Medisave for Chronic Disease Management Programme

28 Aug 2006

Earlier this year, the Ministry of Health (MOH) announced its plan to improve the care for chronic diseases, starting with four conditions - namely diabetes, hypertension, lipid disorders (eg: high cholesterol) and stroke. The level of care will be raised through the promotion and extensive use of systematic, evidence-based chronic disease management programmes (DMPs). Patients with such chronic diseases are encouraged to work with their doctors, particularly their Family Physicians, to actively manage their diseases, through regular monitoring, appropriate medical treatment and lifestyle changes. As disease management programmes can largely be effected at the outpatient level, MOH will allow the use of Medisave to help pay part of the outpatient cost, making it affordable to the patients.

Through this initiative, the Ministry aims to achieve better health outcomes for these patients and avoid, delay or reduce the development of complications which otherwise would lead to hospitalisation and costly inpatient treatments. About one million Singaporeans suffer from one of the four chronic diseases. If all of them actively participate in this scheme, it is projected that Medisave withdrawal could reach up to $250 million a year, in the steady state.

But as Medisave is primarily set up for inpatient treatment, this significant liberalisation has to be carefully designed to ensure that Medisave does not inadvertently become prematurely depleted. MOH formed 2 committees to develop the programme: a Steering Committee to oversee implementation and integration of clinical, process and IT; and a Clinical Advisory Committee to refine the DMPs and provide professional medical inputs. MOH and CPFB have also consulted doctors, patients and other stakeholders extensively through a series of focus group discussions.

Implementation will be done in two stages. From 1 Oct 2006, the Medisave for Chronic Disease Management Programme will be launched with Diabetes Mellitus as the first chronic disease covered under the scheme. This will help us refine the implementation details with a view to extend the programme to the other chronic diseases - hypertension, lipid disorders and stroke - from 1 January 2007. Other chronic diseases with proven disease management protocols will be considered for inclusion under this scheme, after we have had some time to evaluate the effectiveness of the scheme.

MOH has developed a comprehensive support structure for this programme. First, we have developed web-based IT systems that make it convenient for the doctors to submit Medisave claims and relevant patients' health outcomes to MOH and CPF.

Second, we have developed educational tool-kits and other support materials for use by the doctors to help them explain to their patients more effectively.

Third, we will help the patients and their families better understand these diseases and what they can do to manage their conditions, so that they can achieve better health. Empowering the patients and motivating them to take responsibility for their own health and making relevant changes to their lifestyles, for example changing their diets and exercising, are important success factors. We will provide patients with patient education folders, which will include background information on chronic diseases, patient booklets for recording of vital clinical indicators to aid self-monitoring, and answers to patients' frequently asked questions.

Fourth, we will set up a helpline for the public to call in with their queries, as well as a website listing all participating clinics. The contact details will be provided in due course. This will be operational in September 2006.

During our public consultations with patients and care providers, we received strong support from them for the Medisave for Chronic Disease Management Programme.

Patients understood and supported a systematic program, and agreed on the need to have a regular doctor whom they can trust to manage their chronic diseases. MOH would like to use this opportunity to urge all Singaporeans to have their regular Family Physicians to help them manage their health. Clinic-hopping is less effective in controlling chronic diseases. The "One Singaporean, One Family Physician" approach will help Singaporeans achieve better health while saving cost.

GPs who attended the consultations have responded positively to this initiative, with many registering to provide care for patients under the programme. MOH will continue to reach out to the GPs, including a series of eight road-shows over the next 2 weeks (28 Aug to 9 Sep). These road-shows will elaborate on the details of the scheme and provide an opportunity for GPs to sign up for the programme. We strongly encourage GPs who are interested in the scheme to join us.

This is a national effort to radically change the way we treat chronic diseases. We must move from sub-optimal episodic or reactive care of symptoms, towards life-long holistic care emphasising prevention and health maintenance. The key is to manage such diseases while they are still mild or moderate, with a view to avoid future complications requiring multiple specialist attention. This way, we help save patients money while ensuring longer years of healthy life. We hope all patients will participate actively in this programme and cooperate with us to bring about better health for them.