Friday 6 January 2012

Extended subsidy aims to ease load on polyclinics

Larger role for GPs will allow patients to see doctors nearer home, should cut waiting times
By Salma Khalik, The Straits Times, 5 Jan 2012

MODERN polyclinics are pretty plush, with comfortable seats and all the services that patients with simple ailments might need. On top of that, at least half of the doctors working in polyclinics have post-graduate training.

When you add the high subsidies at polyclinics, it is no wonder that over the years, an increasing number of people have been flocking to them.

Between 2007 and 2010, the number of polyclinic attendances went up by more than 500,000, to 4.3 million a year.

General practitioners in private practice are also seeing more patients over the years. But there are many more of them - about 2,000 - compared to just 324 doctors working in the 18 polyclinics.

Polyclinics are especially popular with older patients, with 47 per cent of those aged 65 and over using them, according to the Ministry of Health (MOH).

With Singapore's ageing population, this trend could see impossibly heavy patient loads in the coming decade, when the number of elderly residents is set to double from the current 300,000 to about 600,000.

In an attempt to correct this imbalance and to get the 2,000 private GPs to take a larger role in treating patients with chronic diseases, the MOH will extend its subsidy scheme to cover half the population aged 40 years and older. It is currently limited to needy elderly patients. This extension will start on Jan 15, and about 710,000 people are expected to qualify for subsidies from that date.

Under the *Primary Care Partnership Scheme (PCPS), the ministry pays part of the bill for consultation and medicines when a patient sees a GP. Health Minister Gan Kim Yong hopes the subsidy, which is capped at $80 per visit and $480 a year, will make going to a GP more affordable for lower middle-income families. This could lead to a significant shift of patients to the private sector, given the convenience of being able to see a doctor near their homes and not having to endure the long waits typical of crowded polyclinics.

To give the scheme a boost, three more community health centres will be set up this year. They will support GPs with things most clinics do not provide, such as eye tests for diabetics and nurse counselling services.

Because the MOH provides only a fixed subsidy but does not control how much a doctor charges, the final amount the patient pays will depend on the clinic he goes to. Based on current practice, they could expect to pay anything from close to polyclinic rates to 30 per cent more.

GPs taking part in the scheme welcome the extension, as they will probably see more patients.

Mr Lam Pin Woon, chief executive officer of Healthway, Singapore's largest GP chain, said: 'Given a choice, many patients would prefer to visit their neighbourhood GP clinics for more personalised service, shorter waiting time and easy accessibility - especially the elderly.'


What is PCPS?

The Primary Care Partnership Scheme (PCPS) is a subsidy scheme where the Ministry of Health (MOH) pays part of the consultation fee and cost of medicine at a private general practice (GP) clinic.

Do I qualify for the subsidy?

You qualify if you are at least 40 and your monthly per capita family income is $1,500 or less. To calculate that, take the total income of all members of your family and divide that by the number of people living in the same house.

You also qualify if your monthly per capita family income is $1,500 or less and you have a disability that prevents you from doing one of the following without help: washing/bathing, going to the toilet, moving from place to place, eating and dressing.

Those on public assistance also qualify.

What does it entitle me to?

Blue Health Assist card (above) is for people with monthly per capita income of $900 or less: You get an $18.50 subsidy when you see your GP for an acute problem such as flu or stomach ache.

You get an $80 subsidy if the treatment is for a chronic ailment like high blood pressure or diabetes.

There is a cap of $320 a year if you suffer from one chronic ailment, and a cap of $480 a year if you have two or more chronic ailments, or if there are complications with your single chronic ailment.

You can also see a private dentist and get a subsidy of up to $256.50 a year for procedures such as dentures, crowns and root canal treatment.

People from households with no income - such as a retired couple - can also get the Blue Health Assist card if their homes have an annual value of $13,000 or less. This covers most HDB flats.

The Orange Health Assist card (below) is for people with monthly per capita income of $901-$1,500: You get a $50 subsidy per visit for treatment of chronic ailments. This is subject to a cap of $200 a year if you suffer from one chronic disease and $300 a year if you have two or more chronic ailments.

You have a $170.50 annual subsidy for dental procedures.

Can I use the card at any GP or dental clinic?

No, you can use it only at GPs and dentists who have signed up for the scheme. They will bill you minus what they will get from MOH so it is hassle-free for patients. There are currently about 440 GP clinics on the scheme and more are expected to sign up this year. You will be given a list of GPs and dentists you can consult with when you get your Health Assist card.

How do I get a Health Assist card?

You can get an application form at any public hospital, polyclinic, community centre or club and community development council. You can also download the form at

When can I start using it?

From Jan 15 this year. The cards are valid for two years from the time they are issued.


Extended health-care scheme attracts many
Subsidy for GP care to rise; plan covers those aged 40 and above
By Salma Khalik, The Straits Times, 10 Jan 2012

About 10,000 people have signed up for the *Primary Care Partnership Scheme (PCPS) since last August when it was announced that coverage would be extended to more people.

The scheme allows patients to get treatment from a general practitioner (GP) and still enjoy government subsidy. From this Sunday, the subsidy will range from $18.50 to $80 a visit, capped at $200 to $480 a year, up from $60 a visit, capped at $360 a year previously.

The scheme was introduced in 2000 for patients from poor families and who were at least 65 years old or disabled.

About 36,000 patients are on the existing PCPS. But the numbers are expected to soar, now that more than 700,000 Singaporeans aged 40 and older are eligible for the subsidy.

The purpose of the scheme includes alleviating the visitor crunch at polyclinics and making it easier for people to get treatment.

Answering a question from Dr Teo Ho Pin (Bukit Panjang) in Parliament on Monday, Health Minister Gan Kim Yong said 58 more GPs have applied to join the scheme, adding to the 400 who have been on it for some years.

Dr Teo also asked how many GPs saw fewer than 10 PCPS patients a year. Mr Gan did not have the answer to that but told Dr Teo that with the changes, many more patients would be eligible.

Mr Sitoh Yih Pin (Potong Pasir) said that of 10 GP clinics in his constituency, three are on the scheme, two are planning to sign up, and five are thinking about it. One of the five, he added, does not use computers in his clinic.

Mr Gan said the MOH can help GP clinics computerise. He added that aside from PCPS, it would be helpful if all GP clinics were computerised.

This would make it easier for another doctor to take over the care of patients when a GP goes on leave.

It would also help the patients, should they be hospitalised, as the doctors in the hospital would be able to access their medical records.

Mr Gan also told Parliament that the Ministry of Health (MOH) is looking at ways to streamline the work for GPs submitting PCPS claims. He promised to share more details shortly.

As to Dr Lam Pin Min's (Sengkang West) suggestion to remove the 40-year age limit, the minister said he would review the scheme in future.

According to the MOH, the majority of patients on the scheme go to their GPs for acute problems such as coughs, colds and headaches.

Of the $4.1 million spent by the MOH on PCPS since January 2009 - when chronic ailments were included - $3 million went to acute treatments. Chronic ailments like diabetes and high blood pressure accounted for only $1 million.

Under the expanded scheme, patients from households with per capita family income - derived from dividing total income by the number of people in the family - of $901 to $1,500 a month would get subsidy for treatment of only chronic ailments.

Only those whose per capita family income is $900 or less a month will get a subsidy for treatment of acute problems.

*Related post;
*The Primary Care Partnership Scheme (PCPS), was renamed as the Community Health Assist Scheme (CHAS) from 15 January 2012

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