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Most needy elderly patients getting Govt subsidies: Really?

By Leong Sze Hian

I refer to the report "8,000 needy elderly to benefit from national medical subsidy scheme" (Channel News Asia, Oct 10).

It states that "Come April 1 next year, some 8,000 more needy senior citizens (aged 65 years and above) will stand to benefit from a national medical subsidy scheme that will be extended to five more chronic diseases".

To qualify for the Primary Care Partnership Scheme (PCPS), you must be either:

  1. A Singapore citizen who is 65 years old or above, with a per capita monthly household income of $800 or below; or
  2. A Singapore citizen who is disabled- i.e. unable to perform at least one of the 6 activities of daily living (ADLs) such as washing/bathing; feeding; toileting; transferring; dressing; and mobility and with a per capita monthly household income of $800 and below and; or
  3. be on the Public Assistance (PA) Scheme.

As "there are some 28,500 PCPS card holders", does it mean that come April next year, the estimated number of PCPS card holders is estimated to be about 36,500 (28,500 plus 8,000)?

Since the eligibility criteria is quite stringent, I find it rather alarming that so many elderly Singaporeans have the PCPS card. How many elderly Singaporeans who qualify, may not have applied for the card yet?

$1.2 million subsidies – not quite enough

With regard to "The Ministry of Health (MOH) said GPs (General Practitioners) received about $1.2 million in subsidies funded by the Government, reducing the medical expenses of the patients", what the report does not mention is that the PCPS also applies to Common Medical Illnesses like cough, cold and flu, muscle, bone and joint pains, etc.

Since "Last year, GPs served nearly 60,000 clinic attendances for these patients", the average subsidy per clinic attendance is about $20 ($1.2 million divided by 60,000 clinic attendances).

But, this statistic looks quite strange, because "for the treatment of chronic conditions, you will be given an annual subsidy of up to $240 or $360 depending upon the number and severity of your condition(s)".

Why? If just a quarter of the 28,500 PCPS card holders suffer from one of the current three chronic diseases covered under the scheme, the subsidy should already be about $2.1 million (28,500 divided by 4 times $300 ($240 plus $360 divided by 2)).

Add to this a very conservative estimate that each PCPS card holder only sees a participating GP just once a year for a Common Medical Illness, and the sum may be about $285,500 (28,500 card holders times $10 Polyclinic subsidy).

But this is not all of it, as the PCPS also covers Basic Dental Services.

So, if each of the 28.500 goes for just one dental treatment in a year, what would the total amount of subsidy be?

Perhaps the only way to solve this mystery may be for MOH to disclose the subsidy for each of the different services covered, and the breakdown as to how many patients benefited, instead of just giving the number of clinic attendances. For example, 60,000 clinic attendances could be say for just 15,000 patients, if on the average a patient has four clinic attendances in a year.

What the above data appears to indicate, may be that very few PCPS card holders may be benefiting from the Government subsidies under the scheme.

One possible reason could be that since Medifund does not cover Polyclinic fees, or PCPS GP fees, those who can't afford the $9 Polyclinic fee plus the additional medicine costs, may simply not be able to afford any form of healthcare at all.

Chronic Disease Management Programme – who gets excluded?

According to the article, patients under the Chronic Disease Management Programme (CDMP) programme are “getting better health outcomes.”

For example, it has been found that “CDMP patients with diabetes who stayed for a year or more on the programme did not get hospitalised as often as those who were on the programme for less than 12 months.”

What’s glaringly missing is the question of how many needy elderly patients may not even be able to afford to utilise the scheme in the first place.

To illustrate this issue, the "60,000 clinic attendances" statistic, may be similar to what the MOH has been saying all along- that "The (Medifund) approval rate is 99 per cent".

However, with about 360,000 approved Medifund applications in a year, this refers to the approval of applications, and not the approval rate of patients who apply.

For example, a patient who has 12 medical treatments in a year may be counted as 12 approved applications. Whereas, the approval rate in terms of the number of patients who apply has never been disclosed. It was reported in 2008, that 301,126 approved applications were made by about 20,000 to 30,000 patients.

In this connection, the number of rejections increased dramatically by 2,900 per cent from 210 to 6,456 in 2006, and then declined dramatically by 79 per cent from 6,456 to 1,266 in 2007.

What about those who were told that they do not meet the basic criteria (which is not public information), and thus do not even need to apply? Could this be one of the possible reasons why the rejection rate declined dramatically?

On the same note, why is it that such "rejections" statistics do not seem to have appeared any more?