Medifund: Stop Gap of Last Resort

"Medifund is an endowment fund set up by the Government to help needy Singaporeans who are unable to pay for their medical expenses. Medifund acts as a safety net for those who cannot afford the subsidised bill charges, despite Medisave and MediShield coverage. Set up in April 1993 with an initial capital of S$200 million, the Government will inject capital into the fund when budget surpluses are available. The Government utilises the interest income from the capital sum, which stands at S$3 billion (FY 2012), to help needy patients who have difficulty paying their medical bills.
With an ageing population, the government decided to carve out a portion of Medifund as Medifund Silver to deliver assistance to needy elderly Singaporean patients in a more targeted manner. In November 2007, Medifund Silver was launched with a start-up capital sum of $500 million." - Ministry of Health Website
Medifund is an endowment fund set up by the government to help needy Singaporeans with their medical expenses. The scheme was designed to be a measure of last resort for Singaporeans who had insufficient lead time to build up their Medisave savings and/or failed  to qualify for MediShield coverage. Medifund today has been institutionalized as a permanent scheme that "acts as a safety net for those who cannot afford their subsidized bill charges, despite Medisave and MediShield coverage."
The government has singled out two particular patient populations for specific assistance:
1. The elderly through Medifund Silver
2. Children through Medifund Junior. 
The Genesis of Medifund
The parliamentary debate on the creation of Medifund in 1990 was relatively muted as every parliamentarian supported the creation of a fund to help impoverished Singaporeans pay for their healthcare. There was also acknowledgement that no national financing scheme could ever cater to every possible scenario. Mr. Yeo Cheow Tong argued that there was no need to overhaul the current healthcare system by presenting the following figures: 6,000 patients out of over 160,000 admissions, or about 3.75%, in Class B2 and C wards applied for fee waivers. He then used the presented data to supported the need for a hospital administered final safety net that could be flexible and responsive to a patient's unique situations. 
Then Health Minister Yeo praised the Singapore healthcare system by saying: "we have today one of the best health systems in the world" during the second reading of the Medical Endowment Scheme Bill (which would later lead to the creation of Medifund). However, he then acknowledged that there were some Singaporeans who still fall through the cracks of the Medisave/Medishield net: 
"We recognize that there would be some who, for various reasons, cannot even afford to pay the heavily subsidized Class B2 or C bills. At the moment, they can apply to have their bills fully or partially waived...When this Bill is passed, Singaporeans using the heavily subsidized health services who face problems paying their hospital bills can apply for waivers from Medifund. The scheme will have more flexibility when considering appeals for fee waiver. The Medifund privilege will be extended only to Singaporean citizens, and not to non Singaporeans." (Yeo Cheow Tong. Singapore parliament reports, Hansard. Medical Endowment Scheme Bill, 18 Jan 1993)
The only substantial criticism lobbied on the Medical Endowment Scheme Bill was raised by Mr. Low Thia Khiang of the Workers' Party. He called attention to the fact that the Medifund scheme was designed to draw upon the investment income from the endowment, thus giving rise to the possibility of fluctuations on an annual basis. Mr. Low challenged the government's premise that Medifund would fulfill the government's commitment of financial protection for Singaporeans by saying: 
"This Bill does not tie in with the Government's original promise. Singaporeans who cannot afford to pay for their medical expenses cannot expect the Government to keep its promise of writing off their outstanding medical bills. They have to pray that the investment committed by the Medical Endowment Fund would reap big profits all the way, and that the Medifund Account of the hospital which they are admitted to is also receiving profits from all sources of investment, so that they will have a chance to make use of this fund. Can this truly said to be a form of protection?" (Low Thia Kiang, Singapore parliament reports, Hansard. Medical Endowment Scheme Bill, 18 Jan 1993) 
Mr. Low went on to ask: "If unfortunately, the investment does not yield any profit, or even suffers losses, then Medifund will have no money to pay the medical bills of those people who cannot afford to meet their own medical expenses. What will happen to those people?" 
Mr. Yeo responded to Mr. Low by stressing the "need to tie Medifund to our ability to generate a budget surplus" and closed the discussion by repeating two points:
1. "We must make sure our budgetary process allows us to generate a surplus so that we can contribute to Medifund. 
2. The government will keep injecting funds into Medifund during good years whenever the government has healthy budget surpluses. And the government has kept this promise - Medifund initially started with a $200 million endowment which has grown into $1.7 billion as of now.
Come back next time where we discuss in Medifund Eligibility in more detail.
A Special Look At The Singapore Healthcare System

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