LAUNCH OF THE 2023 NATIONAL STRATEGY FOR PALLIATIVE CARE

The Ministry of Health (MOH) has launched the 2023 National Strategy for Palliative Care (NSPC), which outlines recommendations to expand and improve palliative care in Singapore, to enable more people to fulfil their aspirations to leave with dignity and comfort according to their preferences. In parallel, MOH has reviewed the financing framework for palliative care, and will enhance financing support for palliative care from 2024, which will improve affordability and support capacity expansion.

National Strategy for Palliative Care

2. A workgroup, comprising palliative care experts appointed by MOH, has formulated a new suite of 11 recommendations under the focus areas of Access, Quality, and Palliative Care Environment, which informs MOH’s development plans for the palliative care sector for the next five to 10 years. MOH has accepted the recommendations, and an Implementation Committee comprising sector stakeholders will oversee their implementation over the next five years. 

Access

3. All patients with life-threatening illnesses should receive timely access to palliative care that meets their needs. To do this, we should develop a sustainable care model across all care settings. 

4. There should be clear definitions of the roles, competencies, and training requirements of each healthcare profession in each setting. Patients should also be systematically screened to enable timely identification and support. To expand palliative care capacity to meet the growing needs of an ageing population, besides increasing specialised palliative care services, there should be a need to build basic palliative care capabilities in nursing homes, home care and primary care.

5. Financing support for palliative care should also be reviewed to ensure affordability. This will better support patients and caregivers to take up palliative care services.

Quality 

6. All patients with life-threatening illnesses should receive quality palliative care, and providers should achieve continuous improvement in their service standards. To achieve this, the national palliative care guidelines should be enhanced for both general and specialised palliative care providers, with greater emphasis on psychosocial domains, and bereavement care and support for caregivers. National benchmarking should be implemented to ensure that palliative care delivery in Singapore is held to high standards. 

Palliative Care Environment

7. All stakeholders – professionals, caregivers, public – should leverage a supportive and growing palliative care environment. Support for caregivers of palliative care patients should be enhanced, through improved clinical protocols for hospital discharge and enhanced respite care. To deepen the understanding of death and dying within the community, awareness of palliative care and pre-planning should be raised through public education efforts. This should include building up a pool of community volunteers to serve as advocates of palliative care and provide support to end-of-life patients and their caregivers. 

8. Succession planning within the palliative care fraternity should be developed, with more opportunities for exposure of healthcare workers to the community care sector. There should also be greater alignment of research efforts with policymaking, with a focus on ways to measure and improve access and quality of palliative care, innovative care models, and use of technology in palliative care. 

Enhanced Financing for Palliative Care from 2024

9. MOH will enhance subsidies for palliative care, adjust the MediShield Life claim limits for inpatient palliative care, and remove the MediSave lifetime withdrawal limit for home palliative care and day hospice patients who use their own MediSave. This will improve affordability and access to palliative care and complement the recommendations by the NSPC workgroup. The increased financing support will also enable palliative care providers to expand their capacity to support more clients in meeting their preferences to pass away at home.

Subsidy 

10. MOH will significantly enhance subsidies for inpatient palliative care, home palliative care, and day hospice care. Under the revised palliative care subsidy framework, all Singapore Citizens will receive subsidies of at least 50%, regardless of their Per Capita Household Income (PCHI). Overall, almost all patients will benefit from higher subsidies, with increases of up to 55 percentage points. These changes will be implemented in the fourth quarter of 2024. 

MediShield Life
 
11. MediShield Life coverage was extended to inpatient palliative care in 2020 to better support patients who require these services. To improve patient affordability, we will increase the MediShield Life claim limits for inpatient palliative care. The daily claim limits will be raised from $250 to $460 for general inpatient palliative care, and from $350 to $500 for specialised inpatient palliative care. Details of the revised financing framework are in the Annex.

MediSave

12. We will remove the MediSave $2,500 lifetime withdrawal limit for all home palliative care and day hospice patients who use their own MediSave. The limit will remain for patients who tap on their family members’ MediSave, to preserve it for their own healthcare needs. 

13. The above MediShield Life and MediSave changes will be implemented in the first quarter of 2024.

Long-Term Care Drug Subsidy Scheme and Vaccine Subsidy Framework

14. To complement the financing shifts for palliative care services, MOH will also enhance drug and vaccine subsidies for long-term medical care services, such as nursing home, home medical, and palliative care services. Currently, drug and vaccine subsidies are only extended to long-term medical care patients from lower- to middle-income households. Moving forward, we will extend drug and vaccine subsidies^[1] of at least 50%, similar to what they would receive at public healthcare institutions, to all Singapore Citizens who are patients of MOH-funded providers of eligible long-term medical care services. This will improve access to subsidised drugs and vaccines, especially for homebound patients.

15. In addition, we will align drug and vaccine subsidies for patients utilising nursing home, home medical, home palliative care, and day hospice services with those at Specialist Outpatient Clinics. These changes will take place in the fourth quarter of 2024.

16. The full details of the 2023 National Strategy for Palliative Care are available at https://go.gov.sg/2023nspc.

MINISTRY OF HEALTH 
1 JULY 2023

^[1] Vaccine subsidies are not applicable to palliative care patients.

As of 5 July 2023, paragraph 14 has been amended for factual accuracy.