Subsidies provided on reimbursement basis

MOH’s Reply

Straits Times, 26 April 2014

WE THANK Mr Ian Sim ("Designating a way to improve Chas take-up"; Monday), Mr Francis Cheng ("Return unused entitlements to a sinking fund"; Monday) and Dr Yik Keng Yeong ("Let family members pool entitlements"; April 15) for their feedback and suggestions to enhance primary care services.

Primary care plays an important role in our health-care system. Many Singaporeans understand this and visit our polyclinics and general practitioner (GP) clinics to manage their medical conditions, including chronic diseases.

Even as we continue to add capacity and enhance services in our polyclinics, the Ministry of Health has progressively expanded the Community Health Assist Scheme (Chas) so that more Singaporeans can receive subsidised care at participating GP and dental clinics. About 1,000 private clinics around Singapore are now participating in Chas, and we encourage Singaporeans to see a regular GP in a Chas clinic near their homes, as suggested by Mr Sim.

Dr Yik suggested that Chas subsidies be treated as entitlements that families can pool together, so that unused benefits from healthy members can be channelled to the less healthy ones.

Chas subsidies, as with other health-care subsidies, are provided on a reimbursement basis, to bring down the cost of treatment actually delivered to patients.

We review the level of subsidies regularly to keep the cost of treatment affordable for patients. Needy patients may seek financial assistance for their treatment at public health-care institutions.

We will continue to explore initiatives to improve accessibility to primary care for Singaporeans, and will take the suggestions into consideration as we review Chas in future.

Bey Mui Leng (Ms)

Director

Corporate Communications

Ministry of Health

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Straits Times, 21 April 2014

Designating a way to improve Chas take-up

THE Community Health Assist Scheme (Chas), which is a scheme by the Ministry of Health (MOH) to enable Singaporeans to receive subsidies at participating general practitioner (GP) clinics, aims to ensure that Singaporeans receive medical care near their homes.

However, based on anecdotal comments that have appeared in the press, many patients still prefer to seek medical treatments at polyclinics, resulting, in many cases, in longer waiting times for them.

A coordinated national system where every Singaporean is assigned a few Chas-accredited GP clinics near his home - rather like the practice where voters are allocated designated polling stations in a general election - may reduce the high patient load at polyclinics, as well as provide more convenient and coordinated care by the GPs.

This measure is also in line with the MOH vision of "One family physician for every Singaporean".

To make the system more appealing, incentives such as more subsidies for medical treatments could encourage a shift in public mindset, to one that sees that such GP clinics also provide quality and affordable health care for the population.

This initiative may also persuade those GPs who are at present not interested in joining Chas, to rethink their stance.

The MOH has taken the right steps to speed up development of the health-care infrastructure, by way of building more polyclinics and introducing greater liberalisation of the use of Medisave.

It should, however, recognise that polyclinics would never provide the same convenience as private clinics, and public resistance to seeking subsidised care at Chas-accredited GPs remains because of a lack of education on the issue and proper communication.

There is thus more urgency on the part of MOH to improve and ensure the right siting of care, so that other public health-care resources, such as hospital accident and emergency departments, can focus more on their core roles.

Ian Sim

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Straits Times, 21 April 2014

Return unused entitlements to a sinking fund

PROGRAMMES like the Community Health Assist Scheme (Chas) are heavily subsidised by our Government and taxpayers, so it is fair for the unused portions to be put back into a sinking fund to help other needy people ("Let family members pool entitlements" by Dr Yik Keng Yeong; last Tuesday).

Funds are needed not just for health care but also for education, and social and family safety nets, among others.

Unlike Medisave, which is paid for with an individual's own money, funds for Chas come from government surplus and should be distributed evenly on a national scale.

The duty of care should not pass entirely to the State. Working adults should chip in with their own cash if a family member has exhausted his Chas entitlement. If a family is indeed very poor, it can apply for Medifund or the Public Assistance Scheme.

As demographics change, the health-care challenge Singapore faces is tremendous. There is also a limit to how much the Ministry of Health (MOH) can do to care for our people.

The MOH has done a good job over the years to implement health programmes, improve policies and build infrastructure.

But expanding health-care facilities and training health-care professionals will take time. We should try to do our part by keeping ourselves fit to minimise age-related illnesses.

Education, early detection, prevention and preparation are key to staying healthy.

We must understand that Chas is not the only scheme that needs funding. Perhaps the MOH can consider a tiered Chas entitlement, where the young get less and the elderly more.

Francis Cheng

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Straits Times, 21 April 2014

Let family members pool entitlements

WITH our rapidly ageing population, chronic diseases associated with old age have become prevalent.

Primary health care is key in maintaining meaningful and productive longevity.

The Community Health Assist Scheme (Chas) has shifted some of the patient load from busy polyclinics to the private sector, effectively subsidising patients' medical fees regardless of whether they choose polyclinics or private practitioners.

Most patients can easily access general practitioners (GPs). Mr Ng Kum Leng, who wrote about his difficulties getting to polyclinics and hospitals, could persuade his GP to enlist in Chas ("Ease access to health-care facilities for seniors"; last Friday), just like how many of my GP friends and I were convinced to do so by our patients.

Doctors on the scheme find it easy to administer, the Government a good paymaster, and the scheme mutually beneficial to patients and themselves.

Almost all chronic conditions can be handled in private clinics just as well as they would be in polyclinics.

Anecdotally, the major problem with Chas is that patients with three or more chronic diseases find the subsidies insufficient, these being capped at $480 each year.

It would be helpful if families could pool their Chas entitlements, so unused benefits that healthy members are entitled to can be utilised by the sickly ones.

This is consistent with the current approach to Medisave, which allows family members to use their funds to pay for their family members' medical fees.

Yik Keng Yeong (Dr)