Monday, January 07, 2008

Medical fee protection in Singapore, or the lack of it.

Posted as a comment on Yawningbread's comment blog, about his article on the lack of clarity on how to access medical cost support from the various systems available from the government (or not available). Click on the link above to go to his article.

I seem to remember some time ago, some minister, mayhap from some health-related portfolio, or someone, made the statement or expressed the philosophy that:

The family is the FIRST line of medical cost defense for any individual.
(and addendum - the state is the last line of defence).

Now, if I comprehend the philosophical concept of insurance, it was to ensure that the greater whole help take care of those struck by the fate of randomness. From one perspective, they 'subsidize' or help defray the costs of those unlucky individuals. (who, if one believes in societal-level of karma, some must die for the majority to prosper kind of philosophy)

However, private insurance guarantees that those most likely to need fee assistance, are also those most likely to be rejected. (in the interests of profit, every payout is a loss to the bottom line).

I understand that under the SWISS level of healthcare - everyone pays a fixed fee a year (or a higher fee depending on their desire for better beds), and then to a certain level, all medical coverage is paid for by the national fund. It is complicated in its own way, but when elderly swiss prefer to live in Switzerland rather than risk expensive medical fees in Bangkok, then, there must be some real societal level of medical care for its members.

Coming back to the SG philosophy - now, as aptly described by many, the family is nuclear (stop at 2 punishing us further again), small, and unable to seriously fund medical care should illness strike more than one member of the 'family'.

If so, it then begins a negative spiral of medical un-surance, where once the family's medisave is empty due to one illness, the family cannot let any other member fall to another long-term illness.

Now, as I understand it, most nuclear families have up to 4 grandparents, who may or may not have 4 kids (or more) to support them. So, we should choose now which of the 4 grandparents should get the medical fee support in advance now? Or, amongst the four grandparents, see who gets to be the lucky one?

Also, it appears that with the family as the first line of medical fee defense, it leads that a second medical crisis will lead to the family ending up in all kinds of debt to pay for the fees. (all in all, medical care be medical care, but money does matter when determining when to carry out that potentially life-saving but not critical injury).

By saddling the family with such loans, rather than spreading the financial load out amongst the greater society, we continue to create a society of haves and have nots.

and sadly, no one can predict when a medical crisis can strike a 'family'. Our system guarantees that not only the individual and immediate family's financial defense is consumed, but that the family must now pray that no other illnesses ever strike them again.

Its a wonder that we claim to have a swiss-standard of living. I dread the day when my remaining parent's medical bill becomes a reality.




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