Letter by Tan Guan Seng to Strait Times Forum:
I HAD an accident at work last June. Initially, the interim hospital bill from the National University Hospital indicated a subsidy. But when the final bill was given to me, I was shocked. The bill for my stay at a C-class ward amounted to an unsubsidised total of $147,000.Response by NUH:
I was discharged on Aug 13 last year and the reason for the difference between what was stated in the interim bill and the final one was not explained at all.
Only after I asked was I told that the Ministry of Health had withdrawn the subsidy as the accident was work- related.
About a month after my discharge, I applied for a waiver of the outstanding amount of about $122,000 through my MP. This was after my company had paid $25,000.
As far as I am aware, the hospital did not reply to the appeal.
Three months later, after more deductions from my MediShield ($41,000) and Medisave accounts ($31,000), I was informed that the hospital was in the process of scheduling an instalment payment plan for the remaining $50,000.
MR TAN Guan Seng spent most of his hospitalisation at the high-dependency and intensive-care units during his two-month stay at the National University Hospital.So from what I gather from the letter and the response, there was a mistake made by a staff of NUH who overlooked the subsidy requirements, causing the bill to be not subsidized in the end. This mistake was not revealed when the patient was discharged following 2 whole months of hospital stay. It was only revealed after the patient inquired about the pricey bill. This is tragic misrepresentation. Tragic because the patient was given the impression that his bills would be subsidized if he were to stay in a class C ward. Since NUH is willing to acknowledge their mistake, NUH should go a step further and provide the subsidy. After all, an apology without appropriate action is not much of an apology.
His hospitalisation charges were originally pegged at the subsidised rate as our admission office staff had overlooked that it was a work-related injury. We apologised to him for this.
When Mr Tan's wife made a request to upgrade him to a private ward, the hospital's staff informed her that the estimated bill would exceed the quantum to be borne by Mr Tan's employer under the Work Injury Compensation Act.
Under the Act, Mr Tan's employer is liable to pay medical expenses for up to one year from the date of the accident, subject to a cap of $25,000.
However, hospitals are given the discretion to downgrade patients admitted for work-related injuries and who have financial difficulties to subsidised status, if they meet the criteria after a financial assessment.
We empathise with Mr Tan's situation. In our bid to assist him, we advised him to undergo a financial assessment to confirm if he could qualify for higher subsidies for his medical expenses. Mr Tan did not take up the offer.
I wonder why there has to be a "financial assessment to confirm if he could qualify for higher subsidies" (which presumes that he qualified for a subsidy in the first place) when he was not eligible for any subsidy. I also wonder if the patient was in a good state of mind to make decisions on financial assessment. It is very sad that patients often have to make difficult financial decisions when they are at their weakest states. Perhaps, there should be some guidelines to make financial assessment without requiring the patient's input. This would allow the financial assessment to be more robust, and less susceptible to human error (staff or patient). This would reduce the number of cases where people can't pay for their medical fees. It does not make sense to charge a construction worker a 6-digit sum when he probably does not even have a 5-digit savings in his combined bank accounts. Perhaps there should be a system set up to automatically screen through every patient's financial ability before deciding where best to ward them. This would prevent low-income families from being bogged down by heavy bills just because the hospital allows them to be upgraded to a private ward. This should not even be allowed, unless the patient can provide substantial evidence of financial strength to justify upgrading to a private ward.
Things to learn from this incident: Everybody is responsible for their own financial situation, even if you are injured and not in the best state of mind to make decisions. Medishield does not cover all your H&S as it is not "as charged". Medisave is your money too, so don't waste it unnecessarily. Get financial assessment in the presence of a trusted friend/loved one so they can provide good counsel.
The letter by Tan Guan Seng can be found here.
The response by NUH can be found here.