Further Medisave Liberalisation

29 Mar 2009

MOH will launch two new initiatives this year, to allow Singaporeans to make greater use of their Medisave accounts:

(a) to cover elective (i.e. non-urgent) hospitalisation in approved hospitals overseas;

(b) to cover home palliative care.

(a) Elective Hospitalisation for Treatment Overseas

2. Medisave is meant to cover treatment in Singapore; but we have allowed the use of Medisave overseas under strict conditions such as emergency treatment (e.g. a heart attack while overseas).

3. Over the years, we have received requests from many Singaporeans about allowing the use of their Medisave for elective hospitalisation overseas.  The unionists have asked for this at a public dialogue with the Minister for Health. More recently, the issue was raised in Parliament by several MPs.

4. MOH has decided to allow this.  This will give Singaporeans a wider choice of hospitals when considering elective treatment, so as to help them stretch their Medisave dollars and save money.  There are however, concerns over ensuring safety and adequate standards, while guarding against fraudulent claims.

5. We will hence allow this use cautiously, with suitable safeguards.  Overseas Medisave use will only be limited to hospitalisations and day surgeries. The overseas hospital should have an approved working arrangement with a Medisave-accredited hospital in Singapore. Medisave claims can only be made through the Singapore hospitals, and subject to the following conditions:

(i) Overseas use of Medisave should be limited to patients normally resident in Singapore;

(ii) The local attending doctor should certify the patient’s condition and necessity of medical treatment; and

(iii) The referring local hospitals remain accountable for patient satisfaction and good clinical outcomes for patients referred overseas, at the same standard as if the patients were treated in Singapore.

6. MOH has started discussions with a number of Singapore hospitals who are keen to make this option available to their patients.  The scheme will be implemented as soon as they are ready.

(b) Home Palliative Care

7. Palliative care provides a programme of coordinated medical and nursing care to the terminally ill. It aims to improve the quality of life for the patients through pain control, symptom relief, nursing care, counselling and bereavement support. 

8. Palliative care can be provided at home or in a hospice.  Currently, Medisave can be used for inpatient hospice stays, subject to a withdrawal limit of $160 per day. Many patients who do not require inpatient hospice treatment often prefer to spend their last days in their own homes.  MOH encourages this and will hence facilitate this by allowing them to use their Medisave for home palliative care.  This extension of Medisave will provide the patients with more choice for palliative care.

9. MOH is working with the providers of palliative care on the implementation details such as home palliative protocols and suitable guidelines.  The scheme will be implemented as soon as they are ready.

(c) Other Initiatives

10. These two initiatives add to the other Medisave liberalisation initiatives which MOH had earlier announced for implementation this year:

(i) Higher surgical withdrawal limits.  The current Medisave limits of $150 to $5,000 will be raised, to range from $250 to $7,550 .  This will take effect from 1 June 2009. This would reduce the out-of-pocket expenses of all surgical patients, and will particularly help those in Class A/B1 and private hospitals.

(ii) Extension of CDMP to mental illnesses. The Medisave Chronic Disease Management Programme (CDMP) will be extended to cover the mentally ill patients, starting with schizophrenia and major depression. This will be rolled out in Oct 2009.

11. To gear up for this implementation, MOH has just appointed a Clinical Advisory Committee to help guide the implementation of the programme.

12. The committee will be chaired by A/Prof Wong Kim Eng, Clinical Director of the National Addictions Management Service and former Chair of the Medical Board of the Institute of Mental Health, and comprise experts from both the public and private sectors (see composition in Annex). The Committee would develop treatment guidelines, quality assurance framework and identify suitable indicators to track progress of this programme.