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Medical Service Package To Ensure Good Healthcare At Affordable Prices For All Singaporeans

2 July 2004

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02 Jul 2004

Introduction

From 5 July 2004, the Ministry of Health will introduce the Medical Service Package (MSP) in all public sector institutions, starting with cardiac services. This is part of the Ministry's continuing efforts to ensure that all Singaporeans will continue to receive good healthcare at affordable prices. Currently, there is minimal or no subsidy for medical devises like cardiac stents, defibrillators, pace-makers and some new cardiac drugs. With the new package, B2 patients will receive 65% subsidy for cardiac implants and these cardiac drugs. C class patients will receive 80% subsidy.

Expensive treatment does not equate better treatment. Choosing a new or a more expensive treatment or procedure may not be necessary for all patients. Often the evidence to substantiate the use of expensive treatments and devises is not conclusive and its promotion is driven by industry. Patients may end up with a larger bill than is necessary. MOH has a duty to prevent over-servicing of subsidised patients by doctors.

The new MSP aims to help patients stretch their health dollar by controlling over-servicing by healthcare providers. It introduces a system of peer-review that ensures patients receive the correct treatment. The peer-review will be conducted by specialist within the same speciality. This will be a check to ensure there is no over-servicing of patients and will ensure continued healthcare affordability for all Singaporeans.

Framework of the Medical Service Package

The pilot project will kick off with cardiology and cardiothoracic services for inpatient and day surgery services. MOH will consider extending the MSP to other specialties and outpatient services at a later date. The MSP will apply to only subsidised patients (B2+, B2 and C Class).

The MSP will cover medical procedures, devices, investigations, and drugs. These are grouped into 3 categories depending on the degree of peer review. Subsidised patients will be entitled to services in all 3 categories based on medical necessity.

  1. Basic - this refers to health services that are standard and where the indications are not controversial. The majority of medical services will belong to this category. No peer review is necessary.

  2. Extended - this category will include the more controversial, or advanced and newer medical services. These services would be required in special circumstances for selected groups of patients or are services for which the indications may still be evolving. A peer review system will be developed within each department to monitor indications and usage. MOH will monitor this category of services and investigate any significant deviations from the norm. This will reduce over-servicing of patients by individual doctors.

  3. Excluded - this refers to non-essential medical services such as cosmetic surgery and experimental and unproven treatments.

Under the new framework, the provision of subsidy for basic or extended items would be based on medical necessity. The medical team looking after the patient will have to decide on the appropriate care based on the patient's medical condition. The decision of the medical team will be final. Treatment decisions will be based on medical need and not on the patient's ability to pay. Where patients are unable to afford treatment despite the subsidies, they will be referred to the medical social worker.

On 5th July, the MSP for cardiac services will start off with devices and nine new "extended" cardiac drugs. We would continue to work with the hospitals to progressively extend the MSP to other items. The list was drawn up by the National Committee on Cardiac Care in consultation with the various heads of cardiology and cardiothoracic surgery. The MSP list will be reviewed on an annual basis or more frequently if necessary.

Benefits to Patients

The MSP will ensure that subsidised patients continue to obtain affordable healthcare. Patients who require essential cardiac implants or drugs will now enjoy subsidised rates if their medical team's assessment is that such services are necessary for their medical conditions. Peer-review will check quality and prevent over-servicing by doctors.

More Information

For more information on MSP, please refer to the FAQs.

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