Should hospitals send debt collectors to recover unpaid bills?

By March 17, 2017Current

TL;DR – Maybe. Maybe not.

A Facebook user uploaded what apparently was an over-25 min long telephone conversation between an angry Changi General Hospital (CGH) patient and the staff of CGH’s business department. In the conversation, the patient sounded very upset with CGH for sending debt collectors to recover the $37 he owed to the hospital. He claimed that the debt collector’s harsh tone over the phone intimidated his wife and kids.

The man admitted that he had ignored three warning letters from CGH. The reason? He told a staff member in CGH that he would settle the bill at his next appointment at CGH a month later. However, that staff member in CGH neglected to convey that information to the hospital’s billing office. That was truly unfortunate. And kudos to this man for trying to bear his own medical costs.

But what about those people who really refuse to pay their medical bills?

Should we not take active steps to recover the fees owed? For those who think we shouldn’t, consider this hypothetical situation: imagine your friend borrowed money from you. And even after you called him numerous times, he still doesn’t return you the money he owes you. Do you think that behaviour is acceptable? If you do, I would love to be your friend.

But this is the government we’re talking about. Isn’t it the responsibility of the government to take care of people? Shouldn’t the government be more compassionate? How can the government be so cold, heartless, and calculative? So even if that patient doesn’t pay at all, what’s the big deal?

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If patient doesn’t pay, who pays?

Well. Here’s the big deal. Where do you think the government gets its money from? So if a patient doesn’t pay, it means that we are effectively paying his medical bills. Do you want to pay someone else’s medical bills?

But what if that patient is really in need? What if he really is in financial distress? Then should we deny him the medical treatment he needs? Of course not. If indeed that is the case, the government should indeed offer help. And there are indeed schemes to help. In his COS speech this year, Mr Gan Kim Yong, Minister of Health, pointed out that:

“Finally, for needy Singaporeans who still have difficulty with healthcare costs after Government subsidies, MediShield Life coverage and Medisave, we have Medifund to help them… To help patients with their medication costs, our public healthcare institutions such as our Specialist Outpatient Clinics (SOCs) and polyclinics, provide subsidies of up to 75% for standard drugs, with Pioneers receiving a further 50% subsidy. In addition, the Medication Assistance Fund (MAF) is also available to help patients with selected high cost non-standard drugs, if it is deemed necessary. Patients who still face difficulties despite all these subsidies can also apply for Medifund.”

So if any patient really had financial difficulties, he can apply for Medifund, which is a sum of money that has been set aside precisely to help patients with financial difficulties. There really isn’t any need to ignore warning letters if you have difficulty paying. Just ask to speak to the hospital’s medical social worker.

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But the system does need to improve

That said, there is a case to be made that CGH could have taken an active step to find out about the financial situation of the patient before resorting to debt collection. Perhaps hospitals should assume that people who don’t pay medical bills even after multiple warnings are in financial distress. If hospitals start with that assumption, then they should first send social workers and not debt collectors to speak to those patients who don’t pay bills.

That would help in making our healthcare system more affordable.

That alone isn’t enough. We need to improve the quality of our healthcare system. We’ve heard of horror stories of friends who have met with completely unacceptable standards of care in our government hospitals. We definitely have to make the necessary investments to raise the standards of our government hospitals.

But where are we going to get the money to do that? We can of course increase the budget of MOH. Which we are. Healthcare expenditure in 2011 is $4 billion. Healthcare expenditure in 2017 is expected to hit close to $11 billion. That means that Singapore’s healthcare expenditure has nearly tripled in a short span of five years. With an ageing population, our healthcare expenditure is set to increase even further.

So we need to consider other ways to ensure that all Singaporeans get quality healthcare. In a large part, that means that Singaporeans who can pay, should pay. And pay on time. Then Singaporeans who really need financial assistance will get the help that they need.

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That is still not enough. We need to use our money in a far wiser manner. We need to get a greater bang for our buck. To do that, Minister Gan explained that we need to go beyond:

  • Beyond hospital to community. This includes improving upstream care within the community so that health issues can be nipped in the bud before developing into more serious conditions.
  • Beyond quality to value. This includes efforts to  identify treatments with good outcomes at affordable costs and guide our doctors and patients.
  • Beyond healthcare to health. This includes plans to nurture a healthy nation and a healthy people.

The last thrust of going beyond healthcare to health is probably the most radical paradigm shift. As the saying goes, prevention is better than cure. If most of us can stay as healthy as possible for as long as possible, then we would only need to spend resources on those who truly need it. That’s a tall order.

Not straightforward to implement.

But if we can achieve these three “beyonds”, then we, as a nation, may have a decent chance of getting a great healthcare system at an affordable price.

Meanwhile, you can listen to the voice recording of the conversation here.


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Jake Koh

Author Jake Koh

Recovering sushi addict, I'm a man of mystery and power, whose power is exceeded only by his mystery.

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