MEDICAL ENDOWMENT SCHEME ANNUAL REPORT 2013/2014

MEDICAL ENDOWMENT SCHEME ANNUAL REPORT 2013/2014

MEDICAL ENDOWMENT FUND ANNUAL REPORT FOR THE FINANCIAL YEAR 1 APRIL 2013 TO 31 MARCH 2014 CONTENTS PAGE 1. Introduction 1 2. Overview of Medical Endowment Fund 1 3. Financial Status of Medical Endowment Fund 2 4. Grants Disbursed 3 5. Medifund and Medifund Silver Usage 3 6. Auditor's Reports 6 7. Conclusion 7 EXHIBITS Exhibit 1 Financial status of Medical Endowment Fund 2 Exhibit 2 Medifund and Medifund Silver grants to MFIs 3 Exhibit 3 Medifund and Medifund Silver applications approved 4 Exhibit 4 Utilisation of Medifund and Medifund Silver by MFIs 4 Exhibit 5 Medifund and Medifund Silver assistance disbursed to 5 patients Exhibit 6 Average FY13 assistance by treatment settings in PH/Is 6 Exhibit 7 Percentage of applications which received Full Help from Medifund and Medifund Silver in FY13 6 CHARTS Chart 1a: Chart 1b: Chart 2a: Chart 2b: Chart 3a: Chart 3b: Chart 4a: Chart 4b: Distribution of Medifund Grant to Medifund Committees of Public Hospitals and Institutions in FY13 Distribution of Medifund Grant to Medifund Committees of ILTC Facilities in FY13 Total Number of Medifund Applications approved by Public Hospitals and Institutions in FY12 and FY13 Total Number of Medifund Applications approved by ILTC Facilities in FY12 and FY13 Total Amount of Medifund Help Approved by Medifund Committees of Public Hospitals and Institutions in FY12 and FY13 Total Amount of Medifund Help Approved by ILTC Facilities in FY12 and FY13 Breakdown of Number of Approved Medifund Applications by Medifund Committees of Public Hospitals and Institutions in FY13 Breakdown of Number of Approved Medifund Applications by ILTC Facilities in FY13: Non- Residential Services 8 9 10 10 11 11 12 13

Chart 4c: Chart 4d: Chart 5a: Chart 5b: Breakdown of Number of Approved Medifund Applications by ILTC Facilities in FY13: Intermediate Term Residential Services Breakdown of Number of Approved Medifund Applications by ILTC Facilities in FY13: Long Term Residential Services Breakdown of Amount of Medifund Help Approved by Medifund Committees of Public Hospitals and Institutions in FY13 Breakdown of Amount of Medifund Help Approved by Medifund Committees of ILTC Facilities in FY13 13 14 15 16 ANNEXES Annex A: List of Medifund Committees and Medifund approved Institutions in FY13 Annex B: Medifund Advisory Council in FY13 22 Annex C: Auditor s Report on Medifund Accounts 23 17

MEDICAL ENDOWMENT FUND ANNUAL REPORT FOR THE FINANCIAL YEAR 1 APRIL 2013 TO 31 MARCH 2014 1. INTRODUCTION 1.1. The Medical Endowment Fund (Medifund) is governed by the Medical and Elderly Care Endowment Schemes Act (Chapter 173A). As required under the Act, this Report gives an account of the administration of Medifund for the Financial Year 2013 (FY13), i.e. for the period 1 April 2013 to 31 March 2014. 2. OVERVIEW OF MEDICAL ENDOWMENT FUND Objective 2.1 Medifund was created by the government on 1 April 1993 to assist needy Singapore citizens who are unable to afford their medical bills, despite government subsidies and having made use of their Medisave and MediShield. 2.2 Needy Singaporeans who receive subsidised treatment and have difficulties paying their medical bills can apply for Medifund assistance. The quantum of assistance given is tailored to individual circumstances. 2.3 Over the years, Medifund has been enhanced to ensure that needy Singapore Citizens receive the help needed. For example, Medifund Silver and Medifund Junior were introduced to better target assistance at the elderly and children respectively from needy families. Medifund has also been extended to cover more healthcare services. For example, the use of Medifund was extended in 2013 to primary care at the polyclinics, dental services, antenatal and delivery services. 2.4 To strengthen our social safety net and support these enhancements to Medifund, the Government has injected significant sums into Medifund over the years. In FY13, the Government injected $1 billion into Medifund and Medifund Silver. As at end FY13, the respective capital sums for Medifund and Medifund Silver stood at $2.78 billion and $1.22 billion. Medifund Committees 2.5 Every Medifund-approved institution (MFI) has a Medifund Committee to evaluate and approve applications from eligible patients. In FY13, there were 42 Medifund Committees administering Medifund for 93 Medifund-Approved Institutions (MFIs), an increase of 12 institutions from FY12. The MFIs include Public Hospitals, National Speciality Centres, Polyclinics (collectively referred as Public Hospitals and Institutions, PH/Is) and various intermediate and long term care (ILTC) Facilities (Annex A). 1 1 A Medifund Committee may administer Medifund for more than one institution. For instance, in FY13 the Agency for Integrated Care (AIC) Medifund Committee administered Medifund for 1

2.6 The Medifund Committees approve applications from patients at their respective institutions and decide on the quantum of Medifund assistance to be provided. Medifund Committee members are nominated by the respective institutions and represent a diversity of backgrounds. They are appointed by the Permanent Secretary (Health). Medifund Advisory Council 2.7 The Medifund Advisory Council (MAC) is appointed by the Minister for Health to advise him on all matters relating to the application of the income of Medifund. The MAC also recommends directives and guidelines on the approval of applications from eligible patients and on the administration of the Medifund Account of Medifund Committees. The seventh MAC was appointed on 1 April 2011 for a 3-year term till 31 March 2014 (see Annex B for composition of the Council). 3. FINANCIAL STATUS OF MEDICAL ENDOWMENT FUND 3.1 In FY13, the Government injected $1 billion into the Medical Endowment Fund, bringing its total size to $4.11 billion (in capital sum and protected reserves) (see Exhibit 1 for details). This provided additional resources for financial assistance. Exhibit 1: Financial status of Medical Endowment Fund 1 Medifund FY12 ($ million) Medifund Silver FY13 ($ million) Total Medifund Medifund Silver Total Balance at 1 Apr of FY 1,736.1 740.0 2,476.2 2,158.7 922.9 3,081.6 Capital Injection 420.0 180.0 600.0 700.0 300.0 1,000.0 Total Income in the FY 72.8 31.1 103.8 112.0 47.9 159.9 Total Expenditure in the FY (70.2) 3 (28.1) (98.4) (86.5) (43.5) (130.1) 3 Balance at end of FY 2,158.7 923.0 3,081.7 2,884.1 1,227.3 4,111.4 Comprising: Capital Sum 2,080.0 920.0 3,000.0 2,780.0 1,220.0 4,000.0 Protected Reserves 2 77.3 0.6 78.0 77.3 0.6 78.0 Accumulated Income 2 1.4 2.3 3.7 26.8 6.7 33.4 Note: 1. The figures in this and subsequent tables may not add up due to rounding. patients from 42 institutions, including private nursing homes that are on the Portable Subsidy Scheme and selected non-residential ILTC facilities. 2

2. The protected reserves comprise accumulated unutilised interest monies that were locked-up at the change-over of Government in December 2001, May 2006 and May 2011. 3. Total expenditure includes $130,818 payment for auditor s fees and printing of the annual report in FY13 ($124,634 for FY12). 4. GRANTS DISBURSED 4.1 The Ministry of Health (MOH) provides the MFIs with grants from income generated from the Medical Endowment Fund each year. The Medifund Committees in the MFIs then approve payments of Medifund and Medifund Silver assistance for patient bills out of their Institution s Medifund Account. 4.2 In FY13, MOH distributed $130.0 million in Medifund and Medifund Silver grants to the institutions, 32.4% more than the previous year s allocation (see Exhibit 2). The grants to the MFIs are shown in Chart 1a and Chart 1b respectively. Exhibit 2: Medifund and Medifund Silver grants to MFIs MFIs FY12 ($ million) FY13 ($ million) % Change PH/Is 81.6 108.8 + 33.4% ILTCs 16.6 21.2 + 27.7% Total 98.2 130.0 + 32.4% Note: 1. PH/Is refer to Medifund-approved Public Hospitals and Institutions (i.e. Public Hospitals, National Speciality Centres and Polyclinics). 2. ILTCs refers to Medifund-approved institutions in the Intermediate and Long Term Care sector. 5. MEDIFUND AND MEDIFUND SILVER USAGE 2 Applications approved 5.1 In FY13, 766,110 Medifund and Medifund Silver applications were approved, an increase of about 30% from FY12 (see Exhibit 3). A breakdown of the approved Medifund applications by PH/Is and ILTCs setting are shown in Chart 4a to Chart 4d. The increase in Medifund applications reflected the extension of Medifund to more healthcare services in FY12 and FY13. For example, Medifund was extended to the polyclinics from June 2013 and about 68,000 approved applications were for polyclinic patients. Similarly, Medifund was extended to non-residential ILTC services from FY12 and the approved applications for these services nearly tripled from 9,400 in FY12 to 27,000 in FY13. 2 All application figures refer to approved applications. 3

Exhibit 3: Medifund and Medifund Silver applications 1 approved FY12 FY13 Total Medifund Medifund Silver Total % Change PH/Is 548,744 514,317 194,270 708,587 + 29.1% ILTCs 38,737 27,586 29,937 57,523 + 48.5 % Overall 587,481 54,1970 224,207 766,110 + 30.4% Note: 1. Applications are not equivalent to unique patients. A patient may make an application for assistance for the bill(s) for each hospitalisation or a stretch of outpatient visits, resulting in more than one successful application in the year. 2. One Medifund application in the PH/I sector accounts for one inpatient admission or one outpatient attendance. 3. Medifund applications in the ILTC sector have different units of measure to reflect the nature of the services: one attendance for a Non-Residential Service (e.g. Dementia Day Care), one admission into Intermediate Term Residential Service (e.g. Community Hospital), and 30 days of stay in a Long Term Residential Service (e.g. Nursing Home) accounts for one Medifund application respectively. Medifund and Medifund assistance 5.2 The total assistance given by MFIs to patients increased by 27.3%, from $101.9 million in FY12 to $129.8 million in FY13. In aggregate, MFIs almost fully utilised the amount of Medifund allocated in FY13 (see Exhibit 4). 5.3 Medifund and Medifund Silver assistance increased from $71.9 million in FY12 to $88.0 million in FY13 and from $30.0 million in FY12 to $41.8 million in FY13 respectively. Exhibit 4: Utilisation of Medifund and Medifund Silver by MFIs Quantum of Assistance to Patients ($ million) FY12 Utilisation of Allocation Quantum of Assistance to Patients ($ million) FY13 Utilisation of Allocation Medifund 71.9 102.6% 88.0 101.8% Medifund Silver 30.0 106.6% 41.8 96.0% Overall 101.9 103.8% 129.8 99.8% Note: 1. Utilisation can exceed allocation when MFIs utilise the amount of Medifund allocated in a year as well as surpluses of Medifund accumulated from previous years to assist patients. 4

Assistance for Singaporeans 5.4 Overall, Medifund and Medifund Silver assistance to patients increased by 27.3% in FY13 compared to a year ago. For patients aged 65 and above, it increased by 29.4% (See Exhibit 5). Exhibit 5: Assistance disbursed to patients To all patients FY12 ($ million) FY13 ($ million) % Change PH/Is 86.0 110.1 +28.0% ILTCs 15.9 19.7 +23.4% Overall 101.9 129.8 +27.3% To patients aged 65 and above PH/Is 21.9 29.3 +33.7 % ILTCs 11.2 13.6 +21.0% Overall 33.2 42.9 +29.4% To patients aged below 18 PH/Is N.A. 9.8 N.A. ILTCs N.A. 0.03 N.A. Overall N.A. 9.8 N.A. Note: 1. No figures are available for assistance given to patients aged below 18 in FY12. Adequacy of assistance per application 5.5 Similar to previous years, applications for outpatient treatment formed the majority of Medifund applications. In FY13, Medifund applications for outpatient treatment made up 96.4% of applications in PH/Is. 63.8% of the total Medifund assistance disbursed in PH/Is was for patients who needed help with their outpatient treatment bills. 5.6 The quantum of Medifund assistance received by patients would vary according to treatment setting and the actual bill incurred in each individual case (See Exhibit 6). For inpatient treatments, the average assistance per application, i.e. assistance per admission, was $1,579. For outpatient treatments, the average Medifund assistance per application (i.e. the assistance per attendance) was $103. 5

Exhibit 6: Average FY13 assistance by treatment settings in PH/Is Number of applications Quantum of assistance disbursed ($ million) Average assistance ($) Inpatient Class B2 2,315 2.6 1,129 Class C 20,863 35.4 1,697 Day Surgery 2,088 1.9 904 Overall 25,266 39.9 1,579 Outpatient 683,321 70.2 103 5.7 Medifund and Medifund Silver paid fully for the outstanding subsidised bills of 92.6% of the approved applications in FY13. (See Exhibit 7) Exhibit 7: Percentage of applications which received Full Help from Medifund and Medifund Silver in FY13 MFIs % of Applications with Full Help 1 Inpatient 92.1% PH/Is Outpatient 94.0% ILTC 2 Overall 94.0% Non-residential (attendances) 67.7% Intermediate term residential (admissions) 82.8% Long term residential (bed months) 83.5% Overall 92.6% Note: 1. Full Help means that Medifund and Medifund Silver paid for 100% of the outstanding subsidised bills which the patient could not afford after drawing on all other means of payment. 2. Besides Medifund, patients in ILTC settings may also receive charity assistance. 6. AUDITOR S REPORTS 6.1 In accordance with Section 13 of the Act, every Medifund Committee will submit the annual financial statements of its Institution Medifund Account to the auditor appointed by MOH. 6.2 KPMG LLP was appointed the auditor for the FY13 accounts. The audited financial statements of the main Medifund account administered by MOH and the various Institution Medifund Accounts are included as Annex C. 6

7. CONCLUSION 7.1 The Government injected an additional $1 billion into the Medical Endowment Fund in FY13. This provided additional resources to offer more help to needy Singaporeans. The Ministry of Health will continue to work closely with the Ministry of Finance to progressively grow the capital sum in years of surplus to ensure that sufficient funds are available to assist needy Singapore Citizens with their medical bills. 7

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Note: No Medifund monies were allocated to Assisi Hospice because it had sufficient Medifund reserves to meet their needs for FY13. 9

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Note: The Agency for Integrated Care Medifund Committee administers Medifund for 42 different institutions, as shown in Annex A. 14

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LIST OF MEDIFUND COMMITTEES AND MEDIFUND APPROVED INSTITUTIONS IN FY13 Name of Medifund Approved institutions committee ANNEX A 1. Agency for Integrated Care Medifund Committee (1) Adventist Nursing and Rehabilitation Centre (2) Alzheimer s Disease Association New Horizon Centre (Tampines) (3) Apex Day Rehabilitation Centre for Elderly (4) Econ Medicare Centre (Braddell Road) (5) Econ Medicare Centre (Chai Chee) (6) Econ Medicare Centre (Recreation Road) (7) Econ Medicare Centre (Upper East Coast) (8) Econ Medicare Centre Yio Chu Kang (9) Econ Nursing Home (Buangkok) (10) Green Avenue Home for the Elderly (11) Lee Ah Mooi Old Age Home (12) Marine Parade Aspiration Elderly Lodge (13) Orange Valley Nursing Home (14) Orange Valley Nursing Home (Bukit Merah) (15) Orange Valley Nursing Home (Clementi) (16) Orange Valley Nursing Home (Marsiling) (17) Orange Valley Nursing Home (Simei) (18) Orange Valley Nursing Home (Thomson) (19) Our Lady of Lourdes Nursing Home Pte Ltd (20) Pacific Healthcare Nursing Home (Bukit Merah) (21) Society for the Physically Disabled Community Rehabilitation Centre (22) Society for the Physically Disabled SPD Ability Centre (23) St Hilda s Community Services 17

Name of Medifund committee 2. All Saints Home Medifund Committee 3. Ang Mo Kio Thye Hua Kwan Hospital Medifund Committee 4. Apex Harmony Lodge Medifund Committee 5. Assisi Home and Hospice Medifund Committee 6. Bethany Methodist Nursing Home Medifund Committee Approved institutions Centre (Ageing in Place) (24) Sunlove Abode for Intellectually Infirmed Ltd (Sunlove Rehab Centre @ Ang Mo Kio) (25) Sunlove Home (26) SunnyVille Home (27) Surya Home (28) Tembusu Rehab and Day Care Centre (29) The Lentor Residence (30) TOUCH Community Services Ltd TOUCH Home Care (Jurong) (31) TOUCH Community Services Ltd TOUCH Home Care (Toa Payoh) (32) TP Healthcare Ltd (33) Tsao Foundation (34) United Medicare Centre (35) United Medicare (Elizabeth Drive) Pte Ltd (36) Pacific Healthcare Nursing Home II (37) Econ Medicare Centre (Choa Chu Kang) (38) Thian Leng Old Folks Home (39) Silver Circle (Serangoon Central) (40) Sunlove Home@IMH (41) Sunlove Home@SILRA (42) Tembusu Eldercare Centre (SPICE) (1) All Saints Home (2) All Saints Home (Hougang) Ang Mo Kio Thye Hua Kwan Hospital Apex Harmony Lodge Assisi Home and Hospice Bethany Methodist Nursing Home 18

Name of Medifund committee 7. Bright Hill Evergreen Home Medifund Committee 8. Bright Vision Hospital Medifund Committee 9. Catholic Welfare Services Nursing Home Medifund Committee 10. Changi General Hospital Medifund Committee 11. Dover Park Hospice Medifund Committee 12. Grace Lodge Medifund Committee 13. Home Nursing Foundation Medifund Committee 14. Jamiyah Nursing Home Medifund Committee 15. Ju Eng Home for Senior Citizens Medifund Committee 16. Khoo Teck Puat Hospital Medifund Committee 17. KK Women s and Children s Hospital Medifund Committee 18. Kwong Wai Shiu Hospital & Nursing Home Medifund Committee 19. Ling Kwang Home for Senior Citizens Medifund Committee 20. Lions Home for the Elders Medifund Committee 21. Man Fut Tong Nursing Home Medifund Committee Approved institutions Bright Hill Evergreen Home Bright Vision Hospital (1) St Joseph s Home (2) St Theresa s Home (3) Villa Francis Home for the Aged Changi General Hospital Dover Park Hospice Grace Lodge Home Nursing Foundation Jamiyah Nursing Home Ju Eng Home for Senior Citizens Khoo Teck Puat Hospital KK Women s and Children's Hospital Kwong Wai Shiu Hospital & Nursing Home Ling Kwang Home for Senior Citizens (1) Lions Home for the Elders (2) Lions Home for the Elders (Toa Payoh Branch) Man Fut Tong Nursing Home 19

Name of Medifund committee 22. National Cancer Centre Medifund Committee 23. National Healthcare Group Polyclinics Medifund Committee 24. National Heart Centre Medifund Committee 25. National Neuroscience Institute Medifund Committee 26. National Skin Centre Medifund Committee 27. National University Hospital Medifund Committee 28. Peacehaven Nursing Home for the Aged Medifund Committee 29. Ren Ci Community Hospital Medifund Committee 30. Singapore Christian Home for the Aged Medifund Committee 31. Singapore General Hospital Medifund Committee 32. Singapore National Eye Centre Medifund Committee 33. SingHealth Polyclinics Medifund Committee 34. Society for the Aged Sick Medifund Committee 35. Sree Narayana Mission Home for the Aged Sick Medifund Committee Approved institutions (1) National Cancer Centre (2) National Dental Centre National Healthcare Group Polyclinics National Heart Centre National Neuroscience Institute National Skin Centre National University Hospital (1) Peacehaven Nursing Home for the Aged (2) The Salvation Army (Bedok Multiservice Centre) (1) Ren Ci Hospital & Medicare Centre (2) Ren Ci Community Hospital Singapore Christian Home for the Aged Singapore General Hospital Singapore National Eye Centre SingHealth Polyclinics Society for the Aged Sick Sree Narayana Mission Home for the Aged Sick 36. St. Andrew s Community (1) St. Andrew s Community Hospital 20

Name of Medifund committee Hospital Medifund Committee 37. St Luke s Hospital for the Elderly Medifund Committee 38. Sunshine Welfare Action Mission (SWAMI) Home Medifund Committee 39. Tai Pei Social Service (TPSS) Medifund Committee 40. Tan Tock Seng Hospital Medifund Committee 41. Woodbridge Hospital/Institute of Mental Health Medifund Committee 42. Alexandra Hospital Medifund Committee Approved institutions (2) Singapore Anglican Community Services Hougang Care Centre (3) Singapore Anglican Community Services Simei Care Centre (4) St. Andrew s Nursing Home St. Luke s Hospital for the Elderly Sunshine Welfare Action Mission (SWAMI) Home Tai Pei Social Service (TPSS) Tan Tock Seng Hospital Woodbridge Hospital/Institute of Mental Health (1) Alexandra Hospital (2) Jurong Medical Centre 21

ANNEX B SEVENTH MEDIFUND ADVISORY COUNCIL Chairman Mr Benedict Cheong (from 1 Dec 2012 onwards) Prof Tan Wee Hin, Leo 3 (from 1 April 2011 to 31 Nov 2012) CEO, Temasek Foundation Director (Special Projects) Faculty of Science National University of Singapore Members Mrs Mui-Kok Kah Wei Mr Thiagarajan s/o Subramaniam Mr Abdul Rohim Sarip Ms Ang Bee Lian Mr Christopher Woo Dr Ang Peng Chye Mr Shaik Aziz Shaik Mohideen Ms Lim Hsiu Mei Director NTUC Fairprice Director Ong Teng Cheong Labour Leadership Institute NTUC Centre Lawyer A. Rohim and Partners Chief Executive Officer National Council of Social Service Lawyer Lawrence Quahe & Woo LLC Psychiatrist The Psychiatric & Behavioural Medicine Clinic Managing Director Management Synergy Pte Ltd Director M & M Link 3 On 1 December 2012, Prof Tan Wee Hin, Leo stepped down from the MAC and Mr Benedict Cheong, CEO of Temasek Foundation, took over as Chairman. 22

ANNEX C AUDITOR S REPORT ON MEDIFUND ACCOUNTS 23