Monday, March 18, 2013

Call for wider Medisave coverage

Mar 18, 2013
Experts and patients want more for outpatient care and screening tests

By Poon Chian Hui

A RENEWED call has been made by experts and patients to expand Medisave to cover a wider range of outpatient treatment, in the light of the current review of the health-care financing system.

Health Minister Gan Kim Yong said during the Budget debate last week that the review of the 3M framework - comprising Medi- save, MediShield and Medifund - will involve "fundamental shifts".

The Straits Times asked some 20 health-care professionals, patients and MPs to list the changes they would like to see for Medisave, the national medical savings scheme that was started in 1984.

Besides more outpatient care, more funding for health screening and diagnostic tests like CT scans was also high on their wishlists.

Some suggested that more savings could go towards better medical insurance coverage, to better cushion health-care shocks.

But a few pointed out that a more liberal use of Medisave may mean that people have to contribute more than the current 7 per cent to 9.5 per cent of their wages into Medisave.

Currently, Medisave can be used for outpatient costs of up to $400 a year for the treatment of 10 chronic ailments, including diabetes and depression.

As of the end of last year, elderly people between 65 and 70 years old had an average of about $19,000 left in their Medisave accounts, said the Health Ministry.

With the traditional focus of the scheme on inpatient care, it may be timely to examine how it can be further used for outpatient expenses, said Dr Chia Shi-Lu, MP for Tanjong Pagar GRC. "The fact remains that many more of us need outpatient rather than inpatient care."

Dr Chia, an orthopaedic surgeon at Singapore General Hospital, suggested having higher withdrawal limits for patients with multiple chronic illnesses - a sentiment shared by National Heart Centre Singapore's chief medical social worker Genevieve Wong.

Ms Wong said it may be helpful to increase withdrawal limits according to age, as older patients tend to succumb to several chronic illnesses at once, and yet have less disposable income.

Dr Lam Pin Min, MP for Sengkang West and head of the Government Parliamentary Committee for Health, also hopes that more chronic illnesses beyond the current 10 can be covered.

A group of medical social workers from Tan Tock Seng Hospital went one step further and said those with non-chronic diseases "have equal rights to the use of Medisave".

Such a measure would help cancer survivor Chua Seng Lan. The 73-year-old beat colon cancer two years ago but now has hearing loss and cataracts.

Yet, these two common age- related health problems are not among the chronic illnesses that Medisave can be used for.

"For everything, I'm paying in cash," Mrs Chua said, adding that one of the consultations cost over $100.

Khoo Teck Puat Hospital's deputy chairman of the medical board Michael Wong said Medisave could be liberalised for preventive care such as health screenings, a point echoed by MP for Marine Parade GRC Fatimah Lateef.

Dr Wong suggested a one-time claim of $1,000 for screening tests after the age of 40. By then, most people would have insurance coverage in place, he said.

Structural engineer Koh Chian Meng, 33, suggested removing the $600 annual cap for cancer patients' outpatient scans as a full-body MRI scan can run into the thousands of dollars.

Health economist Phua Kai Hong of the National University of Singapore said more can go towards better coverage under government insurance schemes MediShield and ElderShield.

There are annual limits on how much one can use Medisave to pay for the premiums, and this mainly covers only the basic plan. Add-ons may have to be paid for in cash.

But Prof Phua said insurance is better suited to deal with big bills and long-term care.

Other ideas include extending Medisave to cover day rehabilitation, nursing home stays, home care and hospice care for the terminally ill.

Medical director of Dover Park Hospice, Dr Angel Lee, suggested that inpatient and home hospice care bills be fully paid for using Medisave, as "it is probably the last time they'll use their hard- earned Medisave for themselves".

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