MOH to allow use of Medisave to defray costs of chronic illnesses

It's in the news today. MOH is going to allow patients to use their Medisave for the treatment of chronic illnesses. Diseases like hypertension and diabetes would be included in the list of chronic illnesses.

I applaud the move. For many patients, they choose not to do certain tests eg HbA1c because they do not want to pay for it even though we doctors strongly advise them to do so. I am not sure how it is with the polyclinics, but in the private sector GP clinics we do get some of these problems. Also some patients cannot afford our non-bulk purchase subsidized glitazones (eg Avandia) among other things. There have already been many cases of patients telling us they wish to be "transferred" to the polyclinic for further care and ask us to write memos to indicate this (because the polyclinics will not accept them if they do not have a doctor's letter. I find it ridiculous that we GPs have to write such memos when it has nothing to do with our decisions. It's the patient's decision at the end of the day. Who are we to tell the patient 'no you must stick with me!")

In the latest issue of the SMA newsletter, the new Perm Sec of MOH, Ms Yong mentioned that some private GP clinics do not have the patient numbers and feel the GPs are under utilized in the primary health system. She admitted that this was due to the way MOH structures our primary health care.

I applaud this new Medisave usage initiative because it would allow doctors to do their best for the patient with a minimum of obstacles especially financially. This leads to patients with better controlled hypertension and diabetes for instance, leading to reduced complications eg renal failure, retinopathy, heart disease, cerebrovascular disease etc. This reduces costs in the long run and more importantly reduces morbidity for such patients in later years.

However I would hope that the scheme is not confined only to the polyclinics and public hospitals. If it was I foresee that many patients would choose to forgo seeing their private GP who had been managing their chronic illnesses eg hypertension and diabetes. They would choose to go to the polyclinic to make use of their Medisave when they cannot by continuing to see their private GP. This would result in patients switching doctors. Polyclinics would see a large number of new patients with chronic illnesses armed with memos they had requested their GP to write saying they want to go to Polyclinic for follow up from now on so that they can use their Medisave. Is this really the intention of MOH? I hope not. Yes, you can say that one reason I say this is because I worry for my rice bowl. I would not deny that. However in medical terms it is also not a prudent practise to periodically have different doctors manage patients with long term diseases.

While I know some of the old folks I see will continue to come back to me because of familiarity and the relationship we have formed with one another, I feel it is unfair to them that the government would punish them for not going to the polyclinics.

The use of Medisave to defray costs should be extended to private GPs as well. I see no reason why not. The use of Medisave per visit could be capped at a certain amount. And the patient could top up the difference if the bill was higher regardless whether they are in the polyclinic or a private GP clinic. The money in the Medisave account is after all the patient's own money.

However I have a feeling the scheme will only be extended to Polyclinics and Public Hospitals. For this I am preparing myself with ready printed letters of referral to transfer patients to Polyclinics for their long term illnesses so that they can use their Medisave to defray costs.