MOH wants to help those who wish to spend last days at home, beginning with MediSave coverage

SINGAPORE — To support medical care at home and ageing within the community, the Ministry of Health (MOH) will extend the use of MediSave to patients receiving care at home from the second half of 2023.

This will benefit close to 6,800 patients a year.

For a start, MOH will work with 25 medical and home nursing providers that now receive funds from the ministry, said Health Minister Ong Ye Kung during the debate on his ministry's budget on Friday (March 3).

He said: "Our healthcare financing framework — S+3Ms, namely subsidies, MediShield Life, MediSave and MediFund — must extend beyond hospitals, to wherever healthcare services are delivered."

The availability and extent of financing coverage will depend on the type of care services received by the patient, rather than where the care is delivered.

Those who receive treatment at home for the 23 conditions under the Chronic Disease Management Programme can use up to $500 or $700 of their MediSave to pay their home care bills, depending on the complexity of their condition.

This is similar to seeking outpatient treatment at the clinic. The coverage includes components such as consultation fees and blood tests conducted at home.

Patients who are 60 years old and above can use an additional $300 yearly under Flexi-MediSave, which can be used for outpatient medical treatments.

Ong also announced stronger support for palliative care, in response to Yip Hon Weng (Yio Chu Kang SMC) and Xie Yao Quan (Jurong GRC).

He said: "Survey findings consistently show that the great majority of Singaporeans prefer to pass on at home, in familiar surroundings, in the presence of loved ones, instead of an unfamiliar hospital environment. However, currently three in five deaths still happen in hospitals. We have a long way to go in fulfilling the wishes of Singaporeans."

Towards this end, MOH will undertake a review of the financing framework for palliative care services, he said.

Currently, only those who provide specialised palliative care can help patients make Medisave claims. This will be expanded to also include MOH-supported home medical and nursing providers who offer basic palliative care.

Ong also told the House that 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 settings, depending on their needs.

Instead of providing funding for care as and when utilised in each 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, he said.

Adjunct Assistant Professor Neo Han Yee, the head of department of palliative medicine at Tan Tock Seng Hospital, told The Straits Times that the current system can lead to inconvenience for patients who may need to be moved from one facility to another, especially in the last months of their lives.

The new approach will hopefully allow for a more seamless experience and provide better care for patients, he said.

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Dover Park Hospice chairman Jeremy Lim said the planned changes would provide more predictability.

"For us as a hospice, we can reasonably predict how many patients we will get in a year and how many will need inpatient and outpatient services… This means that we can plan for services upfront in anticipation of patient needs, rather than be on the backfoot," he said.

Ong said that MOH will learn from the pilot and review the arrangements, with a view to mainstream the scheme next year.

Another important move for the health sector is to normalise telehealth for care delivery, he noted.

Ong said that telehealth services have allowed healthy individuals to recover from Covid-19 infections at home and minimise visits to clinics during the pandemic.

At the time, to support and encourage the use of telehealth during the pandemic, MOH had extended use of MediSave and CHAS Chronic subsidies for teleconsultations for chronic disease management.

He said: "Now that we are in Dorscon Green, telehealth has become widely accepted and demonstrated to be effective. Hence, we have decided to continue the pandemic arrangement, normalise the use of appropriate telehealth and make it part of routine chronic disease management."

More details on implementation will be provided later this year, he said.

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