Chronic disease management program

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

Featured in half-yearly report: Health Policy Developments 11

Abstract

Encouraged by the initial success of the ?Medisave for chronic disease management program? launched in January 2007, the government has decided to include two more conditions, namely asthma and chronic obstructive pulmonary disease, to the program, with the hope that more of the patient load for chronic diseases can be shifted to general practitioners.

Recent developments

The "Medisave for chronic disease management program" was launched in January 2007 (see Surveys (7)2006 and (8)2006). It represented a loosening of the Medisave purse strings to allow patients with four chronic conditions - diabetes, high cholesterol, high blood pressure and stroke - to use up to Sing$300 a year from Medisave to co-pay for their treatment.  The purpose was to ease the financial burden of patients with chronic illness and to shift the care of stable chronic conditions to primary care doctors such as general practitioners (see survey (7)2006).  

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: MoH was encouraged by the first results (see below at

• Providers: General practitioners also support the program but some believe that some GPs might need more training in caring for chronically ill patients (see below).

• Patients, Consumers: Patients have welcomed the financial relief of being able to use Medisave to cover the costs of the consultations, and also welcome the possibility of seeing their general practitioners instead of hosptial specialists.

• Media

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Providers
Providers	very supportive		strongly opposed
Patients, Consumers
Patients	very supportive		strongly opposed
Media
Newspapers	very supportive		strongly opposed
current    previous

Actors and influence

Government
Ministry of Health	very strong		none
Providers
Providers	very strong		none
Patients, Consumers
Patients	very strong		none
Media
Newspapers	very strong		none
current    previous

Positions and Influences at a glance

Monitoring and evaluation

After one year of implementation, the results of the first phase of the program, which was targeted at the "Big Four" diseases - diabetes, hypertension, lipid disorders and stroke - have been encouraging. According to the Ministry of Health, some 70,500 patients have withdrawn a total of Sing$15 million to pay for their outpatient treatment. Over 80% of the patients who participated in the program during the first year of implementation had more than one chronic condition. Two thirds were diabetics and 90% were over 50 years old. About a third of the claims were for specialist outpatient clinics at hospitals; about half were for polyclinic-based treatment; and 20 per cent were for general practice care.   

Patients have not only welcomed the financial relief of being able to use up to Sing$300 a month of their Medisave to cover the costs of the consultations, but they also report  traveling shorter distances to see their general practitioners (instead of hosptial specialists) and improved relationship with their doctors "because general practitioners can take more time to talk to them."   

As a holistic program which required the patients to go through regular examinations and tests according to prescribed clinical protocols, however, the results showed room for improvement.  Only 19 percent of diabetic patients had all the necessary tests done, while only 27 perecent of patients with stroke received a risk assessment for thromboembolism.  

The results for high blood pressure and high cholesterol were better - with about 62 percent of hypertensive patients and 77 percent of patients with high cholesterol getting all the required checks. Overall, about 70 percent of diabetes patients had acceptable or better control of the disease. Of the diabetic patients with lipid disorders, nearly 50 percent had the ideal range of bad cholesterol level.  

MoH was encouraged by the results, and saw this as "a learning experience" and expects "further improvements over time".  A newspaper report quoted some views expressed by general practitioners:   

1. patients may have found it troublesome to visit different clinics for tests on their eyes and feet. 
2. some GPs might not be trained to perform the most common types of missed tests, like eye and foot checks.   
3. Government's data collection could be inaccurate and more patients might be going for tests than the numbers showed. As most GPs got their assistants to manually submit patients' test results via MoH's online portal, this could have resulted in some results being omitted.

Expected outcome

 Encouraged by this initial "success", the government has decided to include two more conditions, namely asthma and chronic obstructive pulmonary disease, to the program - with effect from April 2008 - with the hope that more of the patient load can be shifted to general practitioners.

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

Tay, Sheralyn . "$15m in withdrawals - Encouraging results in Medisave scheme for treating chronic illnesses." Today. Tuesday, March 18, 2008.

Tay, Sheralyn. "For asthmatics, hope for long-term relief Medisave payment from next month will help shift mindsets." Doctors Today. Monday, March 17, 2008.

Reform formerly reported in

Disease Management Process Stages: Idea

Medisave to cover cost for outpatient chronic care Process Stages: Implementation

Author/s and/or contributors to this survey

Lim Meng Kin

Suggested citation for this online article

Lim Meng Kin. "Chronic disease management program". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/sg/a11/2