Monday 26 December 2011

Applications open for subsidised GP care scheme

Expanded programme lets more enjoy lower rates at family doctors
By Salma Khalik, The Straits Times, 24 Dec 2011

A scheme that will allow more than 700,000 people to see family doctors at subsidised rates is now open for applications.

Half of all Singaporeans aged 40 and over are eligible for up to $480 a year off their bills at private GP clinics under the government initiative, which will begin on Jan 15.

It was introduced in 2000, but until now has been available only to the elderly poor. Health Minister Gan Kim Yong announced the change in August, saying the aim was to encourage more people to see GPs. This could help ease the crowds at Singapore's 18 highly subsidised polyclinics, and allow patients the convenience of being able to visit a family doctor near them for all their ailments.

To be eligible for the enhanced Primary Care Partnership Scheme (PCPS), patients have to live in a household with an income of $1,500 or less per head. So a family of four with a total of $6,000 coming in every month would qualify.

The subsidies come in two tiers. Those with per capita household income of $900 or less get a blue Health Assist card. This gives them a subsidy of $18.50 when they see their GP for acute problems such as coughs, colds and headaches.

The subsidy is higher for treatment of the 10 chronic ailments for which Medisave can be used. These patients get $80 per visit up to a cap of either $320 or $480 a year, depending on how many medical problems they have.

The second tier is for those with per capita household incomes of $901 to $1,500. Their orange card entitles them to subsidised treatment for chronic problems only. They get $50 per visit, capped at $200 or $300 a year.

Application forms can be picked up from any public hospital, polyclinic, community centre or club, as well as community development councils.

If several members of a family are eligible, only one form is needed for all of them. Successful applicants will receive their Health Assist card and a welcome pack with a list of the 450 clinics on the programme.

Dr Tham Kwong Lum, a GP in Toa Payoh, said he has had many inquiries about the expanded scheme since it was announced.

He now treats between 30 and 40 patients on the existing version, but expects to see a lot more next year.

'There are many people in the vicinity who would qualify,' he said.

Even with the subsidy, he said patients can expect to pay about 30 per cent more than they would at a polyclinic. For that, they get convenience, and also better service.

Dr Tham explained that he sees his diabetic patients every month, rather than every three months, which is the norm at polyclinics.

He added: 'A diabetic can deteriorate very quickly. This way, I can pick up poor sugar control early.'

But Dr Jonathan Chan, whose clinic is also in Toa Payoh and who sees as many as 200 PCPS patients a month, charges about polyclinic rates.

Mr Gan told The Straits Times on Friday that he hopes more GPs will sign up for the scheme. There are more than 2,000 of them in Singapore.

The minister said some are put off by the administrative work involved. His ministry is looking at giving them technical help, and is in talks with several firms about providing computer systems.

More focus on primary healthcare in 2012
By Sara Grosse, Channel NewsAsia, 27 Dec 2011

Chairman for the Government Parliamentary Committee (GPC) for Health Lam Pin Min said he wants to see a complete removal of the age criterion for a scheme that provides needy Singaporeans better access to primary healthcare.

Observers Channel NewsAsia spoke with are also pushing for more subsidies that would cover social care support for the elderly.

The calls come even as the Ministry of Health (MOH) announced a slew of measures in 2011, aimed at making healthcare more affordable to Singaporeans.

Next year, some 710, 000 Singaporeans are expected to benefit under the Primary Care Partnership Scheme (PCPS) where needy patients can get subsidised treatments at private general practitioners (GPs) and dentists near their homes.

Observers welcomed the move.

But they said there should be a complete removal of the age criterion so more Singaporeans can benefit.

More GPs also need to be roped into the scheme.

The scheme is currently for Singaporeans aged 65 or older with a per capita monthly household income of S$800 or less.

Currently, only 20 per cent of GPs have opted to join the scheme.

Dr Lam Pin Min said: "In addition to allowing residents to access the GPs nearer to their homes, it helps to ease polyclinic patient load as well.

"The other thing I hope MOH can look into is to encourage more GPs to participate in this scheme.

Without GPs participating, it wouldn't be a useful scheme at all. PCPS basically allows a GP to have a more active role in managing patients especially those from low the income and middle income, in terms of the acute illness and chronic diseases."

Responding to queries from Channel NewsAsia, MOH said the revision to the PCPS "is substantial and many more middle/low income Singaporeans will be eligible for the scheme".

It added: "The lowering of the age (criterion) from 65 to 40 will also enable more middle/low income Singaporeans with chronic diseases better manage their conditions at private GP clinics through the scheme.

"At the same time, the ministry is also expanding its engagement with GPs to get more GPs onboard the scheme.

"The ministry will review the scheme again on its relevance, in due course."

Both the PCPS and national medical savings scheme, Medisave, were enhanced in 2011 to cover more chronic illnesses, such as dementia and bipolar disorder.

This brings the total number of chronic diseases covered under the two schemes to 10.

The other conditions are diabetes, high blood pressure, stroke, lipid disorders, chronic obstructive pulmonary disease, asthma, schizophrenia and major depression.

Under Medisave, individuals put aside part of their monthly income to cover certain outpatient expenses.

But some said this is only a starting point, when it comes to managing chronic diseases among the elderly.

NTUC Eldercare general manager Lim Sia Hoe said "It is still not eldercare services. Eldercare support services come with the functional ability, come with the social care needs. (They are) very basic, very simple.

"If you need some help in terms of personal care, bathing, toileting, transferring, where (would) the money come from? No one looks at it now."

Ms Lim said she wants to see wider coverage under the national medical insurance scheme, ElderShield, which provides a monthly cash payout to help defray costs for the care of a severely-disabled person.

Singapore Citizens and Permanent Residents (PRs) with Medisave accounts are automatically covered under ElderShield at the age of 40.

"ElderShield today is very limited in terms of the coverage, in terms of (benefits)," Ms Lim said.

"It is too limited in terms of the services that we can go into, and it's meant for (the) severely disabled.

"Today, (the) elderly needs start from very early, especially with chronic diseases coming in."

In response, MOH said an elderly who is disabled and requires social care support can use part of his or her ElderShield payout, which is in cash, to help defray such expenses.

It added the primary aim of Medisave is to help Singaporeans set aside savings to pay for their healthcare needs during retirement.

That is why, said MOH, the scheme remains focused on medical treatments.

With a greying population, MOH is expanding infrastructure to ease the tight capacity at public hospitals.

In 2014, Ng Teng Fong General Hospital will add 700 more beds, while the opening of Sengkang General Hospital will be brought forward by two years, to 2018.

But observers said adding more beds is only one part of the solution.

Two community hospitals -- one in Yishun and the other in Jurong -- will open between 2014 and 2015.

Changi General Hospital A&E Department chief & senior consultant Mohan Tiru said: "It's a never-ending pit whenever you build beds.

"I think whatever it is, you need to improve the health of the community as a whole. And I think primary health care is one of the underdeveloped areas as of now in Singapore.

"I think we need to improve that area first. Because no matter how many beds you build in a hospital, if there is no good primary care, you can't discharge the patients out and take care of them in the community."

The Primary Care Masterplan, to be ready by early 2012, aims to do just that with its team-based approach to providing follow-up care in the community.

This means more community-based clinics to better support GPs with a second Community Health Centre in Bedok to be set up in first half of next year.

A draft of the masterplan was announced in October.

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