In the recent Committee of Supply debates, government spending on healthcare costs are estimated to increase. Likewise, in households, healthcare costs are also rising as the population ages, families get smaller, and the demands of modern living make health maintenance more challenging.


A Common Scenario and Problem:

I recently was contacted by someone whose nephew was warded at a private hospital.  He had been seeing a private outpatient surgeon who only practiced at a private hospital. Therefore, he was warded at a private facility to receive his surgery. Unfortunately, a series of complications arose and the patient ended up staying for 5 months before he passed away. In addition to the loss his family suffered, this hospitalisation ruined his family financially. The bill came out to be more than $700,000. But that’s exactly why the Singapore government created public restructured hospitals, and gives people basic healthcare coverage under MediShield Life and the option of buying additional coverage under an Integrated Shield plan.


Possible Solutions that Most People Don’t Know About:

If you find yourself warded in a private hospital for an unanticipated and extended period of time, here’s how to avoid a possible financial catastrophe.

1. Get a rough estimate of your bill. Most people aren’t aware that you could, at any time, ask the private institution for an estimate of the bill. The actual bill is (in general) influenced by the medical condition, type of treatment, length of stay, and doctors’ fees. In a public institution, the doctor’s fees are fixed within their respective departments and priced so as to ensure accessibility. In the private setting, doctor’s fees vary widely and are self-determined.

2. Ask (more than once) to be transferred. It is possible to request a transfer to a public hospital, where the bill can be subsidised to as much as 1/10th the cost. But, don’t wait until the hospital bill becomes too overbearing or for the “right” moment to ask. Because it can take several days to make arrangements for a transfer. And the hospital team needs to know sooner, rather than later, so that it can be incorporated into their care plans.

3. Be persistent. Tell the attending doctor that you cannot afford continuing treatment at the private facility. Transfers are a bit cumbersome as they require the patient to be stable enough for the transfer, the private doctor to identify a public doctor who will accept the transfer, a bed to be available at the receiving facility, and appropriate arrangements to be made so that there is no lapse in care or other errors.

4. Medical records transfer easier from one hospital to another. There will always be information that is lost when transferring from one site of care to another. This can result in unintended and adverse consequences such as the need to redo tests or medical errors. Although hospital care is more complex and there is a higher density of information, it generally is easier for a receiving hospital to handle these challenges, than a clinic. Usually, the receiving doctor will at minimum, be provided with a summary of your care plan, progress, and studies.


If All Else Fails, This is The Last Resort:

There are very good reasons why a transfer cannot happen. One good reason is that there is no receiving public hospital that has the services you need. Another is that in the doctor’s professional opinion the risks of transfer outweigh the potential benefits. But barring these two reasons, keep in mind that doctors will tend to be conservative and keep your health as their priority. They do not necessarily know what your priorities are nor the amount of risk you deem acceptable. It is ultimately your responsibility and right to determine whether financial considerations take priority. If you understand the risks and are willing to take the risks, you can choose to leave against medical advice (AMA). This decision should not be taken lightly, and you will be discouraged from taking this action.


How to Leave Against Medical Advice in the Best Possible Way

1. Make sure you inform the doctors. As your health and safety are their priority, they will help to facilitate your AMA “discharge”.

2. Ask for your medical records. Some institutions have restrictions on the release of medical records to patients, but it is worth jumping through the necessary hoops, so that you can hand deliver them to the public hospital. At the very least, ensure you have notated the ward location, the names of your doctors and their specialty, and who should be contacted in case additional information is needed.

3. Make sure you understand any insurance consequences with leaving AMA. Do note that although you are leaving AMA and then immediately going to another facility, it will count as two hospitalisations.


Why People May Still Choose to Stay at a Private Hospital

1. They can afford it and don’t want to take the risks inherent in transferring care to another hospital.

2. They think private hospitals offer better care. Let me remind readers that our current Prime Minister, our late Founding Father, and Minister for Finance were all recently warded in public hospitals.

3. They choose to “follow” their private doctor (who only practices at a private hospital). The bottom line is that you need to know what your estimated costs are, what your health insurance covers, and what you’re willing to risk and what you’re willing to pay.

To find out more about health insurance and Integrated Shield Plans, you can visit the Medishield Life website or call the Medishield Life hotline.

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