the ip riders premiums.

But rich people claim frequently since their rider covers 100%, even with the new inclusions of 5% co-insurances.

My point is: even if you changed the premiums revision, which is a good thing, you can't exactly solve the bigger underlying problem which motivates a rich/poor person's claims;

Poverty.
Which is why all these stupid tag-on integrated shield plans should either be scrapped (dissociate themselves from basic medishield-life) or else MUST conform to the basic principles that enshrine medishield-life: universally enforced deductible and co-payment % amount, pro-rated for hospital type and class: same philosophy as for NATIONAL SERVICE : 2yrs at 18yrs age to be served without delay regardless if person wants to later change citizenship or if family is influential/ rich because its a national security issue.

If the individual wants to have other alternative private insurance plans, he can have whatever he wants from anywhere in the world; however, he must first pay his dues to basic medishield-life and thereafter buy whatever he wants. Just as for NS all have to serve when called to do so and all defaulters are immediately sent to jail.

Technically PAP planned medishield-life it this way (it is self-explainatory by its design), however in between, they chose the populist path, wanted to please the rich and also profit the insurance companies ... this time bomb could be hidden by the then youthful and healthy population, juvenile(inexpensive) medical technology and facile audits of medishield-life claims since riders were sold starting 1994... ends up, with today's high costs medicine and aging population, the cat is now out of the bag with evidence that the system is broken with the poor having to subsidise the healthcare costs of the rich- which is a grave injustice and the antithesis of a modern egalitarian cosmopolitan society.
 
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