Help for clinic making claims

28 January 2014, Straits Times

Maximise potential of health aid scheme

THE Community Health Assist Scheme (Chas) is an excellent strategy to improve our health-care system, and I commend the respective agencies for their efforts ("Health help plan crosses half a million mark"; Jan 20).

However, the number of participating clinics has reached a saturation point.

Deputy Prime Minister Tharman Shanmugaratnam said close to half of all general practitioner and dental clinics in Singapore are on the scheme.

So what is stopping the other half from signing up?

First, it is difficult to administer the scheme.

Approval for claims is not automatic. The clinic manager will need to check if the reimbursement is approved and transferred into the clinic's bank account.

Should the submission be rejected, the doctor can choose to make an appeal, absorb the cost or claim it back from the patient. All these options are not ideal and need additional resources and goodwill to accomplish.

Second, the clinic needs to submit the diagnoses along with the claims.

But the suggested list of medical conditions is not comprehensive and free text is not allowed, adding to the doctors' frustration.

Third, the audit is too onerous.

Doctors may be asked questions that would not have arisen if the auditors understood the context or if the online template was better designed.

On the bright side, with more clinics participating in the scheme, Chas can be used to distribute health-care subsidies equitably across all segments of the population and at all public institutions.

The scheme can be extended to cover all Singaporeans. The subsidies granted can be stored in the Chas card and vary according to per capita income. The subsidies can be adjusted annually after the authorities have reviewed the cardholders' income tax returns. They can also be adjusted more frequently in bad times when retrenchment is high.

The Chas card should cover treatment at primary care, secondary care, tertiary care, and intermediate and long-term care facilities.

Singapore has an excellent tool in Chas. I hope the authorities will maximise its potential for the benefit of all.

Leong Choon Kit (Dr)

Reply from MOH

21 February 2014, Straits Times

Help for clinics making claims

WE THANK Dr Leong Choon Kit for sharing his views on the Community Health Assist Scheme ("Maximise potential of health aid scheme"; Jan 28).

While the scheme was originally conceptualised to offer alternative subsidised health care to needy citizens at clinics run by general practitioners (GPs), the Ministry of Health has enhanced the scheme over the years to enable more Singaporeans to receive subsidised care at participating GP and dental clinics.

In 2012, the qualifying age floor for the scheme was lowered from 65 to 40 years old, and the monthly household income per person cut-off was raised from $800 to $1,500.

More recently, we removed the age floor and further raised the monthly household income per person cut-off to $1,800, allowing more middle-income families, including young children, to enjoy subsidised care.

We have also expanded the list of acute conditions claimable under the scheme to allow for more comprehensive coverage of medical conditions commonly seen in the primary care setting.

Clinics can submit their claims electronically, and these are reimbursed automatically within one month of the date of receipt of the claims.

In some cases, the reimbursement can take longer than one month due to the need to seek further clarification from the clinics on the claims submitted, but this relates to a minority of claims.

We agree with Dr Leong that more can be done to simplify the claims process. Apart from providing training and support for participating clinics, we have introduced a designated hotline for clinics to call for assistance and to provide feedback.

Guides, collaterals and forms are also available to assist the doctors and clinic assistants, and facilitate the implementation of the scheme at their clinics.

On Dr Leong's concern that the suggested list of medical conditions is not comprehensive, we have expanded the drop-down list since January.

We have regular engagement with participating clinics and have been working towards progressively improving our processes to lower the administrative hurdle for these clinics.

We welcome suggestions on ways to further improve the claims process, to make it easier for clinics to come on board the scheme.

Bey Mui Leng (Ms)
Director
Corporate Communications
Ministry of Health