DIALYSIS COSTS AT PUBLIC HOSPITALS AND VWOs

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DIALYSIS COSTS AT PUBLIC HOSPITALS AND VWOs: 9.

Ms Eunice Elizabeth Olsen asked the Minister for Health (a) what is the average effective treatment cost of a dialysis session at public hospitals, private dialysis centres, and VWOs (Voluntary Welfare Organisations); (b) what accounts for the

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variance in treatment costs; (c) how does Singapore's dialysis costs compare with those of other countries in the region; and (d) what scope is there to further lower dialysis costs at public hospitals and VWOs like NKF.

Mr Khaw Boon Wan: Mr Speaker, like other medical treatments, the cost of kidney dialysis can vary widely depending on several factors. First, patients can be treated using either haemodialysis (HD) or peritoneal dialysis (PD). Peritoneal dialysis, in turn, can be provided using either continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). Each treatment option has its pros and cons, and medical opinion continues to evolve.

Second, the patients' medical conditions will ultimately impact on the treatment option and hence the cost. In particular, those who at the same time have other medical illnesses will have to be handled differently.

Third, different providers offer different quality of services, resulting in different costs. For example, there is a range of reagents for the doctors and patients to choose. Even the same reagent can cost different patients differently, depending on how often the reagent is re-cycled.

Currently, the treatment cost for haemodialysis, without subsidy, ranges from about $2,000 to $3,000 per month. So it is quite a wide range. For CAPD, the monthly equivalent is between about $1,200 and $1,800, while that for automated peritoneal dialysis ranges from about $1,700 to $2,300 per month. Note that peritoneal dialysis is cheaper than haemodialysis.

Public hospitals have focused on acute haemodialysis with complicated co-existing illnesses. In other words, our patients are much more complicated. For

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chronic dialysis, public hospitals offer peritoneal dialysis as it is cheaper for the patients. In public hospitals, their CAPD cost, before subsidy, is about $1,300 per month, while the automated peritoneal dialysis equivalent is about $1,800. So for both modalities, the public hospitals' rates are at the lower end of the market range.

My Ministry will shortly publish on the MOH website the detailed comparison of the kidney dialysis charges by the various providers in Singapore . Cost comparison with other countries is not meaningful, because different countries practise different levels of service and care.

By publishing the dialysis costs, I expect the providers to review their cost structures to see if they can lower their dialysis costs further. I have done this for other illnesses and treatments with quite good results.

The new NKF has already made the first round of cost reduction, by reducing its haemodialysis rate from $2,600 per month to $2,106 per month, in other words, from the high end of the cost range to now the lowest end of the cost range. And I understand that there is scope for further reduction by the NKF in the near future. Being the largest provider of this service, it really should have the most competitive cost structure and, in this way, it can stretch its donations to the maximum.

Ms Eunice Elizabeth Olsen (Nominated Member): Sir, one observation that has been made in the aftermath of the NKF issue is that dialysis subsidies are not as high as people imagine it to be vis-a-vis how much the kidney patients have to cough out of their own pockets. So I would like to ask the Minister whether there is scope to increase subsidies and therefore lower the cost patients have to pay from their own pockets.

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Mr Khaw Boon Wan: Mr Speaker, the cost figures, I quoted just now, are costs before subsidy. In other words, if the patient is not subsidised at all, whether it is $2,600, $2,800, or whatever, these are the costs that the patients will have to bear. But of course, for most patients treated by VWOs, including NKF, there are subsidies. The subsidies will vary because they do means testing and I think - I am relying on memory here - NKF, out of nearly 1,800 patients that they are handling, 10% pay less than $100 per month. I remember that end of the price spectrum, and there are varying levels of subsidies. The new NKF has pushed for transparency and they have published the guidelines, and also set up a panel of wise men and women to review appeals whenever the patients feel that the charges have been unaffordable.

Ms Eunice Elizabeth Olsen: I thank the Minister for his reply. I would like to ask the Minister also whether there are other cost saving methods that he and his Ministry are evaluating and whether or not he can share it with the House.

Mr Khaw Boon Wan: Dialysis is a complicated business. Many years ago, when I was in NUH running it, I started the first off-hospital dialysis centre at the SLF building. I think it is still running there. So I got to know a little bit about this business. There are indeed many possibilities of cost savings so that you can try to meet the patient's affordability level. Just now I talked about reuse of reagents. Clinically, it is safe and you have some room to play around. You can reuse two times, or you can stretch a bit, four times, and you can bring down the cost significantly. So a lot depends on the doctor's experience with his patients and he can push the boundary. Of course, there are also other possibilities.

In the case of NKF, my own observation is that a big part of the costs,

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not a major part, but a significant part of the costs are non-clinical activities, in other words, the administrative side, because they have a very heavy fund-raising component. But the new board has reviewed that particular portion and they have significantly reduced the involvement and the headcount and, therefore, the cost. So that is why I have hinted in my reply just now that they have done the first round, but this is not the end of it and, in fact, I received an email last night from the CEO, Prof. Goh Chee Leok, who told me that there is a possibility of another 10% reduction very soon, within days.