SINGAPORE — With hospitals and clinics well-placed to treat those who are very sick, the nation's healthcare priorities now include helping people stay healthy, and keeping seniors out of hospitals and nursing homes.

When Healthier SG kicks off in July, for instance, invited Singapore citizens and permanent residents who enrol with a general practitioner (GP) clinic or polyclinic to schedule an appointment will get $20 worth of healthpoints upon completion of the first free health plan consultation, said Health Minister Ong Ye Kung in Parliament on Friday (March 3).

The 3,000 healthpoints, available through the Healthy 365 app, can be exchanged for vouchers from NTUC FairPrice, credits from TransitLink or other participating merchants.

Those with high chronic medication needs and bills who enrol with a GP clinic can opt for a new Healthier SG chronic tier, to access certain common drugs at prices comparable to those in polyclinics, from early next year.

This is an enhanced subsidy for chronic drugs at GP clinics for Healthier SG enrollees who are Community Health Assist Scheme (CHAS) cardholders, he said.

Apart from this preventive health strategy, the Ministry of Health (MOH) is also focusing on developing the aged care system to make it easier for residents to age in the community, instead of nursing homes, as they continue to increase hospital capacity and build more polyclinics to meet rising needs.

MOH now looks at healthcare as three interlinked systems, Ong said during the debate on his ministry's budget on Friday.

One is the acute care system which is mature and well-developed, treats people who are very sick, through hospitals and specialist clinics.

Then there is the population health system, which stresses good health and preventive care, through Healthier SG.

Thirdly, the aged care system that is in its infancy, is still developing, but needs to focus on aged care taking place predominantly in the community, he said.

The imperative for this transformation is the rapidly ageing population, which Ong believes is the biggest social development of this generation. 

Ong first described Healthier SG, which seeks to shift the gravity of care from the hospitals to the community, at last year's budget debate.

Enrolment will start with those aged 60 and above from July, but younger residents with chronic illness who are aged 40 and above can pre-enrol from May with their GP, if their doctors have signed up for Healthier SG.

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The idea is to get residents to build a long-term relationship with one family doctor, who will help them take charge of their health.

Enrolment will start with those aged 60 and above from July, but younger residents with chronic illness who are aged 40 and above can pre-enrol from May with their GP, if their doctors have signed up for Healthier SG.

Traditionally, many patients with complex chronic diseases prefer to get their medications from the polyclinics because of the lower prices. Their current CHAS benefits are not enough to pay for the drugs at GP clinics. 

But, with the new chronic tier, they will be able to get their supply of polyclinic chronic drugs at around the same price at GP clinics, said Ong.

MPs such as Dr Tan Wu Meng (Jurong GRC), Dr Lim Wee Kiak (Sembawang GRC), Ang Wei Neng (West Coast GRC) and Ng Ling Ling (Ang Mo Kio GRC) had asked for updates on Healthier SG.

Most Healthier SG enrollees, however, won't likely need to switch to the new tier.

Ong said that today, CHAS already provides significant subsidies for patients who have lower chronic medication needs. They pay $0 or very little for their chronic visits and medications. 

Under this new tier, there is no dollar cap attached to the 50 per cent to 87.5 per cent subsidy  for a selected white list of drugs, which are those that are commonly used in polyclinics, such as metformin and losartan.

The subsidy level depends on income level.

But there will be a lower yearly cap for the subsidies for consultation, investigations, other non-drug related care, and non-whitelisted drugs, when compared with the original CHAS chronic tier, which is for all components of the patient's bill, including all medications.

Healthier SG enrollees with CHAS cards will have the same CHAS subsidies for common illnesses. There is no change for CHAS cardholders who do not enrol in Healthier SG.

Also, from early next year, enrolled residents with chronic conditions can use their Medisave savings to pay for their full treatment at their primary care clinic, subject to a withdrawal limit, instead of having to co-pay 15 per cent of their bill in cash. 

Dr Tan said the healthcare system must allow sufficient time for consultations, particularly in Singapore's ageing society.

"If a clinic is too busy and consultation times are too short, it becomes harder to promote health," he said. "Six sessions of five minutes each, are not the same as a half-hour conversation."

So far, about 800 of the 1,200 GP clinics that are on the CHAS scheme are part of a primary care network, which is a pre-requisite for Healthier SG. 

Eligible residents will be invited to register and choose their preferred clinic, with the HealthHub app. In the next two years, Healthier SG will be progressively rolled out for the 40 to 59 age groups. 

In his speech, Ong also said his ministry is looking into the rising issue of abuse in healthcare institutions, and will be sharing its plans on this later this month.

This will help to keep healthcare staff motivated, particularly given how tight the healthcare manpower situation is, even as the nursing and support care workforce is being beefed up.

MOH will also invest in the right IT tools and systems to allow patients' key health data to be shared across health providers in a safe and secure manner.

It is supporting GPs in many ways — IT grants, annual service fees for Healthier SG, and this is a new stream of revenue for the GPs for managing the health of enrolled residents, Ong said. 

As MOH will also be fully funding preventive services like nationally recommended vaccinations and health screenings for enrolled Singaporeans, GPs will very likely have to deliver more of these services, Ong said. 

He added that GPs will earn more fee-based income, from the Government. 

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This article was first published in The Straits Times. Permission required for reproduction.