Medisave to cover cost for outpatient chronic care

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments 7/8

Abstract

Details of Singapore?s nationwide Chronic Disease Management Programme (see Report 07/2006) have been announced.

Recent developments

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

Stakeholder positions

 

 

Actors and positions

Government
Government	very supportive		strongly opposed
current    previous

Actors and influence

Government
Government	very strong		none
current    previous

Positions and Influences at a glance

Adoption and implementation

 

With effect from 1 October 2006, Medisave can be used to cover the cost of diabetic care in government polyclinics and participating private clinics. Hitherto, it was only allowed for inpatient care. From Jan 1 2006, another three conditions will be added to the list of eligible chronic illnesses, viz. high blood pressure, high cholesterol and stroke.

Patients will be allowed to withdraw up to Sing$300 from their own Medisave accounts or draw on any or all of their family members' Medisave accounts up Sing$300 from each account for selected outpatient treatment. The scheme will however be subject to the following conditions:

1. A deductible of Sing$30 on each outpatient bill. 
2. A co-payment of 15% on each outpatient bill in excess of the deductible (see table 1 below); and
3. Continuation of withdrawals from Medisave will need regular certification by the attending doctor(s) indicating that the patients are complying with the recommended protocols of the disease management programmes.

Table 1: Example

Medical bill	Patient Pays	Medisave Pays
$100	Deductible = $30.00	$100 - $30 - $10.50 = $59.50
	15% of balance ($100 - $30) = $10.50
	Total = $40.50	Total = $59.50

 

To prevent healthcare providers from abusing the system by offering unnecessary treatments, MOH will be conducting periodic audits on clinics to ensure that the care rendered is according to established treatment protocols.  

MOH has also stepped up public education efforts such as an information hotline and a website through which the public can field questions about the Programme.

There is also a web-based system through which doctors across Singapore can certify that they are treating a patient for chronic illness, and submit Medisave claims for central processing. This will also provide a useful database for future research.

 

Monitoring and evaluation

A list of participating clinics will be posted on the MOH website. The clinics will also be identified by a prominent display sticker.So far, about 150 General practitioners (GPs) have signed up to participate in the scheme.  MOH's target is to enroll about 2000 GPs eventually.   

A poll carried out among the public by a local newspaper indicated that 69% of respondents felt the yearly limit of Sing$300 withdrawal from Medisave was too low, 29% felt it was suitable and 2% felt it was too high. With regards to the $30 deductible, 76% agreed that this was appropriate.  Others who disagreed proposed that the deductible should be between Sing$5 - $10 instead. In response, the MOH has commented that the  $300 withdrawal limit could be reviewed in future to take into account inflation. 

In response to queries, MOH has also indicated that other chronic ailments with
well-established treatment protocols, e.g. asthma, may be added to the list in due course. 

Expected outcome

Investing in low-intensity, life-long care, capturing chronic diseases in their early stages before complications set in, makes economic sense. Allowing the use of Medisave for this purpose helps to alleviate the concerns of patients faced with substantial medical bills because of long-term care and long-term medication due to  chronic illnesses. It will also encourage patients to adopt a more proactive approach rather than delaying treatment because of concerns with medical bills.  

 

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high
current    previous

References

Sources of Information

www.moh.gov.sg/corp/financing/medisave/chronicdisease.do

www.hpb.gov.sg/chronicdisease/

Reform formerly reported in

Liberalization of Medisave Use Process Stages: Idea

Disease Management Process Stages: Idea

Author/s and/or contributors to this survey

Lim Meng Kin

National University of Singapore

Suggested citation for this online article

Lim Meng Kin. "Medisave to cover cost for outpatient chronic care". Health Policy Monitor, October 2006. Available at http://www.hpm.org/survey/sg/a8/5