CHAS subsidies for pioneer generation

Pioneers to get medical subsidies
From September, those 65 or older will pay less for visits to the doctor and dentist
By Salma Khalik, The Sunday Times, 18 May 2014

Singapore's oldest citizens will pay less when they visit the doctor or dentist from September.

Their Pioneer Generation card will entitle them to significant subsidies when they need treatment for the common cold or chronic ailments, as well as selected dental treatments and health screening.

Everyone 65 or older this year will qualify, regardless of what they earn or where they live, and will get these subsidies at 1,000 clinics across Singapore.

Health Minister Gan Kim Yong revealed last night that the subsidies, under the Government's Community Health Assist Scheme (CHAS), will be more generous for pioneers than for poor and middle-income families already receiving this help.

The scheme is referred to commonly by the colour of the cards held by those who qualify - blue for lower-income families with a per capita household income of up to $1,100 and orange for middle-income families with a per capita income of between $1,101 and $1,800.

Mr Gan said subsidies for the pioneers will be "better than orange and blue" and easy to use once their Pioneer Generation cards are activated on Sept 1. About 450,000 seniors will qualify.

For common illnesses like the cough and cold, a blue card holder gets a subsidy of $18.50 when he sees the doctor, and orange card holders get no subsidy. But a pioneer will get $28.50 per visit to the doctor.

Someone with a single chronic condition like diabetes gets a subsidy of $80 per visit and up to $320 per year with a blue card, and $50 per visit and up to $200 a year with the orange card. The pioneer will get $90 per visit, and up to $360 a year. Pioneers with multiple chronic illnesses can get up to $540 a year compared with $480 for those with the blue card and $300 for orange card-holders.

Mr Gan said a million people already suffer from diabetes, hypertension, high cholesterol levels and stroke. "As the population ages, we will be faced with not only a growing number of patients with chronic diseases but also patients with more complex co-morbidities which will in turn place a heavier demand for health-care services," he said at the World Family Doctors' Day dinner at Marina Bay Sands. "This shift in disease burden calls for a strong, comprehensive and integrated people-centred primary care."

Like those with the blue and orange cards, pioneers who need specialist treatment will qualify to be referred directly to a public hospital specialist at subsidised rates, without needing a polyclinic referral.

Prime Minister Lee Hsien Loong announced last year that Singapore's pioneers would be recognised for their contributions in the early days of nation-building. Not all the benefits have been announced, but most are likely to be health-linked, such as help with paying for medical insurance.

Mr Gan hoped more general practitioners would join the CHAS network of doctors. So far, more than half the GP clinics here have signed up since CHAS was rolled out in 2012.

To help GPs care for patients with multiple chronic problems, he also encouraged them to tap into the National Electronic Health Record. So far, just over 200 GP clinics are linked in.

He said GPs will play an important role in advising patients when to see a specialist and helping them navigate the different health-care settings, such as step-down care.

Retiree's asthma medication bill cut by $10 each trip
By Salma Khalik and Hoe Pei Shan, The Sunday Times, 18 May 2014

Every three months, Mr Ahmad Jawaher visits his polyclinic to buy asthma medication, without which he has difficulty breathing.

The 66-year-old receives medical subsidies under the blue tier of the Community Health Assist Scheme (CHAS), which caters to those with per capita household income of up to $1,100.

Mr Ahmad still ends up forking out $100 for each batch of medication, so he welcomed yesterday's news of further subsidies for pioneers like himself.

Health Minister Gan Kim Yong announced that from Sept 1, those eligible for the Pioneer Generation Package will get the highest subsidies under CHAS.

So for a doctor's visit for a single chronic condition like asthma, seniors such as Mr Ahmad will get a $90 subsidy instead of the current $80 he receives under the blue tier.

The annual cap has also been increased from $320 to $360.

"It's good for us," said the retiree. "A lot of my friends also have health problems."

Dr Chia Shi-Lu, who took over as head of the Government Parliamentary Committee (GPC) for Health last Friday, lauded the new subsidies, saying: "I have previously commented that for PG (pioneer generation) Singaporeans, there should be no means testing or income criteria for CHAS eligibility and I am glad this is now confirmed."

He said the higher subsidy is the cherry on the cake "which I am certain will have a significant impact and will be much welcomed".

He added: "It can be argued that recognition for a person's contribution to nation-building should not depend on a person's financial position.

"The PG Package is first and foremost a recognition measure and secondarily a welfare measure and it should stay true to that."

CHAS was originally meant for seniors aged 65 and older, to make it easier for them to get medical care at a general practitioner clinic nearer home, rather than go to a polyclinic for subsidised care.

It was later extended to patients aged 40 and older, and from the start of this year, to patients of all ages from low- to middle-income families.

Dr Chia said: "It is good to once again differentiate it with higher subsidies for the more elderly."

Challenge to 'connect the dots' in helping seniors
By Andrea Ong, The Sunday Times, 18 May 2014

The Pioneer Generation Package is a good policy that will ease the burden of medical bills, but the challenge is how to "connect the dots" on the ground to ensure that seniors know they can get help and are able to access the benefits, said Speaker of Parliament Halimah Yacob.

This means finding the right language to relate to them, understanding their unique circumstances, and walking them through every step of the care system, from filling in forms to seeing the doctor, said Madam Halimah and other panellists at a forum on the package yesterday.

The best people to translate policy into reality are thus those who are active in the community, she added. These include voluntary welfare organisations, grassroots groups and even fellow residents.

"This is where on the ground you need a lot of people who are very passionate and very caring, who are prepared to surface these cases and seek help for them," said the MP for Jurong GRC.

She was speaking at an event organised by self-help group Mendaki, for representatives of Malay-Muslim organisations to understand the package better, as well as discuss its outreach and health-care issues.

Since the $8 billion package was announced in February, the Government has used several platforms, from getai to door-to-door household visits, to let older Singaporeans know of its benefits.

Spreading the word about the pioneer package, which subsidises medical care from the primary to acute stages, can also be done by tapping seniors' social networks, said Madam Halimah.

On its part, the Government can join the dots among the many players offering help.

"The question is how do we engage all these various groups so that we make sure at every contact point when seniors are there, they are able to receive this message," she said.

Another speaker, Ms Peh Kim Choo, director of the Hua Mei Centre for Successful Ageing, emphasised the importance of having a network of care managers - both volunteers and professionals - in the community.

This, along with a hearty dash of the kampung spirit, can help seniors to age in place within the community and an environment familiar to them, said Ms Peh.

Mr Gerard Ee, chairman of the Council for Third Age and the Eastern Health Alliance, said the old distinction between health care and social services no longer holds.

There is a growing realisation that agencies need to work together closely to plug gaps in the system, he said.

For instance, pharmacists at Changi General Hospital have been told to keep an eye out for patients who ask for medicine dosages less than what they were prescribed. They will refer these patients to medical social workers, who will ensure those facing financial difficulties do not fall through the cracks.

On the divide between perception and reality, cardiologist Abdul Razakjr Omar called for more effective communication to let people know there is always help on hand - such as through Medifund - to meet medical bills.

All four speakers agreed that health care must go beyond institutions like clinics and hospitals. Madam Halimah and Ms Peh called for more to be done in long-term and home care.

Mr Ee noted that charitable groups can also be guilty of adding to unhealthy diets when they fill food packages for the low-income with items like instant noodles.

"All these bits and pieces are even more important than just subsidies, subsidies and subsidies. We don't want people to fall sick in the first place," he said.