29th Nov 2023
From 1 December 2023, the Ministry of Health (MOH) will implement changes to the subsidy framework for implants. The key changes are:
a. Enhance subsidies to improve affordability for patients who require the use of implants[1] ; and
b. Apply the enhanced subsidy to implants on a new Implant Subsidy List, which comprises implants assessed by the Agency for Care Effectiveness (ACE) to be clinically- and cost-effective for specific clinical indications.
2. Under the current capped implant subsidy framework, patients receive subsidies for all implants, subjected to a dollar cap. Singapore Citizens are subsidised up to 50% capped at $1,000, and Singapore Permanent Residents are subsidised up to 25% capped at $500.
3. This subsidy framework is not ideal. First, it applies to almost all implants irrespective of their clinical- or cost-effectiveness. As a result, there is little incentive for implant manufacturers to reduce prices to improve patient affordability, since their implants are already eligible for subsidy. Second, the dollar cap on the subsidies also disadvantages patients who need higher cost implants.
4. With a rapidly ageing population, the utilisation of implants is expected to increase in the coming years. We also expect newer and higher cost implants entering clinical use rapidly. We should refresh the current implant subsidy framework so that it works better for our patients.
IMPLANT SUBSIDY LIST
5. From 1 December 2023, MOH will introduce the Implant Subsidy List. These are implants that are fully registered with the Health Sciences Authority (HSA), and assessed by ACE to be clinically- and cost-effective for specific clinical indications. Patients who meet the clinical criteria for implants on the Implant Subsidy List will be eligible for higher subsidies than today.
6. For example, from up to 50% capped at $1,000 currently, Singaporeans will receive between 50% to 80% subsidy in class C/B2 wards and day surgery settings depending on their means-test level, with no overall dollar cap. As for Singapore Permanent Residents, from up to 25% capped at $500 currently, they will receive between 25% to 50% subsidy in class C/B2 wards and day surgery settings. The clinical criteria of the implants are published on the MOH website at https://www.moh.gov.sg/healthcare-schemes-subsidies/implant-subsidy-list.
7. With the higher percentage subsidy for implants on the Implant Subsidy List, we will lift the existing dollar cap. With the secured price reductions and enhanced subsidies, patients who meet the clinical criteria to use implants on the Implant Subsidy List will generally have lower out-of-pocket payments than today. Please refer to Annex A for the revised subsidy framework at the various settings.
8. With the Implant Subsidy List, implants are no longer automatically eligible for subsidy. This facilitates negotiations with implant manufacturers for more competitive prices, and increases affordability of clinically- and cost-effective implants to patients. MOH had earlier rolled out a pilot Implant Subsidy List for cardiovascular implantable electronic devices, transcatheter aortic valve implantation implants, transcatheter mitral valve leaflet repair implants and hearing implants. These resulted in price reductions of up to 25% and savings of around $8.3 million over 2017 to 2022. These savings were in turn passed on to patients.
IMPLEMENTATION
9. When launched on 1 December 2023, the Implant Subsidy List will cover 92% of the volume of implants used in public healthcare institutions, from the 15 implant categories that have been assessed. ACE will continue to assess the implant categories, which will transit to the Implant Subsidy List progressively over the next few years by end 2025. The Implant Subsidy List will be updated on MOH’s website every four months. Please refer to Annex B for the list of implant categories.
10. In the interim period, patients who need to use implants from categories that are not yet assessed by ACE will remain eligible for existing capped subsidies. Please see Table 1 for an illustration of the subsidy approach, effective 1 December 2023.
Table 1: Illustration of subsidy approach for Implants from 1 December 2023
| Implant Category
| Have implants been assessed by ACE for clinical and cost-effectiveness?
| Subsidy Approach |
1 | Intraocular Lens | Yes, implants have been assessed by ACE.
Only clinically- and cost-effective implants will be listed on the Implant Subsidy List | If implant is listed on the Implant Subsidy List and patient meets the clinical criteria:
Depending on their means-test status, patients may receive (in class C/B2 wards and day surgery settings): · Singapore Citizens (SCs): between 50% to 80% subsidy · Singapore Permanent Residents (PRs): between 25% to 50% subsidy
There is no dollar cap.
If (a) implant is not listed on the Implant Subsidy List or (b) implant is listed on Implant Subsidy List, but patient does not meet the clinical criteria for the implant:
Patients are not eligible for subsidy.
|
2 | Neurovascular implants | No | Up to 50% subsidy, capped at $1,000 (SCs) or 25% subsidy, capped at $500 (PRs). |
11. There are no changes to MediShield Life, MediSave and Integrated Shield Plans coverage for implants for now. Regardless of whether the implant is listed on the Implant Subsidy List, patients may continue to tap on these schemes where applicable to pay for the implant, subject to the respective limits. MOH will monitor the implementation of the Implant Subsidy List and review the financing coverage of these schemes at a later juncture.
ENSURING HEALTHCARE REMAINS AFFORDABLE
12. These changes are part of MOH’s ongoing efforts to enhance healthcare affordability while ensuring healthcare cost growth remains sustainable. Patients who face affordability concerns may approach medical social workers at Public Healthcare Institutions for financial assistance.
MINISTRY OF HEALTH
29 NOVEMBER 2023
[1] Implants are medical devices that are surgically emplaced in or on the surface of the human body.