Govt to manage possible hike in healthcare demand

Budget measures could ultimately lead to higher costs

By Ng Jing Yng, TODAY, 26 Feb 2014

Acknowledging that Budget measures to help Singaporeans meet the rising healthcare costs could lead to a spike in demand and result in costs going up further, Health Minister Gan Kim Yong said yesterday his ministry is looking to manage the situation — in particular, the demand for hospital care amid the ongoing bed crunch.

Apart from doing more in the areas of step-down care and home care, the Ministry of Health (MOH) will seek to ensure that only patients who are assessed by medical professionals to require acute care will remain in hospitals.

Speaking to reporters after the recording of the Budget Forum in Mandarin organised by MediaCorp, Mr Gan said: “One important aspect the Ministry of Health is looking at is how to manage healthcare costs, because with more funding, the risk is it will drive up demand. If we want to manage costs, we have to look at a holistic approach.”

Among the strategies that the MOH will be adopting is “proper gatekeeping to ensure that access to high-end acute care is on a needs basis, assessed by medical professionals ... if you do not need to be in an acute hospital, then you ought not to be in (it)”, Mr Gan said.

The MOH will also be enhancing support for community step-down care such as nursing homes and home care services. More details will be provided during the ministry’s Committee of Supply debate next month.

Last Friday, the Government continued its push to help the less well-off under measures unveiled in the Budget, with a particular focus on healthcare, which was identified as the main driver of higher social spending by Singapore over the next 10 to 15 years.

The centrepiece was the S$9 billion Pioneer Generation Package which will provide greater outpatient subsidies, Medisave top-ups and MediShield Life subsidies for seniors born in 1949 or earlier, and who became citizens before 1987. Singaporeans aged 55 and above this year who do not qualify for the Pioneer Generation Package will receive a Medisave top-up of between S$100 and S$200 a year over the next five years.

Healthcare practitioners whom TODAY spoke to agreed that the increase in government assistance could inadvertently lead to a spike in demand for hospital services. They suggested improving primary care provided by, for example, polyclinics to reduce the patient load on hospitals.

MOH statistics showed that, two weeks ago, more than four hospitals had bed occupancy rates of more than 85 per cent. The waiting times for admission also peaked at between six and seven hours for some hospitals.

Member of Parliament Chia Shi-Lu, who sits on the Government Parliamentary Committee for Health, noted that it is difficult for doctors to turn away hospital patients or refer them to step-down care facilities and polyclinics. “The patient might feel that we (doctors) are abandoning them,” said Dr Chia, who is a consultant at the Singapore General Hospital. He added that he has come across cases where patients refused to be discharged and these patients had to be persuaded by doctors and medical social workers.

Dr Chia said the MOH is looking at diverting some services to the polyclinics; for example, conducting simple medical tests and dispensing certain types of medicine to relieve the hospitals’ load.

Dr Chia said: “To change people’s perceptions of primary care, there also needs to be more publicity on our polyclinics.”

Tsao Foundation Hui Mei Centre for Successful Ageing Medical Director Ng Wai Chong noted that as older patients tend to have complex medical issues, hospital doctors who are seeing these patients for the first time might also prefer to admit them in order to examine them further.

The Salvation Army Peacehaven Nursing Home Executive Director Low Mui Lang said patients might also prefer to go to hospitals’ accident and emergency departments to obtain quicker referrals for specialist treatments.

To encourage more people to turn to primary care, she proposed that hospitals work with more general practitioners and accept their referrals. There could also be more enhancements to the Community Health Assist Scheme (CHAS) so that more patients do not have to worry about the costs of seeing a family physician, she said.

“The ministry can also consider standardising the income ceiling for the various health subsidy schemes ... to help people understand the healthcare benefits better,” she added.

Govt will ensure MediShield Life premiums affordable: Gan
More support for care in the community to be announced during Committee of Supply debate, says the Minister
By Eileen Poh, Channel NewsAsia, 25 Feb 2014

Health Minister Gan Kim Yong today (Feb 25) said the government will ensure that MediShield Life premiums will be affordable for Singaporeans, and lower-income families may receive more help to pay for the premiums.

Mr Gan also said that more support for care in the community, such as step-down care and homecare services, will be announced during the parliamentary debate on his ministry’s budget next month.

He said: “One important aspect MOH is looking at is how to manage healthcare costs, because with more funding, the risk is that it will drive up demand.

“There are a few strategies we will be adopting. One is proper gatekeeping to ensure that access to high-end expensive acute care is on a need basis.

“For example, if you don’t need to be in the acute hospital, then you ought not to be in the hospital; you may be looked after in a community hospital, the nursing homes or even at home.

“We will also be enhancing community support, primary care from our polyclinics through CHAS enhancement and through our community services support, by building more senior care centres, for example.”

Mr Gan was speaking to reporters after the recording of the Budget Forum in Mandarin, organised by MediaCorp.

Joining Mr Gan on the panel were representatives from social services, business associations and grassroots organisations. They were joined by 12 guests from diverse backgrounds, including tertiary students and owners of SMEs.

The Budget Forum in Mandarin will be aired on Channel 8 on Thursday at 10.30pm.

Measures in place to avoid overuse of health care
Govt has taken steps such as requiring co-payment for services
By Tham Yuen-c, The Straits Times, 27 Feb 2014

GENEROUS health-care subsidies for the pioneer generation and other groups of Singaporeans announced in last Friday's Budget may lead to the buffet syndrome, where people consume more than they actually need because something is free.

But the Government is well aware of this and has put in place safeguards such as co-payments to prevent the health-care sector from being overloaded, Senior Minister of State for Health Amy Khor and Senior Minister of State for Finance Josephine Teo said at a REACH post-Budget public forum yesterday.

Post by REACHSingapore.

Many among the 120 participants raised questions about the Budget's centrepiece, an $8 billion package of health-care measures to honour the efforts of Singapore's pioneer generation.

Some 450,000 Singaporeans will enjoy Medisave top-ups for life, subsidies for the new MediShield Life insurance scheme and subsidies for outpatient treatment.

Addressing a group that included working adults, students and retirees at the National Library, Mrs Teo took pains to warn about the pitfalls of over-consumption of health care, such as a strain on hospitals.

To avoid this scenario, the Government has subsidised outpatient treatment as well as hospitalisation and insurance premiums, said Dr Khor, who is also chairman of REACH, the Government's feedback arm.

Through the Community Health Assist Scheme (CHAS), which subsidises care at private general practitioners and dental clinics, Singaporeans will be encouraged to turn to their family physicians or polyclinics first, instead of going straight to hospitals, she added.

Another way of tackling over-consumption is through requiring co-payment, said Dr Khor. This way, individuals will be encouraged to take personal responsibility in their choices.

Participants also raised the question of whether taxes would rise to fund social spending.

Mrs Teo, who also holds the transport portfolio, said the Government will have to think of ways to increase revenue to balance responsible spending.

Over the last few days, REACH had received more than 400 pieces of feedback about this year's Budget. More than half focused on initiatives such as the Pioneer Generation Package, health-care affordability and further help for older Singaporeans, said Dr Khor.