IT WILL be the most radical change since the introduction of the 3Ms, signalling another paradigm shift in health-care servicing.
But like Medisave in 1984 and MediShield in 1990, once the dust has settled, people will likely come to accept it as necessary.
Medisave introduced the premise that people should be responsible for their own health care and would need to put aside sufficient savings to pay for the high cost of hospitalisation. The amount in Medisave was pegged at 13 hospital admissions in a lifetime.
Today, retirees are gratefully drawing on this sum to help defray their medical costs.
But its introduction caused an uproar more than two decades back. People reacted to its immediate effect: the loss of a large chunk of CPF money on retirement, as it had to be kept against future hospital needs.
Then came MediShield, which essentially told people that the best way to cope with a major medical catastrophe was through a pooling of resources - in other words, insurance.
The take-up rate has improved over the years, with 2.8 million people now having medical insurance paid for with their Medisave money.
The third M - Medifund - was a government initiative, to put aside money for the really poor who cannot afford to pay even the highly subsidised bills. That caused hardly a ripple.
Now we have the fourth M - means testing. It spells the end of the health bedrock: that no one will be denied basic medical care at basic rates.
The basic care will remain. But people will have to get used to the idea that the highly subsidised bills will no longer be for everyone, but for only those in need.
Those who can afford it will have to bear a larger part of their medical bills themselves. The Government will no longer pick up the bulk of their tab.
If anything, it could be an even more difficult pill to swallow than the earlier Ms, given that medical costs will rise in the future, coupled with longer lifespans and demand for more medical care as people age.
Means testing pulls a comfortable rug from under the feet of the average person.
The poor will continue to be taken care of. The indication from the minister is that their care can only get better in the coming years.
It also means nothing to the rich, who do not need to worry about subsidies.
It is the large middle class band who will be most affected.
The well-insured have little to worry about, since insurance should cover the bulk of their big bills.
But those who are uninsured, or have only the basic version of MediShield - pegged to the highly subsidised C and B2 class wards - will need to rethink their coverage. Without sufficient insurance cover, their out-of-pocket expenses could be crippling, should they be unlucky.
For some, it might already be too late. Once a person has developed some serious or chronic ailment, no insurer will allow an upgrade.
It may well be argued that the writing has been on the wall for some time. The idea of means testing has surfaced several times over the past five years. Each time it is mentioned, people shiver.
They picture themselves reduced to penury in order to pay hospital bills.
Health Minister Khaw Boon Wan's reassurances that the test will err on the side of generosity, and that the majority will be hardly affected, go some way towards assuaging these fears.
But people still need a few important answers.
What income level will be used to decide who gets the full subsidy?
How much more will 'richer' people have to pay?
What happens to people with chronic ailments who need to be in and out of hospital many times a year? Each bill might be affordable, but cumulatively they could be crippling. Can the subsidy be increased for such cases?
The answers to these questions, said the minister, will not come from him, but from the people of Singapore. A decision will be made based on the feedback he gets over the next few months.
No matter the assurances, until these details are worked out, there will be very many anxious people out there. So while the minister may not be in a hurry to introduce means testing, now that it is definitely in the works, the sooner all is known, the better.
