Getting old and paying for healthcare is an increasing worry for many people around the world, but the elderly in Singapore could be forgiven for thinking their problems would be sorted.

After all, the Republic's healthcare system ranks among the best in the world, delivering basic, affordable treatment for those who qualify. And this is not all on the taxpayer - individuals pay an initial amount and then a national health insurance scheme kicks in.

The compulsory health insurance scheme, MediShield Life, was introduced in 2015 to help with the needs of a rapidly ageing population, as families worried about the large medical bills that can arise when a loved one becomes frail.

But the recent case of 84-year-old Seow Ban Yam revealed that for some, the worry had not gone away.

He was shocked when he received a medical bill of thousands of dollars from the Singapore National Eye Centre (SNEC), and for which he received only $4.50 in insurance payment.

The normally mild-mannered Mr Seow took it upon himself to challenge the bill, writing to the hospital authorities and insurance administrators to get to the bottom of why he was being charged so much.

The explanation that everything was in order merely confused him further. He did not understand why a public institution would charge him $3,664, after government subsidies, when the maximum amount he could claim under MediShield Life for his surgery was $2,800.

Wondering if he had got his sums wrong, Mr Seow wrote a letter to The Straits Times, saying: "Hopefully, you can find my case worth looking into, not only for myself, but also for the sake of the many people like me who otherwise are not aware of what a MediShield Life claim entails.

What The Straits Times discovered, as a result of Mr Seow's case, shocked even those in the upper echelons of the Ministry of Health (MOH) - that at least one public health institution had raised fees to levels much higher than those covered by the national health insurance scheme."We all think that MediShield Life is to subsidise large hospital bills. It is only when one goes through some kind of operation will one know it may not be true."

In Mr Seow's case, the subsidised bill from the SNEC was 50 per cent higher than the claim limit for that procedure.

The wider implication was that thousands of patients in Singapore were probably in the same boat as Mr Seow, getting bills from public institutions which exceeded the claim limits set by MediShield Life.

s a result, the issue was raised in Parliament in January and the Government decided to review national health insurance claim limits every three years instead of five.

There was more good news for those who need the system to deliver basic, affordable healthcare. In March, the SNEC cut its fees for 20 procedures by between 15 per cent and 32 per cent. This could reduce the bill for 14,500 procedures done each year at the centre.

WHY IT MATTERED

What got Mr Seow so riled up and made the issue such a talking point was that when MediShield Life was introduced, the Government made a promise that lower-income people need never fear having to foot big medical bills entirely by themselves for treatment at public hospitals.

The aim was to cover 90 per cent of the bill for 90 per cent of patients beyond the initial deductible and co-payment over that.

Mr Seow's complaint led to the discovery that, in the years since MediShield Life was launched, full coverage had in fact dropped to 80 per cent of patients with large, fully subsidised bills.

This affected patients who need a helping hand - about a third of four million Singapore residents rely entirely on MediShield Life for their health insurance.

HOW THE PROBLEM CAME TO LIGHT

So how did Mr Seow, a retiree who lives in a subsidised government apartment, end up being a healthcare hero for the needy?

It began in 2017 when he went to the SNEC for two operations to unblock the tear ducts in both eyes, in preparation for cataract surgery.

Mr Seow knew he would have to pay 10 per cent of the bill after the deductible, which is capped at $3,000 a year for those over 80, so he expected to pay a total of $3,148.

But he ended up paying $4,472.30 instead, as the bill exceeded the claim limit by $1,472, including fees for room and board, as well as the operation.

The latter alone was limited to $2,800. This capped amount is stated in MOH's table for surgical procedures, though there is no explanation for how the amount is derived.

Said Mr Seow: "The whole idea of MediShield Life is to meet heavy bills. I don't understand why it is limited to $2,800 when the bill is more than $4,000. This defeats the purpose of insurance."

MediShield Life determined it could pay out $3,005, but there was just $5 to take care of after Mr Seow paid the deductible. Of that, MediShield Life paid $4.50, minus his co-payment of 10 per cent.

Fortunately, Mr Seow did not need to take out a bank loan for the overall bill - he could pay the amount from a long-established national scheme where workers pay into designated savings accounts, including one for healthcare called Medisave.