A Public Health Stranger in the Land of Medical Care
Sunday, March 14, 2010
I received excellent treatment from my physiotherapist for my upper back pain and was able to complete the hot 168km Bike Rally 2010. Physiotherapists in Singapore are like physical therapists in the U.S., however they are not yet licensed professionals though acupuncturists are. They are working with the government to change their status.
My physiotherapist, Sylvia Ho, co-founder of Core Concepts Physiotherapy Centre, was trained in Australia where she earned both her bachelor’s and master’s degrees. She prefers to use manipulative therapy and massage to ultrasound or electrical stimulation machines. She believes my discomfort came from a major change in my ergonomics related to my daily use of 2 computers at new desks and subsequent poor posture. My upper back and neck pain improved more with each visit, exercises she recommended I do at home, and changing my computer posture.
Core Concepts charges about $56 for each therapy session that lasts about 30 minutes and consists of intensive manipulation and massage. Physiotherapists employ hands-on techniques that try to remove blockages, loosen and stretch muscles and joints, and improve posture.
After my first visit, I submitted the bill to my Singapore insurer, which I have through my employer. Soon thereafter, I received an email asking me for the original copy of my written referral. This was news to me. For my U.S. insurer, no written referral is required, so it had not occurred to me that I would need one in Singapore. That was a mistaken assumption and I should have known better.
I told the insurance company the truth: that my physician told me to see a physiotherapist. They responded that they still needed the original written referral. So I contacted the physician via email. He did not respond. One week later, I called his office. They said they would email me the referral. They did not. I called a week later and tried again. This third attempt proved successful. They emailed me a scanned copy of the handwritten referral from the doctor and I received the original in the mail a few days later. However, I did notice one potential problem: there was no date on the referral.
Nonetheless, I filled out the on-line medical claim submission forms and submitted the “certified original” referral and bills. I was told they pay about $35 maximum for each physiotherapy visit.
I should hear within a few weeks.
Meanwhile, I tried to learn more about the “Sixth Best System in the World.” Keep in mind: No system is perfect.
I was interested to learn that at least some of Singapore’s hospitals publish their bed charges and the Ministry of Health publishes the mean costs for certain diagnoses at some hospitals.
Standard Ward Class C - $21- 9 bedded room, natural ventilation
Standard Ward Class B2 - $56 - 6 bedded room, individual ceiling fans, semi-automatic bed
Standard Ward Class B2+ -$84 - 5 bedded room, air-conditioned, attached bath and toilet
Standard Ward Class B1 - $130 - 4 bedded room, all of above, TV, phone, choice of meals
Standard Ward Class A1 - $215 - Single room, all of above, toiletries, fully automated bed, optional sleeper unit
Upgraded Ward Class A1+ = $243- All of above, plus mini-safe, fridge
The charges listed above are what the patient will pay out-of-pocket for their beds exclusive of any care. “Out-of-pocket,” however means that the patient can use a Flexible Spending Account or a Medical Savings Account (Medisave), into which their employer and/or they are required to put a minimum amount. As of December 2008, the average Singaporean had about $10,000 in their Medisave account. They can also use the accounts of the close relatives and dependents in some circumstances.
While this seems complicated to me, most Singaporeans seem to understand how it works. They also have to pay “out-of-pocket” for some expensive therapies including chemotherapy and HIV drugs. How much? I’ll find out and report on it in Part III.