As we anchor ageing in communities, the Ministry of Health (MOH) will review the financing and services framework to be more care-centric and support more Singaporeans to fulfil their wishes to pass away at home. We will also strengthen our healthcare financing safety nets to support the elderly and families in need.
Shift Towards More Premises-Neutral, Care-Centric Financing
Supporting care at home
2. As we encourage ageing-in-place, our healthcare financing policies need to transform to better support care delivery within communities and homes. Currently, our financing coverage varies based on the setting and premises where care is delivered. We intend to make our financing system more premises-neutral to improve affordability for appropriate care delivered across settings. This means that the availability and/or extent of financing coverage will depend on the type of care services received by the patient, rather than whether the patient had received care in a particular healthcare institution or other settings.
3. This will be a major shift and changes will have to be made gradually. As a first step, we will improve affordability for patients who seek care at home. Homebound patients receiving MOH-subvented home medical and home nursing services will be able to tap on the MediSave 500/700 and Flexi-MediSave schemes. This means that homebound patients who receive treatment at home for the 23 conditions under the Chronic Disease Management Programme (CDMP) will be able to use up to $500 or $700 yearly (depending on the complexity of their chronic condition) from MediSave to pay for their home care bills, similar to if they had sought outpatient treatment at a clinic. This will cover components such as consultation fees and blood tests conducted at home. Patients who are aged 60 years and above can also use an additional $300 yearly under Flexi-MediSave.
4. These MediSave changes will benefit up to 6,800 patients each year who seek care at home. The changes will be implemented in the latter half of 2023.
Telehealth as a viable option for care delivery
5. Although telehealth is a relatively new modality of care delivery, we saw its benefits in supporting care in the community and at home during the COVID-19 pandemic. The COVID-19 Virtual Ward Programme allowed patients to continue receiving the necessary medical care, while freeing up beds in acute hospitals. We had also allowed the use of MediSave and Community Health Assist Scheme (CHAS) Chronic subsidies for video consultations of regular follow-ups for chronic diseases under the CDMP for a time-limited period, which helped to support safe distancing.
6. Moving forward, we will continue incorporating telehealth in our care models, where appropriate. Mainstream financing schemes will be progressively extended to more telehealth services. For a start, we intend to extend the usage of MediSave and CHAS Chronic subsidies for video consultations of chronic diseases under CDMP beyond the current time-limited extension. More details on implementation will be provided later this year.
Facilitating more flexible palliative care services
7. Many patients prefer to spend their final days at home rather than in hospitals. To support patients’ wishes to pass away at home, MOH will undertake a review of the financing framework for palliative care services. For a start, more providers will be allowed to make MediSave claims for patients receiving palliative care at home. Currently, only home palliative care providers who specialise in providing palliative care can help patients make MediSave claims. Moving forward, we will allow MOH-subvented home medical and home nursing providers who provide basic palliative care to also help these patients make MediSave claims for palliative care. These changes are expected to benefit more than 200 patients each year.
8. In addition, we will work with hospitals and palliative care providers to pilot new models of palliative care delivery which are setting-neutral to ensure seamless care transition.
9. Tan Tock Seng Hospital will partner Dover Park Hospice in a pilot programme to enable patients to receive timely and seamless care across inpatient, day and home hospice care settings, depending on their needs. This will reduce unnecessary readmissions to hospital. Under this pilot, rather than funding the care as and when utilised in each hospice care setting, MOH will provide a single bundled funding rate to empower hospice care providers to decide which setting is most suitable, based on the patient’s needs. Through this, providers will be better able to streamline referral and transfer protocols across settings, and care will be more tightly coordinated throughout the patient’s journey.
Strengthening Our Safety Nets for Needy Elderly and Families
10. With the ageing population and rising cost of living, there is a need to strengthen our safety nets to ensure that needy patients continue to have access to basic healthcare.
11. The Government will provide a $1.5 billion top-up to the MediFund in 2023, to provide financial support for needy Singaporeans who are unable to afford their remaining healthcare bills after government subsidies, and drawing on other means of payment including MediShield Life and MediSave. Although Permanent Residents (PRs) are not eligible for MediFund, we will separately extend discretionary financial assistance to PRs who face difficulties paying for their healthcare bills on a case-by-case basis later this year. This would alleviate the healthcare burden on needy families, especially those with Singaporean family members.
MINISTRY OF HEALTH
3 MARCH 2023