Extending Medisave use to Asthma and Chronic Obstructive Pulmonary Disease (COPD)

3 March 2008

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03 Mar 2008

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 They have withdrawn a total of $17 million from their Medisave accounts.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 caption

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

29 JANUARY 2008