|Implemented in this survey?|
The Ministry of Health has introduced on a pilot basis, the ?Medical Service Package? (MSP) in all public sector hospitals, starting with cardiac and cardiothoracic services for both inpatient and day surgery services. The new scheme helps subsidized patients pay for devices such as stents and defibrillators and incorporates a new system of peer review of the utilization of these devices.
From 5 July 2004, the Ministry of Health (MOH) has introduced the Medical Service Package (MSP) in all public sector institutions, starting with cardiac services. Currently, there is minimal or no
subsidy for medical devices to treat heart problems such as cardiac stents, defibrillations, pace-makers and some new cardiac drugs. The new MSP aims to help subsidized (B2 and C-class patients)
maximize their money spent on medical care by giving B2 patients a 65% subsidy for cardiac treatment and drugs, while C-class patients will receive 80% of subsidy.
Moreover, by introducing a system of peer-review that ensures patients receive the appropriate treatment, the MSP helps to control over-servicing by healthcare providers.
The MSP will cover medical procedures, devices, investigations and drugs, which will be grouped into three categories depending on the degree of the peer review needed. The three categories are as follows:
1. Basic - this refers to health services that are considered "standard" in which case peer review is unnecessary.- i.e. the indications for their use are not controversial. The majority of medical services fall into to this category.
2. Extended - this category includes the more controversial, advanced, or newer treatment modalities. A peer review system will be developed within each hospital department to monitor indications and usage of these items. MOH will monitor, and will investigate any significant deviations from the norm. This is intended to minimize over-servicing of patients by individual doctors.
3. Excluded - this refers to non-essential medical services such as cosmetic surgery and experimental and unproven treatments.
The list of "basic" and "extended" cardiac medical devices and drugs.was drawn up by the National Committee on Cardiac Care in consultation with the various heads of departments in cardiology and cardiothoracic surgery. The "Basic" list includes angiograms and bypass surgery, for which peer review is not necessary. In the"Extended" list are sophisticated pacemakers and more controversial procedures where the indications are not yet clear.
The creation of the extended list allows every specialist to treat his patient in what he/she would consider a cost-effective manner. Hence it is the doctors making the decisions, but in the knowledge that their decisions are subject to peer review.
The MSP applies only to subsidised patients (B2+, B2 and C Class).
|Medienpräsenz||sehr gering||sehr hoch|
The measure arose out of two concerns:
a. that many Singaporeans were reportedly experiencing financial hardship from having to pay for expensive medical devices such as cardiac stents, defibrillators, pace-makers and some of the newer cardiac drugs which are not subsidized by the government. With the new package, B2 patients will receive 65% subsidy for cardiac implants and the newer cardiac drugs. C class patients will receive 80% subsidy.
b. that health care providers may be over-servicing patients
It is hoped that using this new framework as guidance, the provision of subsidy for both "basic" and "extended" items will be more rational, based on medical necessity rather than ability to pay. Where patients are unable to afford treatment despite the subsidies, they will be referred to the medical social worker to ascertain if they qualify for other state-funded mechanisms for financial assistance, such as Medifund.
The MSP list will be reviewed on an annual basis or more frequently if necessary.
|Implemented in this survey?|
The MSP is both a quality control measure and a measure to give subsidized (B2- and C-Class) patients access to all treatments presently available only to paying-class patients. Patients who
require essential cardiac implants or drugs will now enjoy subsidized rates if their medical team's assessment is that such devices or drugs are necessary for their medical conditions. Peer-review is
intended as a check to prevent over-servicing by doctors. Outliers who deviate significantly from their colleagues and whose patients seem to have a bigger bill compared to everyone else, will be
open to scrutiny.
Public response has been positive. Patients were generally happy as they could now receive more subsidies compared to before the introduction of MSP.
A local newspaper featured the case of a patient who saved $3,316 on a heart procedure she had recently undergone. The same report noted among other things that twenty-two patients at the main public sector cardiac surgery centres - National Heart Centre and NUH - had benefited in the first two days since the new subsidies kicked in.
On the other hand, the new system places the onus on the doctors since they have the final say on whether a subsidised patient should be using a more costly or advanced medical item. They may face pressures from some patients who may find it hard to accept that the newest and more advanced devices are not necessarily better, especially when readily available medication information on the Internet may have given them the opposite view.
If the pilot MSP project proves successful, it will be extend the MSP to other specialties and outpatient services at a later date.