Tuesday, 20 November 2018

Which Hospital Should I Deliver In? (KKH vs TMC. vs MAH)

Public vs. Private?

We took a total of 8 months before deciding on which hospital to deliver in, because being Budget Babe, I wanted to really review and evaluate my options before deciding! After all, childbirth is going to be one of the most major experiences in my life, and I really wanted to think through where would be best for me as I go through this milestone that will change my life forever.

One of the major considerations of whether to deliver in a public or private hospital would be that of costs. To get an estimate of the bill sizes across different hospitals in Singapore, you can refer to MOH's website here. There are pros and cons of each, so ultimately it boils down to your personal preference and affordability.

Source: Ministry of Health
Husbands, do let your wives choose if you can, because they're the ones giving birth and going through the entire painful process, so the least you can do is to give them the maximum level of comfort that both of you can afford.

I was initially leaning towards KKH as it'll be more affordable, but after learning about how in exchange (as a public and subsidized patient), you don't get to choose your doctor / anaesthetist / paediatrician during the whole labour process, I felt I wouldn't be able to handle the uncertainty! Moreover, I got admitted in my 30th week of pregnancy for a premature delivery scare (when I fell down the overhead bridge) and the KKH bill estimate given to me was $5,949 (after government subsidy, for A1 ward via normal delivery), which wasn't really as low as I had expected it to be.

(You can also read my reasons as to why we opted for a private gynae over a public hospital for our first pregnancy journey here.)

As a result, we decided that delivering in a private hospital would be the best and most reassuring option for us. It might be slightly pricier (but not by much, either), but my husband said it'll be more worth it to pay for my comfort and peace of mind :')

Choosing between Thomson Medical Centre & Mount Alvernia Hospital

If you're with a private gynae, you should first ask which hospital(s) they deliver in before deciding which one you prefer to go with. Our gynae only delivers at 3 hospitals, so we were limited to TMC and MAH as both hospitals were the nearest to where we live (a 20-minute drive away).

In choosing our hospital of choice for delivery, my husband and I considered the following factors, in the following order of importance:
  • Cost
  • Labour facilities and room amenities
  • Service and friendliness of their nurses
  • Expertise of their lactation consultant(s)
  • In-hospital food
  • Post-hospitalisation support and freebies (heh)
  • Discounts and incentives
  • Insurance privileges

I took a photo of their rates comparison during my hospital tour as well. This was in one of the lifts!

Many mummies who have previously stayed in shared wards (2 or 4-bedders) have openly talked about how it was difficult for them to rest properly as they were kept awake by their ward neighbours / crying babies / visitors. Also, only single rooms allow for your husband to stay over, and I wanted mine around for emotional support and strength after the birthing ordeal.

Thomson Medical Centre Mount Alvernia Hospital 
Daily room rate
(w. GST)
$567.10 $569.24
Companion fee
/ day
(nicer food + more meals)
Baby nursery charges / day $100 $100
Mother's treatment fees / day $150 $150

According to the Ministry of Health's overall delivery bill estimates, TMC was one of the most affordable. For my fellow friend who delivered a month before me in a public hospital i.e. KKH under Ward A (let's use that as the best equivalent to a single room in a private hospital), the room rate was from $533 a day, so that's really not much of a difference vs. if you head over to a private hospital instead as you can see from the above.

Labour facilities and room amenities
I went for the hospital tour by both TMC and MAH, and although both were equally well-equipped for labour and delivery, I felt more at ease in TMC's atmosphere as it felt more homely, in contrast to MAH where there are both maternity and sick patients. This might be due to the fact that one is a birthing centre whereas the other is ultimately still a hospital.

After my friend's experience with hydrotherapy for pain relief, I was also keen to look for a hospital that could offer this, and that's when I found out TMC is the only private hospital in Singapore with such facilities for water birth. MAH didn't have this option, which was a little disappointing for us.

In terms of rooms, MAH's rooms were slightly bigger in size, especially if you go for their St Michael or Super Deluxe rooms (which are also more expensive). I didn't feel the need to go for such a big room though, and felt TMC's rooms were just nice without being cramped, and of course more cozy with sleek leather sofas for the husbands.

Thomson Medical Centre's maternity ward
Mount Alvernia  Hospital's maternity ward
Some might also feel more awkward at MAH due to their religious affiliation (it is a Catholic hospital), so I would highly encourage that you sign up for a hospital tour with the ones that you're considering so that you can get a better feel of the vibes in person for yourself.

The nurses
I've heard good things from other mothers about the nurses at both hospitals, but when we were there for the hospital tour, TMC's nurses seemed more friendly and helpful. A friend of mine who recently delivered at TMC also had nothing but high praises for their nurses in terms of experience, patience and professionalism.

Expertise of their lactation consultant(s)
Both hospitals are pro-breastfeeding, which was an important consideration for me because I wanted support and guidance on how to latch baby right and breastfeed him.

I attended a few pregnancy conferences even before I decided on which hospital to deliver at, and was particularly impressed by Dr. Wong Boh Boi, so when I found out that she's with TMC, that was an additional plus point for me!

Do also note that Mount Alvernia does NOT allow patients to bring their own breast pump, and instead charges for the rental each time. On the other hand, TMC allows you to use your own breast pump, and the lactation consultant was even kind enough to teach my friend how to operate hers during the visit!

In-hospital food
At the most recent pregnancy conference I attended (in my 8th month), I also got to try out TMC's confinement food and longan red dates tea which was super delicious! You can read my live update of the event here. My friend who recently delivered at TMC also raved about their signature fish and papaya soup, which is served to all mothers who deliver there and is specially designed to boost breast milk supply. I've not tried it yet, but am looking forward to!

Was unable to compare with Mount Alvernia's food since I didn't get to try it at all, but reviews online don't seem to speak well of their food for those who have delivered there. My friend also recently delivered at Mount Alvernia and had a bad experience, to the extent that she said she'll rather go for TMC or pay more for Mount E if she has a third child.

An additional point to note is that at TMC, all mothers get free-flow of longan and red date tea after delivery for the duration of your stay, but at Mount Alvernia, you're only given a cup at each meal. My friend had to pay $8 to top-up for a flask just so she could have more fluids, as a single cup just wasn't enough for her.

Post-hospitalisation support and freebies
While you shouldn't choose a hospital JUST because it offers better freebies, it is always a good plus point if they do :P

I was particularly drawn to TMC's Breastfeeding Essentials Luggage, which is thoughtfully curated with items like:
  • A multi-function diaper bag
  • A cooler bag (for storing breastmilk when you're out)
  • A Hegen breast pump
  • Breastmilk storage bags
  • A box of Pigeon breast pads (for milk leakages)
  • A nursing scarf
  • A pack of nursing tea
  • A memo board (to note baby's feeding times)
  • Calcium supplements 
  • A pack of maternity pads (for lochia) 
  • Feminine wash
  • A breastfeeding guidebook
and more. This was pretty impressive because it contains many essentials that I've been told to get in preparation for my breastfeeding journey. Of course, TMC allows you to bring home your baby's bathtub and their swaddle blanket (with TMC's logo) too!

Whereas at Mount Alvernia, the maternity package includes:
  • A pack of maternity pads
  • 1 pack of baby diapers
  • 1 pack of baby wipes
  • Baby's bathtub
  • Maternity discharge bag
  • Toiletry pouch with basic toiletries
Mount Alvernia bag.
Image credits
You can easily tell which was the more appealing one for me :P

Discounts and incentives
Both fare well in this area, but TMC is slightly superior due to the wide variety of their merchant tie-ups.

The Mount Alvernia's Ladies Card gives savings on single and 2-bedded rooms, as well as services at the hospital, but their partner privileges are lacking and the most compelling for me was probably just the complimentary baby shoot with Baby U Photo Studio (2 x 5" by 5" images and selected soft copies only).

On the other hand, TMC offers their First Born Incentive (FBI) and Subsequent Born Incentive (SBI) 2-year membership program, which helps to offset your room costs, doctor's delivery fees, paediatrician's consultation fees, diagnostic tests (unfortunately I didn't get to utilize this even though I took my Oscar and FA scan tests with Thomson because I didn't sign up early enough since I wasn't yet sure of where I would be delivering in), as well as 10% off their family clinic and other services. 

In addition, complimentary membership of their Celebrating Life is provided, where there's more merchant discounts with STRIP, Tim Ho Wan, Clarins, and more.

Insurance privileges
Both TMC and MAH offers complimentary insurance by Aviva, but I feel TMC's one is more worthwhile as you get free medical insurance for your baby for 12 months, a free 6-month life insurance coverage of $25k for the mother (Aviva's MyJoyfulBundle) and a free 6-month $10k personal accident plan. On the other hand, Mount Alvernia's patients enjoy 6 months free of personal accident insurance for both parents and baby.

Other qualitative factors that we considered are listed out in the table below:

Thomson Medical Centre Mount Alvernia Hospital 
Membership $98 $68
No. of merchants 30 8
Bill discount $100 off single-rooms $100 off single-rooms
PD fees 5% (max. $100) None
Carpark services Valet Ownself (but more lots)
Insurance 12 months medical insurance (baby)
$10k personal accident plan (mother)
$25k life insurance (mother)
6-month personal accident plan for mother, spouse and baby.
Breastfeeding support Dr. Wong Boh Boi
(aka "the baby whisperer"
Sister Kang
Goodie bag Breastfeeding Essentials Luggage + baby bathtub Discharge bag + baby bathtub

Hospital Tour
I didn't manage to document my experience during MAH's hospital tour as my husband couldn't make it at the last minute so I went alone and had no extra hands to take photos or record videos, but you can view my TMC hospital tour experience here! (includes a video of the delivery suite).

Why I eventually chose to deliver in Thomson Medical Centre

In case you didn't manage to read through the entire breakdown above, the TLDR summary of reasons why I decided on TMC over MAH eventually are:
  • Affordable among the various private hospitals
  • Homely and comfortable atmosphere (no "sick patient" vibes)
  • Experienced and helpful nurses
  • The only private hospital with the option for hydrotherapy and water birth
  • Strong breastfeeding and lactation support via their ParentCraft Centre and support helpline
  • Comfortable rooms (feels more like a staycation than a hospital!)
  • Really good food during the stay
  • Better insurance offering by Aviva
  • Super attractive (and practical / useful) goodie bag upon discharge
  • Benefits of being a TMC member (lots of merchant tie-ups for discounts)
  • Discounts on my selected baby's PD
That's it for my review! I hope this helps, and I'll update shortly as I've only just delivered my little baby a few days ago. Will write more once I find some time to share about my birthing experience in Thomson Medical Centre, and will share more photos then :)

In the meantime, motherhood duties calls!

With love,
Budget Babe

Tuesday, 13 November 2018

Pregnant? Here's how much money you may need to prepare from pregnancy to delivery and your baby's first year

Needless to say, being pregnant in Singapore isn't a cheap affair. There are many costs to think about, and the bills can easily add up, leading to stress over a lack of finances if you aren't prepared for it.

What should one expect to spend and save up for when you get pregnant? Here are some costs to think about (numbers are estimations based on my own pregnancy journey this year):

Pre-natal / Pregnancy costs

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Gynae visits ($1,000 - $3,000)
Each consultation will easily set you back by $100 - $300+ depending on whether you're seeing a public or private gynae, and how popular they are. Some offer the option to take on a package after your fourth month, which helps to save on consultation and ultrasound scan costs, but you'll still have to pay for your own supplements / medications.

Pre-diagnostic tests ($400 - $1,500+)
Most expecting mothers in Singapore would have to undergo three tests throughout the duration of their pregnancy:
  • Down syndrome test between 12 - 14 weeks (OSCAR is the cheapest but also has a higher rate of false positives)
  • Fetal assessment test between 20 - 22 weeks
  • Gestational diabetes test in your fifth month
Depending on which tests you opt for (especially to test for Down Syndrome), these can cost you anywhere from $395 - $1500+.

Prenatal classes ($300 - $1,000)
If you're going for prenatal classes (whether for exercise or for knowledge), these cost money too! Costs vary depending on the number of sessions and types of classes you go for, but expect anywhere from a few hundred to a few thousands if you're going with a branded or more well-known provider. My husband and I opted for a one-day intensive workshop at Thomson Medical.

Maternity clothes
Let's get real - you'll probably have to spend some money on new clothes to fit your growing bump, unless you're lucky enough to have friends who will give theirs to you secondhand (and provided that they fit!). You can read my consolidated budget tips here for maternity wear, but the key tips I would share is to stick with loose clothing for your first and second trimester, and then surviving your second and (the start of your) third trimester on clothes that are 1 - 2 sizes bigger. When you have no choice but to buy new clothes towards the last 2 months of your pregnancy, go for maternity-convertible-to-nursing outfits so that you can continue wearing them even after you've delivered your baby. I got 3 of such sets for work from Dear Collective, and the rest from ASOS Maternity when there were sales.

Delivery costs

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Hospital package ($2,000 - $15,000)

Whether you're going for a natural birth, scheduled Caesarean or end up with an emergency Caesarean, the costs rise in that very same order. If you're unsure how much you ought to expect, you can check out this really useful guide by MOH on the average bill sizes for delivery. Note that the higher rates doesn't mean that's the highest, because 1 in 4 patients pay more than the highest figure stated. In fact, my friend ended up with a $18,000 bill because while his wife initially opted for a natural birth, circumstances warranted an emergency C-section at the end. 

Your duration of stay, type of medical consumables and pain relief (laughing gas, spinal block, epidural, etc) will also bring up the costs (in that same order).

Gynae and other professional fees ($2,500 - $8,000)
Aside from the hospital fees, the other component in your hospital bill that has the most variation (because it depends on the professionals you pick) would be the professional service fees incurred by your doctor, anaesthetist and child's pediatrician. Your gynae will most likely charge you a fee per visit to the hospital, so if you're in labour for a really long time, there might be multiple visits to pay for. In addition, there will be a gynae fee for carrying out the delivery as well. Private gynaes charge different rates for different procedures so there's a huge range of costs to expect - check with your own gynae directly to get a better and more accurate estimate for you to plan towards.

Part of these costs can also be paid out of your Medisave (or your husband's):
  • Up to $900 for pre-delivery / prenatal expenses (so do remember to pack your receipts in your hospital bag for submission)
  • Between $750 - $3,950 for surgicial procedures ($750 for normal vaginal delivery, $1,250 for assisted vaginal delivery, and higher for c-section operations)
  • Up to $450 per day in hospital 

Insurance costs

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Maternity insurance ($350 - $550)

To protect against unexpected pregnancy or delivery complications, you can either save up more on your own, or opt for maternity insurance to offset these costs. There are generally two types of maternity insurance plans available in Singapore - the standalone plans and the bundled options. Make sure you pay attention to the conditions covered and the underwriting criteria. For a detailed study across price, coverage and exclusions, you may refer to my 2018 comparison table here for when I was shopping around for my own.

Insurance for yourself and your spouse 
With a new dependent, it is crucial that you and your spouse are financially covered so that lest anything happens to either of you, the insurer(s) will provide a payout that can then go towards covering your child's future expenses. Consider hospitalisation, personal accident, term / life with critical illness riders, and income replacement policies for a start. No cost estimates for this section provided because what and how much you choose to be insured for will affect your premiums paid, so it'll be best to seek advice from a financial adviser(s) and get quotes so you can decide what falls within your affordability.

Insurance for your child 
What insurance policies do you need to get for your newborn? In my view, hospitalisation and personal accident plans are absolutely essential, term/life plans are debatable, whereas endowment and ILP can be skipped provided that you'll do your own savings and investments. You can read more about each policy and its varying functions here, as well as which ones I recommend as must-haves vs. the good-to-have-if-you-can-afford-it. The premiums will also vary according to the level of coverage that you choose for your child, so there isn't any cost estimates here either.

Confinement costs

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Confinement lady ($2,800 - $3,500)
Who will be helping to look after you and your newborn baby (while also assisting on household chores and cooking) in the first month after you've delivered? For those who are lucky enough to have your parents or in-laws help out, then you might be able to save on the costs of a confinement nanny. If not, you can expect to pay upward of $2,800 if you get from a confinement agency like PEM, or $3,000 and above if you're going with a private nanny. 

If your baby comes during the Chinese New Year period, prepare to pay almost double of the price! My friend recently paid over $6,000 for his confinement nanny as his baby was born in February.

Confinement food ($800 - $1,800)
If you're getting a confinement nanny, she will be able to cook confinement meals for you as well, but you'll have to pay for the cost of groceries and ingredients. Otherwise, you can also cater ready-made meals from caterers like Tian Wei Signature or Thomson Medical for convenience because you probably won't have time (or the energy) to handle your own meals and ensure sufficient nutrients for recovery when you're so busy feeding and tending to baby in the first month.

Confinement herbs ($800 - $1,200)
There are herbs for consumption and herbs for bathing, usually obtained from TCM shops like Hock Hua or Thomson Medical.

Post-natal / jamu massage ($700 - $1,500)
After delivery, you'll most likely need post-natal massage to help "reset" your uterus so that your tummy will shrink, as well as potentially get a breast massage to help unclog blocked ducts and reduce engorgement. Depending on the number of sessions you opt for (usually 7 - 15 sessions) and which masseur you use, costs will vary accordingly. If you go directly with private and individual masseurs, please make sure you ask them about transport costs, binder costs and peak periods pricing, as many of them quote upfront without including all these extras. You don't want any surprises, do you?

P.S. I tried a few prenatal massages and eventually booked with Post Natal Singapore for mine as they offered the best value-for-money, especially if you purchase during a baby fair or roadshow where they give out pretty good discounts and freebies. 

Newborn-related expenses

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Cord banking ($5,000 - $10,000)
Will you be banking your baby's cord blood, cord lining or the entire cord? Is it even worth banking your baby's cord? I've written extensively about the need for cord blood banking, the pros and cons of donating vs. storing privately, as well as compared against the cost of storing among the different providers in Singapore. For the record, I decided to go with Cordlife for mine and have detailed my reasons in this blog post.

Breastmilk feeding expenses ($500 - $1,500)
Think breastfeeding is cheap? Not when you need to get breast pumps, milk bottles and teats, nipple balm, breast pads, etc. All these can add up to quite a bit! Expect to spend even more if you end up feeding your baby formula milk.

Baby items ($1,500 - $5,000)
Clothes, mittens, socks, swaddles, diapers, a baby cot, a waterproof mattress protector, a changing mat, a diaper bag, carrier, stroller, car seat, etc. I never knew such a tiny human being needed so many things until I conceived my own! Costs here can vary by quite a bit but there are also various ways of saving money, such as shopping through Taobao, getting hand-me-downs or buying secondhand from Carousell. Some mothers are willing to splurge $1,500 on just their baby cot alone (although I know of none personally except those who have been sponsored), so expect anywhere from $500 and up depending on your own preferences!

Vaccination expenses ($1 or up)
Here's a tip - you get the vaccines for free / at a highly subsidised rate if you go to the polyclinics instead of a private paediatrician. This is because all recommended immunisations under the National Childhood Immunisation Programme (NCIP) are free, thanks to MOH and government subsidies!

Paediatrician expenses (varies)
Depending on how healthy your baby is, costs for paediatrician visits can vary quite widely under this aspect as well. If you need repeated visits for fever, colic or other conditions, then you'll have to pay accordingly per visit and treatment.

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So how much should I save?!

That depends on how much you intend to spend, really, but start budgeting across the above categories and work out a rough budget that you'll need to start saving towards so that you'll be well-prepared. To outsource financial risks (hospitalisation, pregnancy complications, etc), look to insurance to cover that gap, unless you prefer to self-insure the entire sum by yourself.

As a rough gauge, my husband and I initially targeted $20,000 before we realised that some of our friends (especially those who ended up with an emergency C-section) spent close to that sum alone on their hospitalisation and delivery fees. Hence, we've since revised our baby budget to $30,000 to last us throughout pregnancy and the first 4 months of our baby's birth. 

Where to park my child's savings and government grant?
The POSB Child Development Account!

To help us save further on our son's medical, dental and hospital expenses after he's born, we'll be using our POSB Child Development Account together with our Passion POSB Debit Card which gives us 3% rebate for such expenses. I've reviewed this previously against the other CDA options in Singapore and felt that this was the best account for us to open to get our CDA grant of $3000 and also the government's matching of up to $3,000 (since this is our first child). There's also 2% interest p.a. with no minimum balance, which is relatively higher than many bank accounts that offer basic interest of 0.05% onwards.

You can also see my comparison here

We decided to go with POSB Child Development Account as it has:
  • 3% cash rebate on hospital, medical and dental expenses (the only one to offer this)
  • the best variety of merchant offers including baby essentials, Lazada, RedMart and more
  • we can also get a free infant flight on Singapore Airlines to travel with baby Nate next year!

Disclaimer: This post was written in collaboration with POSB, whom I approached after independently reviewing their CDA offering (here) and concluding that they were indeed the best in the market for my family and my baby.