Please enable JavaScript.
Coggle requires JavaScript to display documents.
Lesson2: Subsidy and Subvention (CHAS (Uses (19 chronic conditions under…
Lesson2: Subsidy and Subvention
Patient Subsidy Types
Singaporean (SG)
Pink NRIC
Singapore Birth Cert stating Singapore Citizen at Birth, Neonates (newborn) at birth with Singaporean Father or Mother
Permanent Resident (PR)
Blue NRIC
Entry/Re-entry Permit
Neonate (Mother is a PR)
Foreign Resident (FR)
Foreigner Civil Servant or Pensioner/Gurkha employee
Work Permit
Employment Pass
Student Pass with SG or PR Father
Below 15 years with Singapore Birth Cert stating Not Singapore Citizen at Birth
Non-Resident (NR)
Dependent Pass
Student Pass
Social Visit Pass
Tourist Passport
Malaysian NRIC
Above 15 years with Singapore Birth Cert stating Not Singapore Citizen at Birth
Non-Patient (NPAT)
patients seeking allied health services in a healthcare institution different from the one their doctors are practicing in
polyclinic refers patient to restructured hospital for physiotherapy (treated as non-patient in the restructured hospital)
subsidies given for consult episodes within the doctor's institution
since allied health services are obtained from another institution, non patients will not be subsidised
Update to Healthcare 2020 Plan
Goal: promote healthy living and active ageing
Easier access
Increase capacity (one new hospital in each year; more nursing homes, community and home care services in the community)
Better quality
Appropriate and quality care
Improve primary care services (introduce more community health centres and family medicine clinics; more support for community and home care)
More affordable
Cheaper outpatient and drugs (public hospitals with government subsidies)
Lower cash payment (more uses of Medisave)
More peace of mind with Medishield Life (lifetime coverage for life; enhanced benefits; premium subsidies for lower- to middle-income)
Pioneer Generation (more help)
Reasons for many ppl?
A&E
Comprehensive range of services
Flat rate for range of services
Subsequent admission to inpatient wards will be as subsidised patients for Singaporeans and Singapore PRs
24 hours
Polyclinics
Used to care for the bottom 20 per cent (flu and diarrhoea)
Currently: increasing serving elderly people with chronic ailments
3 of top problems: high blood pressure, high cholesterol levels and diabetes (require ongoing care)
Many patients are older, and either have little income or are not working (big consideration: cost --> explain why many go polyclinics which have subsidised rates)
Singaporean patient who is 65 years and older pay $5.60 for consultation at polyclinic and only 70 cents for a week's supply of each type of subsidised medicine, benefit from additional subsidies under CHAS and PGP as well
Polyclinic doctors adhere to treatment protocol determined by specialists (ample diagnostic facilities at polyclinics)
Condition deteriorates, patients can be referred to specialist clinics at subsidised rates
CHAS
Uses
Common illness (cold, cough, fever)
19 chronic conditions under Chronic Disease Management Programme (CDMP)
Metabolic conditions (diabetes; hypertension; lipid disorders; stroke)
Mental health conditions (anxiety; bipolar disorder; major depression; schizophrenia)
Respiratory conditions (asthma; chronic obstructive pulmonary disease (COPD)
Other health conditions (parkinson's disease; osteoarthritis; nephrosis/nephritis; benign prostatic hyperplasia; dementia; epilepsy; osteoporosis; psoriasis; rheumatoid arthritis)
Selected dental services (dentures; root canal treatments and crowning)
Recommended health screening under the Health Promotion Board (HPB) Integrated Screening Programme (ISP)
Provide Singaporean lower and middle income households with better access to primary healthcare by bringing affordable healthcare services closer to patients
MOH engages GPs and private dentists to provide common outpatient medical and dental treatment to the needy at subsidised rates
Patients referred from GPs and Dentists participating under CHAS scheme to restructured hospitals, SOCs and National Dentist Centre will pay subsidised rates
Patients with chronic conditions: CHAS subsidies at treatment listed under CDMP, can also make use of Medisave to pay
Blue
Eligibility criteria:
household monthly income per person: $1,100 and below
annual value of home: $13,000 and below
common conditions: up to $18.50 per visit
chronic conditions (simple): up to $80 per visit; $320 per calendar year
chronic conditions (complex): up to $120 per visit; $480 per calendar year
dental services: up to $11-$26.50 per procedure
subsidies at SOC: 70%
drug subsidy: 75%
Orange
Eligibility criteria:
household monthly income per person: $1,101-$1,800
annual value of home: $13,001-$21,000
not applicable for common conditions
chronic conditions (simple): up to $50 per visit; up to $200 per calendar year
chronic conditions (complex): up to $75 per visit; up to $300 per calendar year
dental services: up to $26.50-$170.50 per procedure for selected dental procedures (dentures, crowns, root canal treatment only)
subsidies at SOC: 60%
drug subsidy: 75%
Pioneer Generation Package
Intent: recognise and honour the Pioneer Generation
Criteria: Singaporeans who were 65 years and older in 2014; and become a Singaporean by 31 December 1986
Additional 50% off subsidised services at SOC and Polyclinics on top of Means Test Subsidies
From 1 jan 2015: additional 50% off medication listed under the Standard Drug List (SDL) or the Medication Assistance Fund (MAF)
Eligibility criteria:
all pioneers receive CHAs benefits, regardless of income or AV of home
common conditions: up to $28.50 subsidy per visit
chronic conditions (simple): up to $90 per visit; up to $360 per calendar year
chronic conditions (complex): up to $135 per visit; up to $540 per calendar year
dental services: $21-$266.50 per procedure for selected dental procedures (dependent on procedure)
Subsidies
SOC: those who did not apply (50%)
Drug subsidy: without CHAS (50%)
Factors: essential for the treatment of medical conditions that are important causes of morbidity and mortality in Singapore; offers a big improvement in terms of efficacy and effectiveness when compared to existing standard drugs; adequate evidence of long-term safety and the cost-benefit of the drug
Government-funded ILTC services
Enhancement to the subsidy framework for ILTC was one of the key initiatives in Budget 2014
2/3 of Singaporean households (80% of elderly) can receive some form of financial assistance, with middle income households seeing the highest increase in subsidy levels
Goods and Service Tax (GST) chargeable for healthcare services will be absorbed by MOH for all subsidised ILTC patients
Specialist Clinic
Singapore citizen: 50% (without means test); 60-70% (after means test)
Permanent resident: 25%
Foreign resident: 0%
Non-resident: -30%
Day surgery
Singapore Citizen: 65%
Permanent resident: 40%
Foreign resident: 0%
Non-resident: -30%
Inpatient (public hospitals)
Singapore citizen (A: none; B1: 20%; B2: 65%; C: 80%)
Permanent Resident (A: none; B1: 10%; B2: 40%; C: 55%)
Foreign resident: pay full rate
Non-resident: pay surcharge
Inpatient (restructured hospitals)
Singapore citizen (C: 80-65%; B2: 65-30%)
Permanent resident (C: 55-32.5%; B2: 40-25%)
Subvention
MOH started providing public hospitals subvention funds, also known as block funding for patients using subsidised services (Class B2 and C)
Public hospitals derive roughly half their total revenue from government subvention
Allows each hospital to determine how to use subvention funds on its own to cover resources like manpower, consumable supplies (forceps, syringes and cotton pads), operating theatres, and buildings
Subsidy: government grant given by hospital to subsidised patients to fulfil subsidy targets ; subvention: amount of funding given to healthcare providers to provide subsidised services
Types
Lump sum subvention: operating funds given to a healthcare institution based on budgetary forecast (superseded --> fosters a growing budget)
Piece rate subvention: funds awarded based on the total number of patient days and volume of outpatient consult episodes consumed. Funding is based on usage (not ideal funding --> prone to abuse, the more one consumes, the greater the funding. Length of stay of patient will be extended) [KNOWN AS FEE-FOR-SERVICE MODEL]
Casemix subvention: funds allocated based on DRG (Diagnostic Related Group). Every DRG depending on the complexity of treatment will command a different subvention amount
Global budget subvention: funds allocated based on lump sum, piece rate and casemix funding principles (now adopted --> feasible funding model for less common DRGs)