mf's mini world of mf-ism: Navigating Singapore's health sector

Apart from giving birth and the many A&E trips (see list in annex :p), I have not used our health services much, thankfully, until lately.

As a kid, we mostly went to a GP for common childhood fevers, colds and coughs. The middle age doc nearby who gave bright green strange tasting syrup, the old Yoda-lookalike doc near Grams who wore a tie and gave bitter powder, and from my teens onwards, the two pretty docs nearer Yan's place (but still near me) who gave me much comfort.

We went to the polyclinic too. All I could remember was waiting, waiting and waiting! Probably went there for baby wellness coz YQ's childhood glaucoma was first diagnosed there.

So I never went back to polyclinic as an adult. It was always GP.

But now the polyclinics are so good. Ok, I don't know about Singhealth or NHG but my area is under NUHS, and all I need to do is to click a few buttons to make an appointment, check in for my visit, check number of patients before me, check where to go next, pay and retrieve bills and reports. The wait time is very acceptable and sometimes surprisingly short.

How do I know? How do I know indeed!

We started using the polyclinic coz a new one opened in Bukit Panjang, but more for injuries etc, in case need referrals for further treatment. Like Yang fell and hurt his shin in school. I think we still went to Raffles at the mall downstairs for regular illnesses and to grab MC for work purpose.

But I never found a GP I'm comfortable with while staying at BP. The doctors at Raffles are all on rotation. Once I even had one who spilled my blood on the floor when drawing blood, goodness! So I went back to Dr Gill at HV for health checkup and PAP - not having a random doctor for the latter!

Guess it's good that we're making home at HV again?!

Anyway, polyclinic. We went to the polyclinic even more after moving to HV. Sito cut his toe on the metal gate and went for a tetanus shot. I also had a tetanus shot given my frequent brushes with the kitchen knife...! I had a skin issue on a toe - forgot the name - and had to go burn it off with silver nitrate. Yang had a rash on his face and got a referral to the Skin Centre. And of course my intestinal issue.

This intestinal issues opened my eyes to our healthcare sector. Here are some thoughts:

First - how do things work?

Hint: Not everything is automated

I was referred to a specialist at Alexander Hospital who sent me for a CT scan and then scopes. I paid for the CT scan using Medisave and cash.

But I have been paying for an Integrated Shield Plan (ISP) with Great Eastern (GE) since 2014/2015. Even if Medishield doesn't cover outpatient CT scans, wouldn't the GE portion cover?

I asked the staff at the CT scan. They said only Medisave, and were not sure about the ISP. So I went back to ask my agent. He advised me to ask the hospital staff to do e-file at my next visit since I was going back for more stuff.

However, the financial counsellor for my scopes said over the phone that she couldn't do e-file for CT scan. I tried again at my next physical visit to the hospital, which was for the gynae consultation. The registration counter said they did not do e-file there and told me to pay first and then claim from insurance.

*.*

After my first scopes in June, I still had to pay using Medisave due to deductible and co-payment. There was no ISP payout as I hadn't met the deductible. After my second scope in September, Medishield kicked in and I paid a little for the co-payment using Medisave. The GE portion did not kick in.

I wondered why so I did some digging - coz I forgot details told to me when I signed up! - and found that:

Medishield does not cover pre- and post-hospitalisation. So the CT scan and all the consultations were outpatient, not hospitalisation = not covered.
GE (or whatever insurer you have) kicks in only when the hospitalisation exceeds Medishield limits and when Medishield does not cover the specific procedure.
GE also covers pre and post relating to the hospitalisation. So I found out how to claim pre- and post-hospitalisation bills.

After my final visit in October, I put together all my receipts and relevant reports from the hospital, and sent them in. I was pleasantly surprised that I got $1,259 in claims within two weeks, largely cash and some Medisave, from the GE portion of the ISP.

Recently, I put together all the expenses in an Excel sheet, with details from CPF statement, hospital bills and GE statements. Of my total bill of $3,675, I paid $1,798 using Medisave and $56 using cash, the remainder of $1,820 was covered by the ISP, of which only $560 was via auto e-file at the hospital.

The amount is more than what I had paid for the GE portion in the past 10 years ✌ Later, I discovered I should have included the polyclinic bills too but too late, gone from the system + much smaller amount.

Point is - now imagine if someone less savvy didn't know about pre and post claims. That's good money out of pocket!

Next - time:

When we talk healthcare, we often think money. But there's also time. By the time I was done with my final consultation with the gastro specialist, it was almost a year since I went to the polyclinic.

There was a lot of time between appointments. I think it was because I opted for subsidised treatment and I didn't have a nasty prognosis.

Now that's scary if I had something nasty!

But while researching the ISPs recently, we found that in the case of critical illnesses, the wait time for subsidised treatment should not kill you, haha! Indeed, a friend went to polyclinic which told her to go straight to A&E as they suspected meningitis. It was ruled out at A&E but she had a blood culture taken. Next thing she knew, the hospital called her back to be warded immediately for a bacteria infection.

Third - of course, finances:

Cost of healthcare depends on the individual, e.g. type of ward, public or private hospital. But it also depends on the healthcare provider.

I have already chosen subsidised care to minimise my costs as covered in my first point. But does the healthcare provider think about minimising cost to patients as well, besides providing financial counselling?

I recall in previous conversations with XY, she mentioned over treatment in the US. I don't think it's an issue here. Or at least I have not witnessed it. Our polyclinics also kind of make sure that we get a referral to a specialist only if they can't handle - I mean, I went to the polyclinic twice before I got referred to gastro! Same for Yang's rash.

But I have this other issue - over the years, I get prescribed the same types of medicine for my colds etc. Those little packs accumulate in the medicine cabinet and expire, some nearly untouched. After clearing up my medicine cabinet one day some years ago, I've learnt to say no to the usual paracetamol and lozenges. But it is usually at the point of getting medicine, just before paying.

I remember only one instance where the GP told me exactly what he would prescribe for me - I was surprised but very happy as I was able to ask questions and say no to some before they started packing the medicine. Other times, I was probably too ill to think until the medicine was placed in front of me.

For other ailments, the doctors would generally say this cream or that coz must explain how to apply etc. Anyway, for Yang's recent pus-in-toe (not ingrown in the end), I brought along my own antibiotic cream to ask the doctor if he could use that coz those tend to accumulate too!

Knowing my medicines, I save money and clutter and waste.

But this may not be the case for other patients, especially those with very good insurance coverage - insurance will pay, so just consume max. And this begs the question of whether healthcare providers think the same - insurance will pay so just provide/charge max.

Raffles and even my old GP in later years would ask at the point of registration if the fees would be covered by insurance. And my delivery fees went from $2k for Kai to $4k for Yang - for Yang, I had to ask the doctor to sign some documents for Sito's company insurance. I changed to another OBGYN for Yu.

So....

Years back, I wrote about healthcare costs in SG vs. Evanston. I don't know with all this insurance business, whether our healthcare costs will remain affordable in the long run.

Fourth - healthcare for all

I only had three points until I learnt of an incident lately which got me wondering... This is not my personal experience but I thought I should highlight it too.

I mentioned above that a friend was admitted for a bacteria infection. She was supposed to stay for five days for IV antibiotics. Due to bed crunch, the hospital wanted to send her home before the five days were up, for home care for 14 days, during which she would not be allowed to leave home.

When she wanted to just stay in hospital for 14 days instead, the hospital changed its mind and discharged her anyway but she had to return daily for four days of IV and then take seven days of oral antibiotics.

Maths tells me that the number of IV + oral antibiotics days has been reduced. Was her healthcare compromised? At the end of it, she did recover. But the process, to me at least, wasn't very pleasant.

I understand the need to cater to everyone. All the talk about our ageing population taking a toll on the healthcare system isn't just talk. It is understandable to ask less critical cases - or cases that are no longer critical - to make way for critical cases. But it should be done with finesse, no? I think bedside manner is just about as important as the treatment itself, if only to seek greater understanding from patients and their family.

Aftermath

Anyway, after going through the bills and GE statements, Sito and I dug deeper into ISPs. So besides what I mentioned above, our A/B1-type ISP was meant for (a) non-subsidised components such as choosing a doctor, and (b) A/B1 ward stays with less/no subsidies.

Now that Medishield has increased its coverage, and we are going for subsidised treatments and ward stays, we figured there was no need for our A/B1-type ISP. So we downgraded our ISP to the standard one, covering B2 and below ward stays - we are ok with no aircon.

The delta in premiums between these two is not much at this point, as the bulk is still Medishield itself. But with age, the GE part will increase a lot. So it makes sense for us to just switch based on our needs. Seriously, I also don't know why we took the more expensive plan last time - Sito's was from eons ago whereas mine was a copycat of his. Ya I know, I didn't do my research...

But it's never too late!

And we just got ISPs for the kids as well, since we're already paying for Medishield. They're young and the premiums are low. The Medisave interest will take care of everything.

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Annex

Sep 2005: my tummy

Jan 2007: my thumb

Jan 2013: Kai's fever

Feb 2013: Kai's fever

Jun 2013: Kai's HFMD

Jul 2013: Kai's fever

(Ya, first-time parents... No more A&E for fevers for the brothers!)

Jul 2015: Yang's fall

Jan 2016: Yang's febrile fit 1

Jun 2016: Yang's febrile fit 2