Health Minister Ong Ye Kung defends retroactive ward upgrade charges as fair

“When patients stay in a higher-class ward and then downgrade to a lower-class ward towards the end of their stay, they will receive subsidies based on the respective ward classes. This is fair,” said Health Minister Ong Ye Kung as he elaborated on the complexities of hospital ward class selection and the associated financial policies during a parliamentary session on Tuesday.

The discussion was prompted by concerns over retroactive charges applied to patients who choose to upgrade their ward class during their hospital stay, raised by Member of Parliament for West Coast GRC, Ang Wei Neng and Non-Constituency MP Leong Mun Wai through their parliamentary questions.

Mr Ang asked the Minister for Health about the current policy for charging a patient who chooses to stay in different classes of a general ward during each period of their stay at a public hospital; and whether a patient can choose to stay in different classes of a general ward when admitted to a public hospital and be charged the respective fee for each class.

Minister Ong explained that the policy aims to discourage patients from initially choosing lower-class wards to benefit from higher subsidies for costly treatments such as surgeries and intensive care, only to switch to higher-class wards later.

“We have to discourage patients from selecting lower ward classes to secure more subsidies for more costly treatments, such as surgery and ICU, at the beginning of their stay and then switch to higher ward classes once these more expensive treatments are completed,” he stated.

Minister Ong affirmed that while the government seeks to prevent strategic ward class manipulation, support mechanisms are in place for those genuinely struggling with costs.

“Public hospitals will find ways to support patients financially if requests to downgrade to a lower-class ward are due to unaffordability issues,” he assured.

Moreover, Mr Ong mentioned that patients are informed about the financial implications of ward upgrades at the outset of their hospital stay. “Patients are also counseled on the financial implications before upgrading their ward class, so they can decide whether they want to go ahead with the ward change,” he added.

Concluding his remarks, Minister Ong emphasized the availability of MediFund, a government endowment fund designed as a safety net for lower-income Singaporeans, ensuring that everyone can afford necessary hospital care. “So long as they meet the means testing criteria, they can downgrade,” he noted, underscoring the government’s commitment to equitable healthcare access.

In his supplementary questions on Tuesday, Mr Ang asked if patients who require an upgrade but are “not financially very strong” can appeal against the retroactive charges.

Mr Ang also raised the scenario of patients who are not allowed to downgrade to a cheaper ward after having stayed in a higher-class ward previously at the hospital.

“The only time they can escape this is when they are admitted to A&E; then they can go to a lower-class ward,” he said, citing feedback from his residents.

Mr Ong replied that “everyone has the right to appeal,” but authorities are “trying to stop a certain behavior which they don’t think is right.”

He added that patients are counseled financially at the beginning of every hospital stay, and decisions are made by patients “with their eyes open.”

Mr Leong asked the Minister to confirm that patients have to pay the price for the medicine of the higher-class ward even when they want to downgrade from a higher class to a lower class, which Mr Ong confirmed.

The issue came to the forefront after a complaint was published in the Straits Times’ Forum, where a citizen, Mr David Kong, described the case of his 98-year-old mother who faced retroactive charges after upgrading from a high-dependency, Class C ward to a quieter, private A1 ward.

Mr Kong criticized the policy, arguing, “A patient should be charged Class C rates for the period she stayed in a Class C ward, not Class A1 rates for services and amenities she did not consume.”

In MOH’s reply in April, it stated that the current policy is designed to discourage behavior where patients select lower ward classes to enjoy higher subsidies for more costly treatments, such as surgery, and then upgrade to higher ward classes once these treatments have been completed.

“It is important to ensure that our subsidy dollars are targeted at where they are needed most,” said MOH.

For patients who need to upgrade due to medical reasons or require isolation post-surgery, the MOH clarified that facilities are provided at the subsidized rates of the chosen ward class. Additionally, patients facing financial difficulties have the right to appeal retroactive charges.

“Patients are also counseled on the financial implications before upgrading their ward class, so they can decide whether they want to go ahead with the ward change,” said MOH.