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Outpatient Reimbursement for Mental Illness

Country: 
Singapur
Partner Institute: 
Department of Community, Occupational & Family Medicine, National University of Singapore
Survey no: 
(14) 2009
Author(s): 
Lim Meng Kin
Health Policy Issues: 
Vergütung
Reform formerly reported in: 
Chronic disease management program
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein ja nein nein

Abstract

The Chronic Disease Management Programme has been extended to cover the outpatient treatment of two more chronic diseases, namely Schizophrenia and Major Depression.

Neue Entwicklungen

With effect from 1 October 2009,  the use of Medisave has been further liberalized to cover outpatient treatment of Schizophrenia and Major Depression. Medisave withdrawal rules under the Chronic Disease Management Programme (CDMP) will remain unchanged, i.e. withdrawals are capped at S$300 per Medisave account per year, and the existing deductible of S$30 and co-payment of 15% will also apply.  

The Ministry of Health (MOH) has developed a new disease management guideline which provides detailed guidance on the treatment of these two psychiatric conditions, as well as identified clinical care indicators which it will track under MOH's quality assurance framework. It has also produced educational booklets on schizophrenia and major depression meant for patients' and caregivers' reference. These booklets contain relevant information on the disease symptoms, the treatment and help available and what one can do to help loved ones cope with these two diseases.

General practitioners (GPs) who are interested to treat patients with schizophrenia or major depression will be required to participate in a Shared Care or GP Partnership Programme with a public sector hospital. This is to ensure quality and continuity of care for patients. Under this partnership programme, local hospitals will support GPs in training, professional support from nurses or psychologist and periodic review by psychiatrists. 

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell recht innovativ innovativ
Kontroversität unumstritten unumstritten kontrovers
Strukturelle Wirkung marginal recht fundamental fundamental
Medienpräsenz sehr gering recht hoch sehr hoch
Übertragbarkeit sehr systemabhängig neutral systemneutral
current current   previous previous

 

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein nein ja nein nein

Initiators of idea/main actors

  • Regierung
  • Leistungserbringer
  • Patienten, Verbraucher

Stakeholder positions

 

Actors and positions

Description of actors and their positions
Regierung
Ministry of Healthsehr unterstützendsehr unterstützend stark dagegen
Polyclinicssehr unterstützendsehr unterstützend stark dagegen
Leistungserbringer
Private Providerssehr unterstützendsehr unterstützend stark dagegen
Patienten, Verbraucher
General publicsehr unterstützendsehr unterstützend stark dagegen
current current   previous previous

Influences in policy making and legislation

 

Legislative outcome

Enactment

Actors and influence

Description of actors and their influence

Regierung
Ministry of Healthsehr großsehr groß kein
Polyclinicssehr großgering kein
Leistungserbringer
Private Providerssehr großgering kein
Patienten, Verbraucher
General publicsehr großneutral kein
current current   previous previous
Polyclinics, Private ProvidersGeneral publicMinistry of Health

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The Medisave for Chronic Disease Management Programme is a national effort spearheaded by the Ministry of Health (MOH) to radically change the way chronic diseases are treated in Singapore. The aim is to shift the focus away from sub-optimal, episodic, or reactive care of symptoms, towards a paradigm of life-long holistic care that emphasizes prevention and health maintenance.  

Under the Chronic Disease Management Programme (CDMP), Medisave use was liberalized to include the treatment of four chronic diseases, i.e. diabetes, hypertension, lipid disorders (e.g. high cholesterol) and stroke. In April 2008, asthma and chronic obstructive pulmonary disease (COPD) were added to the list.  

There is a comprehensive support structure for this programme, including web-based IT systems that make it convenient for the doctors to submit Medisave claims and relevant patients' health outcomes to MOH.

Monitoring and evaluation

The Ministry of Health (MOH) has identified clinical care indicators which it will track under MOH's quality assurance framework.

Expected outcome

Schizophrenia, a chronic psychiatric disorder that requires long-term treatment, is estimated to affect nearly 1% of the population. Major Depression is a serious form of mental illness causing significant distress or impairment in daily activities, but is highly treatable once diagnosed. It is hoped that managing these conditions in the outpatient setting will minimize potential relapse or complications and reduce costly hospitalization later on. 

The extension of CDMP to these illnesses will potentially benefit many patients with Schizophrenia and Major Depression who can be managed effectively in the community by GPs and psychiatrists. With the establishment of evidence-based treatment and adequate support from caregivers and the community in their journey of rehabilitation, most patients can maintain and lead a near normal functioning or productive life. 

Patients welcomed the idea as it will help reduce out-of-pocket payments. Since its inception, 90,000 patients have enrolled in the program. In 2008, S$18 million had been withdrawn from Singaporeans' Medisave accounts under the scheme.

Impact of this policy

Qualität kaum Einfluss relativ starker Einfluss starker Einfluss
Gerechtigkeit System weniger gerecht four System gerechter
Kosteneffizienz sehr gering high sehr hoch
current current   previous previous

 

References

Sources of Information

  • MINISTRY OF HEALTH Press release. Extending Medisave Use To Schizophrenia And Major Depression. 25 SEPTEMBER 2009

Reform formerly reported in

Chronic disease management program
Process Stages: Evaluation

Author/s and/or contributors to this survey

Lim Meng Kin

National University of Singapore

Empfohlene Zitierweise für diesen Online-Artikel:

Lim Meng Kin. "Outpatient Reimbursement for Mental Illness". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/sg/a14/2