|
Source:
www.moh.gov.sg |
Extending Medisave use to Asthma and Chronic
Obstructive Pulmonary Disease (COPD) |
|
|
From 1 April 2008, Medisave can also be used
for the outpatient treatment of two more chronic diseases: asthma and
chronic obstructive pulmonary disease (COPD). |
In 2006/2007, the Ministry of Health
launched a scheme to allow Medisave to be used to support the treatment
of 4 chronic diseases at the outpatient level: diabetes, hypertension,
lipid disorders (e.g. high cholesterol) and stroke. |
Through this scheme, the Ministry aims to
enhance the health of these patients. If these diseases are better
managed with good compliance by the patients, they are likely to be able
to avoid or delay disease complications which, otherwise, would lead to
hospitalization and costly inpatient treatments. There are
well-established treatment protocols on how these diseases can be better
managed at the community level by family physicians. |
Experience in 2007 |
In the first full year of implementation,
the scheme has benefited more than 91,000 patients. They have withdrawn
a total of $17 million from their Medisave accounts. Medisave has
enabled the patients to pay for the outpatient management of their
chronic diseases. |
Over 700 or half of all GP clinics are
participating in this scheme. This means that well-managed care
for chronic diseases is easily accessible with at least one
participating clinic within walking distance for most
Singaporeans. |
The participating doctors are required to
submit relevant clinical data on their patients to the Ministry. This
serves two purposes. First, it ensures that the patients receive care
under established evidence-based care protocols. Second, it allows us to
track the health status of the patients over time. For instance, does
the cholesterol level improve? |
The implementation has been smooth.
Submission of clinical data is electronic and hassle-free. There is good
compliance with established protocols. For example 8 in 10 diabetic
patients had their blood tested twice a year, in accordance with the
recommended protocol. 70% of them had acceptable, or better, control of
their diabetes. Nearly half of patients with lipid disorders had good
control of their cholesterol. These baseline data would enable us to
monitor the impact of our chronic disease management programme (CDMP)
over time. |
Expanding CDMP to Asthma and COPD |
From April 1, we will extend the scheme to
the two key remaining chronic diseases -- asthma and COPD. This can
potentially benefit 180,000 Singaporeans. |
Medisave withdrawal rules will be identical:
withdrawals will be capped at $300 per Medisave account per year; the
existing deductible of $30 and co-payment of 15% will also apply. |
Through educational materials and a
series of road shows, participating GPs will be informed of the
care protocols for these two diseases. These care protocols are
well-established internationally and have been endorsed by a
Clinical Advisory Committee, consisting of GPs and specialists in
these areas. |
Similar to the other 4 chronic
diseases, GPs are required to submit clinical data for asthma and
COPD. |
Supplementary information on
the clinical outcomes of the scheme in year 1 |
Table 1: Process of Care |
|
Recommended Care Components |
Proportion of patients who
received recommended care components (in %) |
|
Diabetes*: |
|
1 |
2 HbA1c tests(a
blood test to assess the control of diabetes) |
79.3 |
2 |
2 Blood pressure measurements |
68.9 |
3 |
2 Bodyweight measurements |
56.4 |
4 |
1 LDL-C test(a
type of cholesterol blood test) |
74.9 |
5 |
1 Nephropathy assessment |
62.5 |
6 |
1 Eye assessment |
53.8 |
7 |
1 Foot assessment |
51.8 |
8 |
1 Smoking habit assessment |
6.6 |
|
|
|
|
Hypertension*: |
|
1 |
2 Blood pressure measurements |
69.5 |
2 |
1 Bodyweight measurement |
87.6 |
3 |
1 Smoking habit assessment |
5.4 |
|
|
|
|
Lipid Disorders*: |
|
1 |
1 LDL-C test |
78.3 |
2 |
1 Smoking habit assessment |
6.7 |
|
|
|
|
Stroke*: |
|
1 |
2 Blood pressure measurements |
47.2 |
2 |
1 LDL-C test |
52.8 |
3 |
1 Clinical thromboembolism risk
assessment |
27.8 |
4 |
1 Smoking habit assessment |
0.0 |
Note:
*Only
patients who had been on the scheme for one year are included
in this Table. |
|
MINISTRY OF HEALTH |
Source:
www.moh.gov.sg Press Release 3
March 2008 |
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