Can You Afford to Fall Sick? A 20-something Singaporean on the Cost of a Chronic Illness

If you met Wendy (not her real name) on the street, there is no way you can tell that she’s different from any healthy 20-something Singaporean. 

But over the past 3 years, Wendy has been dealing with an as-yet-undiagnosed chronic medical condition that causes debilitating migraines, dizziness and double vision. 

Wendy has been seeing multiple GPs, TCM clinics and checking in and out of hospitals for the past 3 years, racking up more than $15,000 in medical bills in these 3 years.

 

How did she end up spending $15,000?

Over the years, Wendy has been to the doctor’s, TCM clinic and hospitals more times than she can remember. 

Although she has not been tracking her medical expenses faithfully (“because the figures scare me,” she admits), she was able to provide some of the major ones below:

Item	No. of times	Cost
GP consultation	Countless	$38 x ? = ???
Going to A&E	4 times	$150 x 4 = $600
Hospitalisation (2 nights)	3 times	$2,000 x 3 = $6,000
MRI scan	3 times	$800 x 3 = $2,400
Blood patch treatment	1 time	$720
Estimated total		$15,000

These figures don’t include the more minor costs such as TCM treatments and the assorted medication she has taken so far. These range from prosaic painkillers and nausea / dizziness pills, to antidepressants to steroids.

At this age, most of us wouldn’t think of setting aside such a sum — at least $5,000 a year — to pay for medical expenses. So how did Wendy afford it?

 

1. Choosing the right hospital ward

Although the costs of frequent GP visits and medication add up slowly and steadily, it’s hospitalisation that really takes a big hit on the finances.

Wendy was hospitalised 3 times in the past 3 years. Apart from being charged for the length of her stay (ward and doctor’s fees, for example), she was subjected to a battery of costly scans and tests every time she was hospitalised.

“They ran all sorts of tests,” said Wendy. “MRIs, CT scans, PET scans, nerve tests, muscle tests, X-rays, eye tests, blood tests and lumbar punctures.” 

None of the test results were significant enough to point to a possible cause, but, still, she was billed for each of them.

Although Wendy was briefed on her expected medical expenses before being hospitalised, it was still a huge shock when she got her first hospital bill.

“I had no idea everything cost so much,” she said of the unsubsidised fees. 

She managed to obtain higher subsidies by opting for a Class C ward each time she stayed. After subsidies, these added up to about $2,000 each time.

Although staying in a higher class ward gets you a more “hotel-like” experience and perhaps more personalised care, hospitals charge higher (less subsidised) rates for those who choose those wards.

 

2. Knowing your MediShield Life coverage

Wendy’s ongoing healthcare costs are partially offset by her MediShield Life coverage, which is the mandatory health insurance that covers every Singaporean and PR.

Having been through pre-hospitalisation financial briefings several times, Wendy is well aware of what MediShield Life does and does not cover, and what the coverage limits are.

According to Wendy, it is during this mandatory briefing that patients-to-be are told about the estimated total costs and given an overview of their financial options, i.e., how much can be offset by MediShield Life / health insurance, how much can be paid by Medisave, and how much to top up in cash.

“The process is actually quite fuss-free for government hospitals,” she said. “If you’re fine with the estimated bill, you will be asked to sign consent forms for deducting from Medisave. Nothing is done without your consent.”

If you are not able to afford the hospital bill, you can be referred to another unit for financial aid.

Since Wendy is aware of her MediShield Life claim limits, she opts to stay in Class C wards.

 

3. Opting in to use Medisave

During the pre-hospitalisation briefing, apart from learning about MediShield Life coverage, Wendy was also prompted to sign consent forms to use her Medisave to pay for her bills.

“You can either agree to use Medisave just this one time, or to automatically use Medisave in your subsequent visits,” she said.

Having gone through various treatments and tests, she also learnt that Medisave has different withdrawal limits for different procedures. “For MRIs, I had to pay for the extra as they only allow us to use up to $600 from Medisave each year.”

For anyone with a chronic illness, it is important to review the limits of MediSave and make sure you are financially equipped to top up any excess in cash.

In Wendy’s case, the combination of MediShield Life and Medisave reduced her out-of-pocket expenses to about $8,000 in the past 3 years. Without the 2 schemes, she would have needed to pay about $15,000 in cash.

 

What about CHAS for chronic diseases?

I asked Wendy what she thought of the upcoming CHAS green tier (to be launched in Nov 2019), where the healthcare subsidy scheme will be extended to cover all Singaporeans with chronic medical conditions, regardless of their income.

But after we looked through the list of chronic diseases covered under CHAS, Wendy thought that none of them would apply to her.

In any case, since her condition is still undiagnosed, she would not be able to utilise any subsidies under CHAS. 

She was not bothered by the fact that the government scheme does not cover her. 

“I can understand why some people might hope the list of chronic diseases could be extended to cover them,” she said. “But for me, I think it’s fine.”

This is partly because Wendy is aware that some of these common chronic ailments cost a lot to treat compared to her. Citing an acquaintance with kidney failure as an example, she said: “Just a few pills can cost him over $100. But for me, $100 is enough to cover a few months’ worth of medication.”

 

Non-recoverable costs to her career

In addition to the cost of healthcare, Wendy’s chronic health condition also had a significant impact on her career and earning ability.

This was especially the case at the onset of her symptoms, which happened when she was already burnt out from her previous high-stress job. Having a new mysterious illness to diagnose only made it worse.

“I was not able to perform as well as before or to commit fully,” she said. So she eventually resigned.

Having paid off her study loan, Wendy did not have any hefty financial burdens at that time, so she was able to leave her job and cut off her income stream to cope with her illness.

These days, Wendy is employed again, but with a smaller paycheck. “I’m back with the same company but working as a senior officer instead of a managerial role, with fewer duties and less pay.”

Though her income was no doubt affected by her health, Wendy is fine with the reduction in pay. It also helps that she is now transparent with her colleagues about her health and feels empowered to take rest days when she feels the need to.

Wendy may be lucky enough to find an understanding employer, but not every employer is the same. There are undoubtedly some who would see a sickly staff member as an expensive or troublesome hire.

Are you a young person who is also struggling with hefty medical bills? Share your story with us.