In the past 5 years, there has been an increasing support for home based care for elderly chronic sick, bed bound patients. The Ministry of Health and Agency of Integrated Care has done much to support the dependent elderly patients through various policies. Primary health care and long term care sectors have been in the news often and are getting the support they deserve from the policy makers.
MEANS testing has been getting less “mean” and much easier to pass in recent years. Hence, MEANS testing dependent programs such as IDAPE has seen an increase in claims in the past few years. CHAS is another program in recent years to help subsidised patients to see doctors at private GP clinics rather than at polyclinics. CHAS provides subsidies for medical services and other perks, which traditionally only polyclinic holds. One big advantage for CHAS clinics now is the ability to refer patients to Specialist Outpatient Clinic as a subsidised patient.
It has been a heartening 3 years. Authorities are giving more support to our group of chronic sick, bed bound patients to get treatment in their own homes. Support for home-based care is now given only to home care programs from charities and known social enterprises such as NTUC Health.
Private providers for long-term care services are unable to ride onto this program. Hence, we are only seeing those patients that either failed MEANS testing or non-Singaporean. There is a special group of non-Singaporeans patients who have been staying in Singapore for the past 50 years but never converted to a Singaporean citizenship or even permanent residency. For the group of patient who are unable to pass MEANS testing, many of them are actually also HDB dwellers and stays with their unmarried daughter or son with a stable income. Ironically, to pass MEANS testing, it is better for the elderly NOT to stay with their children in order to get maximal subsidies since usually the elderly will not have any active income as they are retired.
In the past, the difference between private and VWO services may not be too great, apart from subsidised consultations. But now, with subsidised medications and Pioneer Generation subsidies, my group of patients are losing out quite a bit. They will not be able to get their prescription subsidized like those in polyclinic or hospital SOCs as PG card holders. As I do not have a physical clinic, my service is unable to be included in CHAS program. All my referrals back to hospital SOCs will be treated as private referrals. It would often be more cost effective to just go to the Emergency department for services such as subsidised referrals! Most of my patients are severely bed bound, hence requiring home based service. It is very difficult or almost impossible for them to go to a CHAS GP clinics or polyclinic to see doctor or to get referrals. I see this as huge disadvantage for my patients. Perhaps, it would be timely for the authorities to come out with new policies to bridge such a gap for this group of patients.
I had been running subsidised home care services with various institutions for the past 7 years. I had witnessed first-hand at the many good subsidized schemes that benefitted patients. As I had recently stop working for a VWO, some of the patients from the VWO wanted me to follow-up with them, but the difference of cost and benefits between subsidised and private service is too great. There are also other patients whom I see along the course of my work who would like to continue to be followed up by me. But as I know they would lose out a lot in terms of subsidized benefits, I had to advise them or refer them to be followed up by VWOs. It seems that being a good doctor to the patient, thinking for the welfare of the patient will result in a losing situation for my own company.
Lotus Eldercare feels like we are falling through the cracks as well in terms of policy, mirroring those patients we serve.