SINGAPORE: Encouraging results in Medisave scheme for treating chronic illnesses

SINGAPORE (NewsToday), March 18, 2008: IT WAS launched to ease the financial burden of chronic illness and shift the care of stable conditions to primary doctors such as general practitioners. Now one year on, initial results of the Medisave for Chronic Disease Management Programme (CDMP) have been "encouraging". According to the Ministry of Health (MOH), some 70,500 patients have made $15 million in withdrawals to pay for outpatient treatment. Over 80 per cent had more than one chronic condition, and diabetes affected about two-thirds of patients. Nearly 9 in 10 were over 50 years old. About a third of the claims were for specialist outpatient clinics at hospitals, about half were for polyclinic-based treatment and 20 per cent were for GP care. But more could be done to shift patient loads to GPs, who - as shown by SingHealth's Delivering on Target (Dot) programme - do just as well as specialists in managing chronic illness. Since its 2005 launch, diabetic patients whose care was "right sited" to partner GPs have shown marked improvement. A sample of 370 readings showed that HbA1c levels - an indicator of diabetes control - dropped from the 2005 baseline of 8.23 to 7.32 per cent. The proportion of patients who achieved the recommended target of under 7 per cent, indicating well-controlled diabetes, nearly doubled to 51.4 per cent. According to Dr Lee Meow Yoong, one of the 134 Dot GPs, this has been "the best so far" of all the shared care programmes he has joined. He has enrolled 10 of his patients in the scheme, which includes free counselling at the Diabetic Society of Singapore and referrals to podiatrists and SingHealth specialists. And under a Dot pilot scheme, he is now also accepting discharged patients from the Singapore General Hospital's (SGH) Diabetes Centre. Madam Yap Lai Chin, 67, visited hospital specialists for more than six years. She had to wait about two hours for each appointment, and spend more than 30 minutes travelling from her home in Bukit Batok to SGH. "Now we only take a 10-minute bus ride and see the doctor within 30 minutes," said her husband Tan Oon Ann. Dr Lee said: "Patients have not only welcomed the financial relief … they also like the improved relationship with their doctor because GPs can take more time to talk to them." Launched in January last year, the first phase of the chronic disease management programme targeted the "Big Four": Diabetes, hypertension, lipid disorders and stroke. Patients can withdraw up to $300 a year from Medisave accounts to co-pay outpatient treatment costs. From April, asthma and chronic obstructive pulmonary disease will be included. Such help is a relief for Mr Ong Tiong Kia, 73, who suffers from asthma, diabetes, high blood pressure and high cholesterol and pays over $200 for asthma medication each month. "$300 a year is not enough but I am happy it can pay for at least a portion of it," he said. By Sheralyn Tay sheralyn@mediacorp.com.sg