Louis delivered his budget cut on Improving Management of Chronic Disease at Committee of Supply 2018.

Louis: The Chronic Disease Management Programme (CDMP) is meant to allow patients with chronic conditions to use Medisave and reduce out of pocket expenses. However, it currently covers only two autoimmune conditions – rheumatoid arthritis and psoriasis.

Members from the Autoimmune Illness Support Group Singapore have bravely shared with me about their conditions, which are lifelong, chronic and not curable. They can only manage their symptoms by regular doctor visits and long-term medications, without which can result in serious complications and prolonged hospitalisation. Because of individual reactions to medications, some have no choice but to take high cost, non-subsidised medications.

Based on an internal survey by the group, there is a huge range and no single most common autoimmune condition. Will the Ministry consider including more autoimmune conditions into the CDMP, allowing patients to use their Medisave and relieve their financial burden?

Louis: I think Senior Minister of State Amy would be relieved that my question is not for her.

I thank Senior Minister of State Chee for sharing the various improvements to the Chronic Disease Management Programme (CDMP), but I would like to ask for one more improvement, which is: addition of more auto-immune conditions, please. 

Mr Chee Hong Tat (The Senior Minister of State for Health): Mr Chairman, I thank Mr Louis Ng for his question. I apologise for not having enough time to address it earlier during my speech.

The CDMP, in deciding what conditions are covered, we have a CDMP Clinical Advisory Committee which comprises healthcare professionals from the public, as well as the private sector. They will review the various conditions based on considerations, such as the disease prevalence and the effectiveness of earlier intervention to reduce complications.

So, certainly, we will refer the suggestion from Mr Ng to the Advisory Committee for their discussion and review. 

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health for each of the years from 2015 to 2017, what have been the respective numbers of unique patients, unique visits, and the average and median costs of each visit for (i) Systemic Lupus Erythematosus (ii) Spondyloarthritis and (iii) Psoriatic Arthritis.

Mr Gam Kim Yong (MOH): The 2015 to 2017 subsidised B2 and C ward hospitalisation statistics on Systemic Lupus Erythematosus, Spondyloarthritis and Psoriatic Arthritis are in the following table.

MOH does not collect specific Specialist Outpatient Clinic (SOC) data and primary care data for these three conditions.

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health (a) in each year of the past five years, for systemic lupus erythematosus and spondyloarthritis respectively, what is (i) the number of Singaporeans and permanent residents with the condition and (ii) the number of unique patients seeking outpatient care in public hospitals; and (b) whether the Ministry will start collecting this data if it is not available.

Mr Gan Kim Yong (MOH): Systemic Lupus Erythematosus (SLE) is a chronic multisystem autoimmune disease that has a wide range of clinical manifestations that can affect virtually any organ. Spondyloarthritis is the term for a group of diseases that causes inflammation in the spine and joints. 

Available data on the total number of unique patients with SLE and spondyloarthritis seeking outpatient care at Specialist Outpatient Clinics (SOC) in public health institutions (PHIs) over the past five years is presented in the table below:

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health (a) for each year in the past five years, for systemic lupus erythematosus and spondyloarthritis respectively, what is (i) the average and median number of outpatient visits in public hospitals per unique patient and (ii) the average and median costs of each outpatient visit in public hospitals; and (b) whether the Ministry will start collecting this data if it is not available.

Mr Gam Kim Yong (MOH): Systemic Lupus Erythematosus (SLE) is a chronic multisystem autoimmune disease that has a wide range of clinical manifestations that can affect virtually any organ. Spondyloarthritis is the term for a group of diseases that causes inflammation in the spine and joints.

Data on the number of Specialist Outpatient Clinics (SOC) visits, bill sizes, and out-of-pocket expenses per SOC visit in the past five years, collected from the public health institutions (PHIs), is presented in the table below:

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health (a) what is the full list of selection criteria used in determining whether to include a disease under the Chronic Disease Management Programme (CDMP); and (b) what studies and public consultations does the Ministry conduct to determine if a disease fulfils the selection criteria for inclusion under the CDMP.

Mr Gam Kim Yong (MOH): CDMP was introduced to help patients manage their chronic conditions well to avoid complications in the future and reduce out-of-pocket costs through the use of MediSave. MOH regularly reviews the list of conditions covered under CDMP to meet the needs of Singaporeans, while ensuring that MediSave balances are not prematurely depleted. For example, ischaemic heart disease and pre-diabetes were most recently identified for inclusion from June 2018.

In selecting conditions for inclusion in the CDMP, the Clinical Advisory Committee (CAC) consults clinical experts from public healthcare institutions as well as the private sector and take into consideration factors such as disease prevalence, potential benefits to patients' outcomes (effectiveness of early intervention that improves quality of life and reduces complications) and the availability of evidence-based clinical guidelines for appropriate care of the condition. The review process will also consider findings and information from studies such as the Singapore Burden of Disease and medical literature. Feedback and requests from the public, medical professionals, and members of Parliament are also collated and taken into account.

The CDMP CAC will continue to review regularly the conditions to be covered under CDMP. Meanwhile, Singaporeans with difficulties managing their medical bills including those relating to conditions not covered by CDMP can approach the Medical Social Workers at public institutions for assistance.

Source: Hansard (Parliament of Singapore)

Louis asked the Minister for Health what are the standard operating protocols in place to ensure that all patients suffering from eligible chronic diseases are informed about the option of applying for the Chronic Disease Management Programme.

Mr Gam Kim Yong (MOH): Medical institutions accredited for the Chronic Disease Management Programme (CDMP), including all public specialist outpatient clinics and polyclinics as well as participating private clinics, are required as part of their accreditation to inform eligible patients that they are able to tap on CHAS chronic subsidies and/or MediSave for treatment of their CDMP conditions. This will help patients to offset out-of-pocket payments. There is no need for patients to apply for the CDMP. 

The Silver Generation Office (SGO) also conducts outreach to share with seniors about the CDMP and CHAS subsidies, and encourage eligible seniors to seek treatment at accredited clinics. As of 31 December 2020, there are more than 1,150 GP clinics that are both CHAS and CDMP-accredited. This forms a good network of accredited clinics island-wide, which enables seniors to better access the healthcare services needed for the management of their chronic conditions. 

We will continue to improve our outreach programmes to improve public awareness of the CDMP and its benefits.

Source: Hansard (Parliament of Singapore)