Friday, 20 March 2020

Medisave withdrawal limits commensurate with Singaporeans' healthcare needs

We thank Dr Yik Keng Yeong for his feedback (Why set Medisave withdrawal limit to per-patient basis?, March 16).

To help Singaporeans manage their chronic conditions, the Ministry of Health (MOH) has been expanding financing support to them. This includes primary care chronic subsidies under the new Community Health Assist Scheme (CHAS) green card, and special outpatient and CHAS subsidies for the Pioneer and Merdeka generations.

Under the Medisave500 scheme, patients are able to withdraw up to $500 yearly to further offset their costs for outpatient chronic disease treatments, approved vaccinations and screenings.

As the cost of treatment is closely linked to the complexity of a patient's chronic medical condition, MOH will introduce Medisave700 from 1 Jan 2021 to better support patients with complex chronic conditions who will be able to withdraw up to $700 yearly under the scheme.

We expect more than 176,000 patients to benefit from the higher withdrawal limit.

MOH has carefully studied the impact of the change of the withdrawal limits to a per-patient basis. Only a small proportion of patients will exceed this limit, especially with the new higher limits for patients with complex conditions. This is also similar to how the rest of the Medisave withdrawal limits are structured.

Furthermore, family members can still use their Medisave to pay for the patient's treatment as suggested by Dr Yik, up to the annual limit of the patient.

Patients who face difficulties with their subsidised medical bills may approach their medical institutions for advice and assistance, and those in need may apply for more financial support through Medifund. No Singaporean will be denied access to appropriate healthcare due to an inability to pay.

Cham Dao Song
Director, Finance Policy
Ministry of Health
ST Forum, 19 Mar 2020

Why set Medisave withdrawal limit to per-patient basis?

The increase in Medisave funds utilisable for chronic medical ailments from $500 to $700 annually per patient, due to be implemented in 2021, is a welcome move (Higher Medisave withdrawal limit for complex chronic conditions, March 6). It is consistent with a trend that the Government has followed since the scheme as first started more than 10 years ago.

But a separate change to the policy, setting the withdrawal limit to per-patient basis instead of per-account basis, so that the limit of $700 is applied regardless of how many family members' accounts are used for treatment, is confusing and seemingly regressive.

Whereas it is easy, especially with Community Health Assist Scheme, Merdeka Generation or Pioneer Generation governmental subsidies, to treat one chronic condition within the new framework, when more comorbidities are present, it is difficult from the general practitioner's perspective to do so as effectively without compromise towards best practice.

When loved ones want the best care for patients, almost all are willing to contribute their own Medisave monies to help out, and far prefer this to cash outlay.

It is not difficult for doctors to exploit this compassion, but we are subjected to constant auditing by the Ministry of Health and the Central Provident Fund Board, so that any shenanigans perpetrated will be exposed and severely punished, as has happened before.

Were there in-depth consultations with the College of Family Physicians before the ministry came out with this new framework?

What is the logic and rationale behind this new policy, which may prove detrimental to both the welfare of patients and general practitioners, when the original system was working well and not broken?

And if we can still use our Medisave funds to pay towards close relatives' hospital bills, is the new policy inconsistent?

Wouldn't it be far more cost effective to use these funds to provide resolute primary healthcare to stave off protracted and expensive stays in hospitals?

Yik Keng Yeong (Dr)
ST Forum, 16 Mar 2020

Higher Medisave withdrawal limit for patients with complex chronic conditions from January 2021
By Amrita Kaur, The Straits Times, 5 Mar 2020

From January 2021, patients with complex chronic conditions such as diabetes, stroke and dementia, can withdraw up to $700 from their Medisave account each year for their treatment, up from $500, said Senior Minister of State for Health Edwin Tong on Thursday (March 5).

But the higher limit is only for patients with two or more conditions under the Chronic Disease Management Plan (CDMP) or one CDMP condition with complications.

The limit stays at $500 for all other Medisave account holders, including those with only one CDMP condition without complications.

The new limits "increase flexibility for patients with complex chronic conditions, as they are likely to incur higher costs for their CDMP treatments", Mr Tong said, during the debate on his ministry's budget.

He was replying to MPs such as Ms Tin Pei Ling (MacPherson) and Mr Pritam Singh (Aljunied GRC), who had called for greater flexibility in the Medisave withdrawal limits, especially for seniors with significant balances.

Another change he announced is that the withdrawal limit will be set according to per-patient basis instead of per-account basis.

This means a patient is eligible to withdraw up to only the $500 or $700 limit regardless of how many family members' accounts he had used for his treatment.

Previously, patients who tap on family members' accounts can have their withdrawal limits raised depending on the number of accounts they used.

The changes are expected to benefit about 176,000 people, Mr Tong said.

He also told the House his ministry is working to increase the flexibility of Medisave in other ways.

One possibility is allowing Medisave savings to be used for more treatments and services.

Currently, it can be used for inpatient and day surgery at acute hospitals, outpatient treatment and some screening tests such as mammogram and colonoscopy.

Another potential move is letting people with severe disabilities withdraw cash, which is set to be part of the upcoming Medisave for Long-Term Care scheme.

"With cash withdrawals, patients will also have greater flexibility to choose appropriate care options," said Mr Tong.

Within schemes, patients are also benefiting from greater flexibility, he added.

An example he cited is the lowering of the age threshold of the Flexi-Medisave scheme in 2018 from 65 to 60.

The scheme allows these Singaporeans to withdraw up to $200 of Medisave each year to pay for their outpatient medical treatments at public sector specialist outpatient clinics and polyclinics, among others.

"These enhancements are designed to strike a balance between current medical expenses and future healthcare needs," said Mr Tong.

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