Better Health Outcomes for the Chronically-Ill Through Structured Disease Management Programmes

17 Apr 2006

Chronic diseases are a major source of morbidity, suffering and misery to patients and their families in Singapore. They are also the major causes of death. This is a phenomenon common to all developed countries.

Four common chronic diseases affect about 1 million Singaporeans: diabetes mellitus, hypertension, hyperlipidemia (lipid disorders) and stroke.

If not properly managed, these diseases often lead to more serious complications. Many patients begin treatments late and only when severe complications arise. They end up going to multiple specialists for treatment of their many problems, suffering significant pain and hefty medical costs.

Yet, this need not be the case. With early detection and good management of these chronic diseases, complications can be avoided or delayed for many years.

There is general consensus among medical experts that for these chronic diseases, patients can achieve better health outcomes if they: (a) take co-responsibility of their care; and (b) receive structured evidence-based treatment by good family physicians working in partnership with hospital specialists. Such an approach is referred to as "disease management programmes".

The benefits of good disease management programmes have been demonstrated both overseas and locally, through pilot projects undertaken by MOH in public hospitals and polyclinics.

For example, if diabetes is well-managed through good control of blood sugar by the patients working in cooperation with their doctors and nurses, patients can avoid serious complications of blindness, kidney failure or foot amputation. Patients who take control of their illnesses and who actively comply with the disease management programmes prescribed by their doctors, including regular medication and changing lifestyle, will be able to substantially avoid the medical complications which would otherwise arise as they age.

MOH aims to raise the care of these four chronic diseases to a high level, in accordance with established disease management programmes which has strong scientific evidence of significantly better health outcomes. The strategic intent is to bring about better health outcomes for these patients and save them cost. Success will require: (a) good compliance by patients; and (b) adherence to prescribed practices by their doctors.

We will progressively transform the model of care for these chronic diseases on the ground. We will encourage GPs, family physicians and other clinics to set up good chronic disease management programmes for their patients. Government hospitals and polyclinics will also play their part. For example, the diabetes centres at SGH, AH and other hospitals will be happy to help family physicians set up such programmes. Government polyclinics will expand their pilot Family Physician clinics to benefit many more such patients. In Jurong, the upcoming Jurong Medical Centre will strive to be a major chronic disease management centre for residents there.

MOH will monitor and publish regularly the performance, cost and effectiveness of these disease management programmes so that patients can make informed choices when selecting providers. We will steer patients and doctors towards this strategy of preventive maintenance to stop or slow down the deterioration of medical conditions.

To do so, MOH will do the following:

• First, doctors who have such interest will be encouraged to participate in these disease management programmes. We will publish a list of such doctors, monitor their effectiveness and include such information on our website.

• Second, patients with any of these chronic diseases will be advised to register with these doctors, who will presumably be their Family Physicians. We will monitor the cost and health outcomes of these patients and publish meaningful data for both patients and doctors to see and learn from one another.

• Third, MOH will allow Medisave to be used to help pay for these disease management programmes, even when treatment is carried out as outpatient care.

This is a big step for Medisave. Medisave was designed primarily to pay for inpatient care; it was not intended for outpatient care as outpatient care can be easily abused or overused. If Medisave is prematurely depleted through unnecessary or ill-advised outpatient treatment or marginally effective medical screening, it will cause financial hardship for the patients when they require hospitalisation in old age.

MOH will therefore proceed with this scheme with prudence.

First, we will initially limit this scheme to these four chronic diseases - diabetes, hypertension, lipid disorders and stroke

Second, the use of Medisave under this scheme will be subject to three safeguards:

1. Deductible: A deductible of $30 will be set on each outpatient bill. Bills below $30 will continue to be paid in cash;

2. Co-payment: A co-payment (in cash) of 15% on each outpatient bill in excess of the deductible will be set; and

3. Annual withdrawal limit: Withdrawals will be subject to an annual outpatient withdrawal limit of $300 per Medisave account.

Third, continuation of withdrawals from Medisave need to be backed up by regular certification by the doctors that the patients are complying with the disease management programmes.

MOH projects annual withdrawals of up to $250 million from Medisave under this scheme. As this is a major move, careful thought is needed to ensure successful implementation. Over the next few months, MOH and CPFB will consult doctors, patients and other relevant parties on the implementation details. We aim to implement the scheme before year end.

Related Info:

• Frequently Asked Questions on Usage of Medisave for Chronic Illnesses (17 KB)