Musculoskeletal patients face highest risk of large hospital bills: Study

SINGAPORE — Patients with conditions that affect the muscles, bones and joints, or those with cancer or heart disease, face the highest risk of racking up large hospital bills, a study by two National University of Singapore researchers has found.

The economists, who analysed over 30,000 hospitalisation episodes seen at the Singapore General Hospital (SGH) in 2007, also found that insured patients are more likely to incur substantial hospital costs, and extreme expenditure is more probable where a patient dies during the illness.

Associate Professor Tilak Abeysinghe, who co-authored the study and presented it recently at the Singapore Health Economics Association conference, said the data was obtained through contacts in the healthcare sector.

The study found that those with musculoskeletal diseases, which include back pain and osteoarthritis, had a 5.6 per cent to 14 per cent chance of incurring over S$10,000 in hospital bills after government subsidies (but before insurance, self-funded payments and Medifund kick in, where applicable).

The probability was 1.3 per cent to 8.3 per cent for those with cancer, and 2 per cent to 8.8 per cent for those with heart disease.

In contrast, patients without these conditions faced a 0.85 per cent to 5.6 per cent chance of incurring net expenditure exceeding S$10,000.

After government subsidies of 65 per cent to 80 per cent, patients in C Class wards paid between S$38 and S$38,721, with an average of S$1,466, and 99 per cent of them paying no more than S$9,004.

B2 patients, who receive 50 to 65 per cent in subsidies, incurred net bills ranging from S$68 to S$95,615, with the average of S$1,727, and 99 per cent of the patients paying no more than S$10,083.

The highest net bill was S$207,741, for an A Class patient.

Patients’ net expenditure was paid through Medisave (68.1 per cent), MediShield (11.2 per cent), private insurance (4.7 per cent), out-of-pocket (6.3 per cent) and other means.

Assoc Prof Abeysinghe acknowledged the limitations of data from a single year, and is working to obtain more data.

With a “richer database”, one could plot the pace of healthcare cost increases and determine if any data from 2007 was unusual, for instance.

The study could then be used to help patients better project their expenses, said Assoc Prof Abeysinghe, who began the study in 2009 with then-PhD student Himani Aggarwal.

“Our objective of the exercise was to prepare an easy-to-use Excel worksheet and provide it to hospitals. Once the diagnosis is done, the doctors can input the patient data into the worksheet and it will show the possible bill size,” he said.

On the finding that the insured were more likely to incur more substantial costs, Assoc Prof Abeysinghe attributed this to the fact that patients with MediShield had more co-morbidities (existing illnesses), while for those with private insurance, it is probably a moral hazard problem, which he said is seen worldwide where patients with insurance tend to consume more healthcare.

“This is why deductibles and co-payments are necessary,” he said.

FINANCIAL COUNSELLING

Studying large bills can aid the design of the co-payment structure for MediShield Life, which will provide coverage for all when implemented next year, said Assoc Prof Abeysinghe.

The creation of multiple tiers of co-payment is important to reduce the burden on patients with very large bills, he said.

Some data on hospital bills is already available. Since 2004, the Ministry of Health has posted online hospital bill sizes of various hospitals. It includes the bill sizes at the middle and higher end of the spectrum for different ward classes, and for many conditions and procedures including heart failure and hip replacement surgery.

The SGH — the only hospital out of five contacted that responded to media queries — said prior to admission, patients undergo “detailed financial counselling” based on their choice of ward class, expected length of stay and types of treatment.

Patients who stay for at least a week are given an interim bill to keep them updated and informed, said Ms Ong Mei Ling, SGH’s business office senior manager. The hospital explores assistance options if patients have difficulties paying.

A Ministry of Health spokesperson told TODAY that the study provides “a useful perspective on hospital bill sizes, and how the appropriate choice of ward classes coupled with heavy government subsidies, Medisave and MediShield work to reduce bill sizes and keep healthcare affordable for Singaporeans”. Those with financial difficulties despite these schemes can tap Medifund.

“We will continue to refine our healthcare financing system to ensure that it continues to meet Singaporeans’ needs,” the spokesperson said.