"Singaporeans should consider private hospitalisation insurance to supplement MediShield and employer-provided cover. This is the appropriate response to the coming of the means-test age, the better to prepare for the grey years. Those with spare income would even want to take out disability or critical illness plans to protect themselves against prolonged loss of employment income."

-- Health Minister Mr Khaw Boon Wan (Straits Times 8 Jan 2008)

Means-testing is a way to focus limited resources on needy Singaporeans, by directing it to those who need it most. Means-testing has been implemented at the government-funded nursing homes since 2000 and at the other intermediate and long term care facilities since 2001. Lower-income patients receive more subsidies than the higher-income at these facilities.

Minister Khaw Boon Wan has announced the means testing framework in Parliament on 3 Mar 2008. The details are:

• Patients whose income is $3,200 and below would receive full subsidy (65% for Class B2 and 80% for Class C)
• Patients whose income is $5,201 and above would receive 50% subsidy for Class B2 and 65% subsidy for Class C
• Patients whose income falls between $3,201 and $5,200 would receive graduated subsidies between 50-65% for Class B2 and between 65-80% for Class C
• Monthly income is defined as average monthly wage based on last available 12-month data
• Patients who are economically inactive will receive full subsidy (65% for Class B2 and 80% for Class C) unless they live in property with Annual Value exceeding $11,000. The latter will receive subsidy at 50% (B2) or 65% (C)
• Subsidy for Permanent Residents will be 10%-points less than citizens of equivalent income level
  
• The implementation date at all public hospitals would be on January 2009

FAQs

1. With means-testing in place, does it mean that I will not be able to choose a Class C or B2 ward if I am a high-income earner?
 
Patients will still retain their freedom to choose their ward class. Any patient, regardless of whether they are rich or poor, can choose to be admitted to a Class C or B2 ward.  They will still be heavily subsidized, but at different rates.
 
2. If I am a high-income earner and I choose to go to a Class C or B2 ward, does it mean that I will not enjoy any subsidy at all?
 
All patients in Class C and B2 will be subsidized, but to different degrees. Higher-income patients will be subsidized less than lower-income patients, but their bills will remain affordable. For example, a better-off patient in Class B2 will still receive higher subsidy in B2, than if he opts for Class B1.  Please refer to question 8 for the details of subsidies for different income earners staying at different class wards.
 
3. Will the means-testing process at the hospitals be similar to the current process at the nursing homes?
 
No, given the acute nature of hospitalization and the shorter length of stay, a simpler way is needed for income assessment.  For example, means-testing at the hospital may be based on a patient’s individual eligibility and will be automated for ease of administration.
 
4. What happens if after means-testing, I am not able to afford my hospital bill?
 
No patient will be denied medical treatment because he cannot afford it. Means-testing will be implemented flexibly and appeals for re-assessment will be considered.
 
5. What will be the subsidies at the restructured hospitals after means-testing is implemented? 
Please refer to the table below the parameters which will define our means-testing framework at the restructured hospitals.  
 

Notes :

• Patients who are economically inactive will receive full subsidy (65% for Class B2 and 80% for Class C) unless they live in property with Annual Value exceeding $11,000.  The latter will receive subsidy at 50% (B2) or 65% (C).

• Subsidy for Permanent Residents will be 10%-points less than citizens of equivalent income level.

6. As I did overtime occasionally, my salary for that month would exceed the income limit. How would this be taken into account in the event that I have to apply for hospital subsidy? 

The hospitals will rely on income data in the CPF system.  A patient's income will be based on his total salary received over the last-available 12-month period.  It will not be based on just the last month's pay.  This will address the concern about month-to-month differences in pay arising from occasional instances of overtime. 
 
 
7. What will be the hospitalisation subsidies for housewives, children, retirees and the unemployed? 

Patients who are economically inactive will receive full subsidy (65% for Class B2 and 80% for Class C) unless they live in property with Annual Value exceeding $11,000.  The latter will receive subsidy at 50% (B2) or 65% (C). 
 
8. How will Singapore Permanent Residents and foreigners be affected with the implementation (from January 2009) of subsidies at the restructured hospitals? 

Subsidies for Singapore Permanent Residents will be 10%-points less than citizens of equivalent income level.

For example, for a Singaporean patient who stays in Class C ward and has a monthly income in the range of $3,351-$3,500, his hospitalisation subsidy will be 78%.  For a Singapore Permanent Resident staying in the same class ward and earning the same salary range, his hospitalisation subsidy will be 68%.

For a foreigner, he does not receive hospitalisation subsidy at the restructured hospital.