05 Jan 2012
By: LEA WEE
1 EXTENSION OF SUBSIDIES TO TREAT CHRONIC DISEASES
In a nutshell: Singaporeans who are aged 40 or older and who have a per capita monthly household income of $1,500 or less will be able to sign up for the Primary Care Partnership Scheme from Jan 15.
The scheme allows patients to get subsidies when they visit their general practitioners (GPs) for the treatment of 10 chronic ailments.
These are diabetes, hypertension, lipid disorders, stroke, chronic obstructive pulmonary disease, asthma, schizophrenia, major depression, dementia and bipolar disorder.
Previously, the scheme was for Singaporeans aged only 65 or older with a per capita monthly household income of $800 or less.
The revamp will benefit potentially 710,000 people, a huge jump from the current 87,000 eligible.
Significance: The scheme will narrow the difference between the fees of a GP and that of a polyclinic and allow more patients to see private GPs and lessen the load on polyclinics.
Announcing the extension of the scheme last August, Health Minister Gan Kim Yong said seeing a GP has advantages such as shorter waiting times, getting to see the same doctor and being able to see him after office hours, which could be important for those who work.
He hoped the move would not just help patients, but also lead to a “significant shift” of patients from polyclinics to GPs.
This would “rebalance” the patient load between the public and private sectors. Today, primary care doctors in the public sector – who make up 14 per cent of all primary care doctors – look after 45 per cent of patients with chronic diseases here.
Otherwise, more polyclinics will have to be built as the population ages, Mr Gan said, even though the private sector has enough resources to cope with the chronic needs of patients here.
2 HIGHER MEDISAVE WITHDRAWAL LIMIT FOR OUTPATIENT TREATMENT
In a nutshell: The Medisave annual withdrawal limit for outpatient treatment of 10 chronic diseases will be raised from $300 to $400 from this month.
The scheme, which used to be known as Medisave300, will be renamed Medisave400.
This money can be used to offset bills at polyclinics, general practitioner clinics and specialist outpatient clinics in hospitals. It can also be used to pay for some vaccines and for mammogram screening for breast cancer.
Significance: Medisave helps Singaporeans pay for their hospitalisation expenses.
In recent years, the Government has liberalised it to help pay for the treatment of common chronic diseases at outpatient clinics. This is in line with the Government’s effort to make health care more affordable for Singaporeans.
Medisave300, which was launched in 2006, lets patients use up to $300 per Medisave account per year for chronic ailments if their doctors follow Ministry of Health treatment guidelines and track their progress.
One third of accounts which had money withdrawn had the full $300 taken out – suggesting that the sum might not be enough.
Health Minister Gan Kim Yong said Medisave400 should be sufficient for the majority of the population, but the cap on the withdrawal amount is not cast in stone.
He said the ministry will monitor the situation and see if there is a need to adjust it further.
3 OPENING OF PARKWAY NOVENA HOSPITAL
In a nutshell: The $2 billion Parkway Novena Hospital (below) is set to open in the second half of this year.
It is the most expensive private hospital to be built in Singapore in the last 30 years.
Housing 333 wards of only single beds, it willl focus on the treatment of heart and vascular diseases, orthopaedics, neuroscience and general surgery.
The hospital is Parkway Pantai’s most expensive investment in Singapore to date.
Parkway Pantai is the biggest private hospital chain here. It also owns Gleneagles Hospital, Mount Elizabeth Hospital and Parkway East Hospital.
Signifiance: To meet the high demand for hospital beds in the public sector, the Government has talked about borrowing ward space from the private sector.
The National University Hospital is already renting ward space from West Point Hospital, a private community hospital in Jurong.
Parkway Pantai’s existing three hospitals now have average occupancy rates of 65 to 70 per cent. These are the rates aimed for by most private hospitals to allow a good balance between flexibility in coping with patient influx and profitability.
The opening of the new hospital will probably free more beds for rental.
The demand for beds in public hospitals has been growing in recent years.
In 2010, public hospitals warded 3.8 per cent more patients – or about 10,000 more than the year before.
The situation worsened last year when the numbers grew by a further 4.3 per cent – or 11,000 more patients – in just the first nine months.
4 EXTENSION OF PALLIATIVE CARE IN HOSPITALS
In a nutshell: A programme to improve the quality of life of terminally ill patients will be made available at Singapore General Hospital, Khoo Teck Puat Hospital and Changi General Hospital this year.
The Holistic Care for Medically Advanced Patients (Home) programme is run by the Agency for Integrated Care.
Since its pilot phase in 2008, about 550 patients from National University Hospital and Tan Tock Seng Hospital have benefited from the programme.
Patients follow a structured and customised palliative home-care plan.
For each patient, this usually involves regular visits by a nurse in charge of caring for the patient and providing updates to a doctor, and a counsellor who facilitates discussions on advance care planning and provides caregiver support.
For now, Home is available only to patients suffering from advanced chronic obstructive pulmonary disease and end-stage heart failure.
There are plans to include other conditions such as liver failure.
Significance: About 17,000 people die in Singapore each year, with one in four receiving palliative care in a hospice, at home or in a nursing home.
In 2007, then Health Minister Khaw Boon Wan pointed out that Singapore lagged behind other countries in giving people “a good death”.
While most prefer to die at home, more than half actually do so in a hospital, he said.
Since then, more has been done to recognise the importance of palliative care.
For instance, palliative medicine became a newly designated sub-speciality in Singapore, with the first specialists officially recognised in February last year.
5 CHEAPER MEDICINE
In a nutshell: Expect more types of medicine to join the list of subsidised drugs this year.
Already, more than 500 types of medicine are on the list.
Some drugs on the existing list are so heavily subsidised that patients pay only $1.40 for a week’s supply.
The remaining drugs are subsidised by 50 per cent. For these drugs, the quantum of subsidy will be increased to 75 per cent at polyclinics and public hospitals early this year.
The people who qualify for these subsidised drugs will be the same as those who qualify for the Primary Care Partnership Scheme.
They have to be aged 40 and above and come from families in which the total income divided by the number of members in the household is $1,500 a month or less.
They can apply for a health benefit card this year.
All these additional drug subsidies will cost the Ministry of Health $45 million more a year.
Significance: Health Minister Gan Kim Yong said the subsidies on drugs will be increased because the cost of drugs forms a hefty portion of a patient’s bill.
The drug subsidies are part of the ministry’s effort to make health care affordable for people.
6 MAKEOVER OF LOCAL NURSING HOMES
In a nutshell: Three nursing homes will move to new and larger premises by this year or next year.
They are Villa Francis Home for the Aged, Singapore Christian Home for the Aged and Bright Hill Evergreen Home (above).
Ernst & Young Advisory has been appointed by the Agency for Integrated Care (AIC) to help these nursing homes improve their productivity and add value to lower-level jobs there.
The AIC looks at the health-care needs of Singapore’s ageing population. Initiatives that work will be rolled out to other homes.
Significance: There will be a greater need for intermediate and long-term care as Singapore’s population ages.
The AIC sees developing infrastructure and manpower capabilities as “critical” for success in this area.
Right now, however, nursing homes face difficulty in recruiting local staff.
There is both an image gap and a remuneration gap between those working in nursing homes and those in hospitals.
It is hoped that with the makeover, nursing homes of the future will no longer be poor cousins to hospitals, with outdated and inefficient procedures, manpower-intensive work and low levels of technology.
And with that, more Singaporeans will want to work in nursing homes.
7 NEW SEDATION GUIDELINES
In a nutshell: Doctors who sedate their patients for surgery in their clinics will have a set of guidelines to refer to by this year.
Among other things, the guidelines will spell out the type of training that doctors administering sedation should have and the monitoring devices needed by clinics for patient safety.
The Ministry of Health appointed an expert committee of 10 specialists in anaesthesiology and other surgical disciplines in November last year to draw up the guidelines.
It said the move is a response to a trend of more non-anaesthesiologists sedating patients in clinics.
The committee will look at guidelines in countries such as the United States, Britain and Australia to draft the guidelines here.
SIgnificance: The guidelines are aimed at improving the safety of sedation in clinics.
While the guidelines are not enforceable, they could form the grounds for taking action against a doctor when there is a complaint to the Singapore Medical Council.
They are unlikely to affect public hospitals and most of the private hospitals here, which already have strict safety measures regarding the use of anaesthesia.
The guidelines will have a greater impact on general practitioners or specialists practising in their own clinics, who have to make their own decisions about engaging an anesthesiologist to perform the sedation.
8 COMMUNITY HEALTH CENTRES TO SUPPORT GENERAL PRACTITIONERS
In a nutshell: At least three more community health centres (CHCs) offering support services to general practitioners (GPs) will be set up this year.
There is currently only one CHC, in Tampines, which is run by Changi General Hospital. GPs in the area can refer patients to the centre, which offers, among other services, foot and eye screening for diabetics and counselling by nurses.
The reports are sent to the GPs, who review the results with the patients.
What such centres offer will depend on what services GPs in that area want. Health Minister Gan Kim Yong said he is open to different models in different locations, but would prefer such centres to be set up by the private sector, with the ministry helping any who are interested.
Significance: With more ancillary support services available in the community, GPs will be better able to deliver good primary care, especially to older Singaporeans with chronic illnesses, said Mr Gan in a blog post last month.
The CHCs would allow GPs to take on more patients with chronic diseases and provide the whole suite of services that their conditions need.
Right now, GPs represent 86 per cent of all primary care doctors, but take care of only 55 per cent of such patients.
But with Singapore’s ageing population and the need for chronic care treatment rising, GPs will need to play a greater role.
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