People in Singapore mask up to take a mass rapid transit train on Friday. Singapore has one of the highest vaccination rates in the world. As of Sunday, 85% of its population was fully vaccinated.

People in Singapore mask up to take a mass rapid transit train on Friday. Singapore has one of the highest vaccination rates in the world. As of Sunday, 85% of its population was fully vaccinated. / AFP via Getty Images

Singapore's government has been covering the medical bills of COVID-19 patients throughout the pandemic. But it says unvaccinated people will soon be on their own.

Those who are "unvaccinated by choice" will have to start paying for their own COVID-19 treatment starting Dec. 8, the Ministry of Health announced on Monday, citing the strain they are putting on the nation's health care system.

"Currently, unvaccinated persons make up a sizeable majority of those who require intensive inpatient care, and disproportionately contribute to the strain on our healthcare resources," it said in a statement.

Until now, the government has been covering the cost of COVID-19 care for all Singaporeans, permanent residents and long-term pass holders, excluding those who tested positive after returning from overseas travel.

"This was to avoid financial considerations adding to public uncertainty and concern when COVID-19 was an emergent and unfamiliar disease," it explained, adding that this system will continue to apply to "the majority who are vaccinated ... until the COVID-19 situation is more stable."

The policy change means the government will start charging all unvaccinated COVID-19 patients admitted to hospitals and designated "COVID-19 Treatment Facilities" on or after Dec. 8. Those patients can still use their regular health care financing arrangements to pay their bills where applicable.

There are a few exceptions. People who aren't eligible for vaccination — like children under 12 and people with medical exemptions — will still have their medical bills covered by the government. And people who are partially vaccinated won't be charged until Dec. 31, to give them time to complete the full series.

Specifically, starting on Jan. 1, the government will only foot the bill for those Singaporeans (including permanent residents and long-term pass holders) who are fully vaccinated and have not recently traveled.

"Our hospitals really much prefer not to have to bill these patients at all, but we have to send this important signal, to urge everyone to get vaccinated if you are eligible," Health Minister Ong Ye Kung said on Monday.

Much of Singapore's population is vaccinated

Singapore has one of the highest vaccination rates in the world. As of Sunday, 85% of its population was fully vaccinated, and 18% had received booster shots, according to health ministry data.

The health minister credited the hard work of vaccination teams with reducing the number of unvaccinated seniors from 175,000 in early August to below 64,000.

"If not for this reduction, our hospitals and ICUs today would have been already overwhelmed," he added.

Singapore had 1,725 recorded hospitalizations as of Monday, with an intensive care unit utilization rate of 68.5%. The health ministry also looked at the difference in cases between those who are fully vaccinated and those who are partially or not at all vaccinated.

Over the last seven days, it said, the number of critically ill cases who were fully vaccinated and not fully vaccinated were at 0.5 and 5.2 per 100,000 population, respectively. Over that same period, the number of fully vaccinated and not fully vaccinated cases who died were 0.1 and 0.9 per 100,000 population, respectively. Those numbers were considerably larger for seniors.

It's part of a larger shift in Singapore's COVID strategy

Singapore has seen a surge in cases over the last few months and decided in October to abandon its "zero COVID strategy" in favor of learning to coexist with the virus.

Officials said on Oct. 20 that they would extend their plan for another month, with a midpoint review. Their Monday announcement about COVID-19 medical coverage also said that the growth in new cases had slowed and that certain restrictions have been eased as a result.

For example, it will allow up to five fully vaccinated people from the same household to eat together at a dining establishment and take steps to simplify travel protocols.

The government also said it would "pilot the resumption of more activities" like sports, meetings and conferences for those who are fully vaccinated, subject to additional rapid testing requirements.

Unvaccinated people are not offered those same options.

"As for individuals who do not want to take any of the vaccines, we will need to have Safe Management Measures which differentiate between the vaccinated and unvaccinated," the health ministry explained. "This is in order to protect the unvaccinated, and also to preserve our healthcare capacity."

This story originally appeared on the Morning Edition live blog.

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Tags: COVID-19 hospitalizations  COVID-19 vaccine  Singapore  Series: The Coronavirus Crisis