As of January 2014, Medisave can be used for outpatient treatment of five more chronic conditions, on top of the 10 already covered under the scheme. The five are osteoarthritis (degenerative joint disease), benign prostatic hyperplasia (enlargement of the prostate gland), anxiety, Parkinson’s disease and nephritis/ nephrosis (forms of kidney disease).

Previously, the 10 conditions covered were diabetes, hypertension, lipid disorders, stroke, asthma, chronic obstructive pulmonary disease, major depression, schizophrenia, dementia, and bipolar disorder.

Chronic diseases a major cause of death and illness in Singapore

As in many developed countries, chronic diseases in Singapore are a major cause of death and illness, mainly because many patients seek treatment when it is already too late. Early treatment for these conditions can include diet and lifestyle changes, as well as regular medication and consultation. Patients who start to manage their conditions in the early stages often avoid serious problems and complications that can come with poor treatment.

Accessible and affordable healthcare for Singaporeans

When complications set in, health care costs can become very costly. For instance, poor diabetes management can lead to a limb being amputated. The patient will then have to pay for undergoing surgery, hospitalisation and follow-up specialist consultations.

In 2006, the Ministry of Health (MOH) launched the Chronic Disease Management Programme as part of a national effort to improve the care and management of chronic diseases by helping patients defray their outpatient costs of these conditions.

MOH included the additional conditions covered under Medisave after public feedback, and because the diseases are among the most prevalent in Singapore. The expanded list now covers 90 per cent of the chronic care conditions seen in the primary care sector. The cost of treating these conditions will be subsidised by up to $400 every year for each Medisave account at specialist clinics, polyclinics and Medisave- accredited GP clinics. Patients who qualify under the Community Health Assist Scheme (CHAS) can enjoy subsidies of up to $480 a year, further reducing cash outlays. CHAS is an MOH programme that helps provide Singaporeans with accessible and affordable medical and dental care.

CHAS was recently expanded to include middle-income households, with the income ceiling to qualify raised from the current $1,500 to a per capita monthly household income of $1,800, or up to $21,000 in annual value of their residential property.

An ageing population

The expansion to include these five additional chronic conditions under Medisave coverage is timely in view of Singapore’s ageing population, but some doctors said they hope that the scheme will be expanded further to include more chronic diseases such as autoimmune disorders.Thyroid disease and rheumatoid arthritis are two common autoimmune disorders.

What can Medisave be used for?

Medisave can be used at participating clinics to pay some outpatient medical bills of 15 chronic conditions.

It can be used for the following services:

• Medical consultation for a chronic condition covered by the Chronic Disease Management Programme and/or its complications.
• Relevant investigations (including laboratory and radiological procedures such as x-rays) for the evaluation of the identified chronic condition and/or its complications.
• Medication for the management of the identified condition and/or its complications.
• Allied Health services such as nursing, physiotherapy, occupational therapy, speech therapy, and dietician or podiatry services as referred by a doctor.

Three safeguards put in place under the Medisave for Chronic Disease Management Programme are:

1. A $30 deductible for each outpatient bill (ie bills below $30 will not be eligible for Medisave claims; this will no longer be applicable from July 1, 2014.)
2. A co-payment of 15 per cent of each outpatient bill, in excess of the deductible.
3. Only $400 can be withdrawn annually from each Medisave account.

How Medisave helps to reduce medical costs

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