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Source:
www.moh.gov.sg |
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Better Health Outcomes for
the Chronically-Ill Through Structured Disease Management
Programmes |
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Chronic diseases are a major source of
morbidity, suffering and misery to patients and their families in
Singapore. They are also the major causes of death. This is a phenomenon
common to all developed countries. |
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Four common chronic diseases affect about 1
million Singaporeans: diabetes mellitus, hypertension, hyperlipidemia
(lipid disorders) and stroke. |
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If not properly managed, these diseases
often lead to more serious complications. Many patients begin treatments
late and only when severe complications arise. They end up going to
multiple specialists for treatment of their many problems, suffering
significant pain and hefty medical costs. |
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Yet, this need not be the case. With early
detection and good management of these chronic diseases, complications
can be avoided or delayed for many years. |
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There is general consensus among medical
experts that for these chronic diseases, patients can achieve better
health outcomes if they: (a) take co-responsibility of their care; and
(b) receive structured evidence-based treatment by good family
physicians working in partnership with hospital specialists. Such an
approach is referred to as "disease management programmes". |
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The benefits of good disease management
programmes have been demonstrated both overseas and locally, through
pilot projects undertaken by MOH in public hospitals and polyclinics. |
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For example, if diabetes is well-managed
through good control of blood sugar by the patients working in
cooperation with their doctors and nurses, patients can avoid serious
complications of blindness, kidney failure or foot amputation. |
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Patients who take control of their illnesses
and who actively comply with the disease management programmes
prescribed by their doctors, including regular medication and changing
lifestyle, will be able to substantially avoid the medical complications
which would otherwise arise as they age. |
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MOH aims to raise the care of these four
chronic diseases to a high level, in accordance with established disease
management programmes which has strong scientific evidence of
significantly better health outcomes. |
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The strategic intent is to bring about
better health outcomes for these patients and save them cost. Success
will require: (a) good compliance by patients; and (b) adherence to
prescribed practices by their doctors. |
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We will progressively transform the model of
care for these chronic diseases on the ground. We will encourage GPs,
family physicians and other clinics to set up good chronic disease
management programmes for their patients. Government hospitals and
polyclinics will also play their part. |
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For example, the diabetes centres at SGH, AH
and other hospitals will be happy to help family physicians set up such
programmes. Government polyclinics will expand their pilot Family
Physician clinics to benefit many more such patients. In Jurong, the
upcoming Jurong Medical Centre will strive to be a major chronic disease
management centre for residents there. |
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MOH will monitor and publish regularly the
performance, cost and effectiveness of these disease management
programmes so that patients can make informed choices when selecting
providers. |
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We will steer patients and doctors towards
this strategy of preventive maintenance to stop or slow down the
deterioration of medical conditions. |
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To do so, MOH will do the following: |
- First, doctors who have such interest
will be encouraged to participate in these disease management
programmes. We will publish a list of such doctors, monitor their
effectiveness and include such information on our website.
- Second, patients with any of these
chronic diseases will be advised to register with these doctors, who
will presumably be their Family Physicians. We will monitor the cost
and health outcomes of these patients and publish meaningful data for
both patients and doctors to see and learn from one another.
- Third, MOH will allow Medisave to be
used to help pay for these disease management programmes, even when
treatment is carried out as outpatient care.
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This is a big step for Medisave.
Medisave was designed primarily to pay for inpatient care; it was
not intended for outpatient care as outpatient care can be easily
abused or overused. |
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If Medisave is prematurely depleted
through unnecessary or ill-advised outpatient treatment or
marginally effective medical screening, it will cause financial
hardship for the patients when they require hospitalisation in old
age. |
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MOH will therefore proceed with this
scheme with prudence. |
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First, we will initially limit this
scheme to these four chronic diseases - diabetes, hypertension,
lipid disorders and stroke. |
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Second, the use of Medisave under this
scheme will be subject to three safeguards: |
- Deductible:
A deductible of $30 will be set on each outpatient bill. Bills
below $30 will continue to be paid in cash;
- Co-payment:
A co-payment (in cash) of 15% on each outpatient bill in excess
of the deductible will be set; and
- Annual withdrawal limit:
Withdrawals will be subject to an annual outpatient withdrawal
limit of $300 per Medisave account.
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Third, continuation of withdrawals
from Medisave need to be backed up by regular certification by the
doctors that the patients are complying with the disease
management programmes. |
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MOH projects annual withdrawals of up
to $250 million from Medisave under this scheme. As this is a
major move, careful thought is needed to ensure successful
implementation. |
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Over the next few months, MOH and CPFB
will consult doctors, patients and other relevant parties on the
implementation details. We aim to implement the scheme before year
end. |
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Source:
www.moh.gov.sg Press Release
17 Apr 2006 |
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Related Article: |
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-
Committee formed to steer Medisave use for chronic disease
management |
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FrontPage Edition: Tue 18 Apr 2006
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