MEDISAVE (Use for dormiciliary medical and nursing care)

Dr Chong Weng Chiew asked the Minister for Health in the light of increased emphasis on step-down services, will his Ministry allow the use of Medisave to pay for dormiciliary medical and nursing care.

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, first, I wish to reiterate that Medisave is primarily intended for inpatient hospitalisations. However, over the years, the Ministry of Health has allowed the use of Medisave for day surgeries and certain expensive treatments, which were originally inpatient treatment but are now carried out more effectively as outpatient treatments, such as renal dialysis and chemotherapy for cancer patients. However, the Ministry does not intend to allow Medisave to be used for dormiciliary medical and nursing care, so that individuals can preserve their Medisave for the more expensive medical treatments.

From 1st October 2002, the Ministry of Health has extended Government subsidies to eligible elderly Singaporeans who require home medical and home nursing services so that they can afford such services. Out-of-pocket expenditure is kept low, at between $30-$60 per home medical visit and $13-$28 per home nursing visit, after the 50% to 75% subsidy from the Government. Those who are severely disabled and covered under ElderShield or IDAPE Scheme can also receive cash payments of $300 per month from ElderShield, or up to $150 per month from IDAPE Scheme. These would further help them pay for their home medical and home nursing services.

Dr Chong Weng Chiew (Tanjong Pagar): There are two principles of home medical and home nursing care. One, it actually gives convenience to the patient as well as providing holistic approach to patient care. The second point is that with home medical and home nursing, it is one of the ways to decrease health expenditure. And the fact that Singapore is moving towards an ageing population ----

Mr Speaker: What is your question, Dr Chong?

Dr Chong Weng Chiew: Home medical is one of the roots which can avoid hospitalisation for patients. Thus, with this change of trend of hospitalisation, can we not use Medisave for home medical and home nursing?

Mr Lim Hng Kiang: As I have explained earlier, medical treatments are very expensive. We are asking Singaporeans to save 6% of their income in Medisave and therefore we have to make use of our Medisave correctly. The policy of Medisave is to target this saving at the more expensive medical treatments, which is largely the inpatient care. Over the years, we have extended it to some outpatient care which is very expensive too. But so far, we have not allowed Medisave to be used for GP care, for step-down care, home medical and home nursing care. And I think these are very sensible reasons. Because if we allow Medisave to be used for GP care, for home nursing and home medical, very soon you will not have very much Medisave left for your hospitalisation care.

Last year, we made an exception. We recognised that home medical and home nursing care for the very severely disabled will cost a lot of money, and that is the reason why we introduced ElderShield and allowed Singaporeans to use up to 1% of their Medisave if they insure themselves under ElderShield. And if they are severely disabled, the group insurance that they participate in will help pay for their home medical and home nursing. So we are already making an extension of using the Medisave for the severely disabled who need home medical, home nursing or institutional nursing care. But if we extend Medisave to all kinds of home medical and home nursing, then your 6% Medisave contribution will not be enough. If the Member can convince other Members of this House to raise the Medisave contribution from 6% to 8%, then I am prepared to consider extending it.

Dr Lily Neo: May I ask the Minister what has his Ministry done to improve dormiciliary step-down services, especially in patient care and in the training of personnel? And does he agree that this is an important area to develop in view of the demographic profile?

Mr Lim Hng Kiang: I agree entirely with the Member. I think home medical and home nursing are critical components of our step-down care infrastructure. Over the last two years, for example, we have put in place what we designate as approved providers - nursing homes, community hospitals - who can extend home medical and home nursing services. We are trying to build up such services, not just by specialised home medical and home nursing services like the Home Nursing Foundation, but also extend the provision by other groups - nursing homes, community hospitals - so that these become more readily available. Recently, I announced that the Ministry is extending training grants for step-down care, not just professionals in the community hospitals and nursing homes, but also people extending home medical and home nursing services. So, we recognise that this is a very important area. It is a very manpower intensive area, despite Singapore being a small island. If we have a nurse visiting homes, there is a very limited number of visits she can make every day. So it is a very expensive service. But we recognise that this is an important service because it helps to keep the elderly in the community, in the home, and we intend to build this up.