Singapore starts means testing in hospitals

Date: 
Thursday, January 8, 2009

Singapore has introduced means testing for public hospital patients starting 1 January 2009. From the first day of the new year, the government will start assessing new patients' entitlement to subsidies for class B2 and class C wards based on their tax-declared incomes or, for non-working patients, the value of their homes.

While income disclosure itself is not mandatory, patients who refuse to do so, effectively opt out of the scheme, and will have their subsidies minimized, similar to that of the highest earning group - currently 50% for class B2 and 65% for class C wards.

The income bands and respective subsidy levels are indicated in the table below. Permanent residents (PR) are entitled to 10% less subsidy than Singapore citizens for the same income levels. Foreigners do not receive subsidies at public hospitals in Singapore.

Average Monthly Income of Patient Class C Subsidy (Citizens) Class B2 Subsidy (Citizens) Class C Subsidy (Permanent Residents) Class B2 Subsidy (Permanent Residents)
$3,200 and below 80% 65% 70% 55%
$3,201 - $3,350 79% 64% 69% 54%
$3,351 - $3,500 78% 63% 68% 53%
$3,501 - $3,650 77% 62% 67% 52%
$3,651 - $3,800 76% 61% 66% 51%
$3,801 - $3,950 75% 60% 65% 50%
$3,951 - $4,100 74% 59% 64% 49%
$4,101 - $4,250 73% 58% 63% 48%
$4,251 - $4,400 72% 57% 62% 47%
$4,401 - $4,550 71% 56% 61% 46%
$4,551 - $4,700 70% 55% 60% 45%
$4,701 - $4,850 69% 54% 59% 44%
$4,851 - $5,000 68% 53% 58% 43%
$5,001 - $5,100 67% 52% 57% 42%
$5,101 - $5,200 66% 51% 56% 41%
$5,201 and above 65% 50% 55% 40%

As seen above, the range of the subsidy is 50% ~ 65% in B2-class and 65% ~ 80% in C-class, corresponding to threshold incomes of $3200 ~ $5200 in which the gradation bands apply at 1% drop per $150 increase above $3,200 (except the last 2 gradations above $5,000 which have 1% drop per $100 increment).

It should be noted that means testing will only apply, as at this time, to B2 and C wards. Patients to other government medical services such as A&E, specialist outpatient and polyclinic visits will not undergo means testing.

For patients with no income, the value of their residential properties will be used to determine their subsidy level entitlements. Those falling into this group include retirees, full-time housewives, and children. The threshold is based on a property annual value (AV) of $11,000 - patients with home AVs below or equal to $11,000 enjoy the maximum subsidy levels whereas above this, they receive the minimum levels (50% for class B2, and 65% for class C).

It is expected that about 60% of Singaporeans will continue to receive the same hospitalization subsidies after the start of means testing.

Health Minister Khaw Boon Wan has stated that the government will be sympathetic to special circumstances such as cases where patients' income levels might have undergone drastic changes or where patients have other major financial dependents. Retrenched workers will receive the maximum subsidy level.