Medisave for Home-based Healthcare

With the ageing population, the need for home-based medical care has grown. Today, home-based intermediate and long-term care is subsidised at up to 80% for eligible patients to ensure that they are affordable.

It is important to ensure that Singaporeans have enough Medisave for hospitalisation and outpatient treatments, which are needed more frequently as one ages. Hence, extending Medisave use to home-based services needs to be selective, bearing in mind the Medisave adequacy of Singaporeans.

In 2010, Medisave was extended to home palliative care to help Singaporeans better afford the service. We have just announced that the lifetime limit for home palliative care will be raised from $1,500 to $2,500 per patient. Those with cancer and end-stage organ failure will have unlimited use of their own Medisave for such care.

Next year, MOH will be introducing Flexi-Medisave, where elderly patients will be able to use up to $200 per year for their outpatient treatment. MOH will continue to consider further flexibility for Medisave use, including for other types of home care services. But we will have to do this carefully, to avoid premature depletion of Medisave and ensure sufficient Medisave savings for healthcare expenses, especially during old age.

I would like to thank the Senior Minister of State for her reply. I do urge the Ministry to reconsider a quick implementation of Medisave for home-based care. I think it is hard for caregivers to take special leave just to bring the elderly to the hospitals and clinics so as to get subsidised medicine and, of course, to use their Medisave.

Three quick supplementary questions: one is that the majority of home-based care providers in Singapore are private operators and that could mean home care can be pricey for some and that the standard of care can vary. My first question is whether the Ministry

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has plans to streamline the quality and price of these service providers.

The second question is whether the Ministry can consider extending the Community Health Assist Scheme (CHAS) to home-based care.

Finally, home-based hospice care and home palliative care share similar requirements of longer term care at home. Will the Ministry also consider the use of Medisave for home-based hospice care?

First, I would like to thank the Member for his supplementary questions. I think these are valid concerns, especially if someone is thinking of home care for their loved ones, as we are looking into expanding home care services to prepare for the future in view of an ageing population.

With regard to his first question, today there are actually 13 Voluntary Welfare Organisations (VWOs) and four private home care providers who are receiving funding to provide subsidised home medical, home nursing and home personal care. A client can receive up to 80% subsidy, depending on his means-tested income tier for such home care services. In fact, last year, the home care service providers actually supported about 5,000 patients for home care services.

To enhance and align the quality of home care services, MOH has worked with home care providers. In fact, we have set up a workgroup of home care providers to develop a set of home care developmental guidelines in order to help to enhance and align the quality of services and articulate the level of care expected of these homecare service providers. These home care guidelines include good practices to better enable them to coordinate care, enhance the quality of care, promote independence as well as encourage organisational excellence. The guidelines have been drafted and they are under consultation with stakeholders. We will finalise these guidelines at the end of the year. In fact, next year, we will embark on a quality improvement programme to help the home care providers adopt these guidelines.

As I have noted earlier, we are planning to expand home care services up to about 10,000 home healthcare places and 7,500 home personal care places by 2020.

In terms of pricing, over the last few years, we have actually enhanced the Intermediate and Long-Term Care (ILTC) subsidy framework that would include home care. We have raised the subsidy framework from the 50th percentile household income per capita to the 67th percentile household income per capita to cover more middle income households. In fact, in 2013, we have raised the income cut-off to $2,600 per capita per month in view of rising

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income. We have also mainstreamed additional home care services, such as a home rehabilitation and home environment review services, since April of this year. So, that would also mean that a client will be eligible for subsidy if he has a need for these services.

With regard to the Member's second question on CHAS, today, if an elderly is home-bound and needs medical services, he can be referred to the Agency for Integrated Care (AIC) or to an MOH-subvented home medical care provider. The client will then be eligible for subsidy for home medical service by a General Practitioner (GP) from the home medical provider, up to $133 in subsidy. If the elderly is not enrolled with a home medical care provider and the elderly needs ad hoc medical services, but the elderly is CHAS-registered, they could get CHAS subsidy from a CHAS-registered GP via a house visit, if that is required. The subsidy will be capped to the CHAS subsidy, which is up to $18.50 for common illnesses and $120 per visit for chronic illnesses.

Regarding the Member's third question about home hospice and home palliative care, we consider them as similar. It is just a matter of semantics, there is no difference. Therefore, home palliative or home hospice care is already eligible for Medisave. You can use Medisave for home palliative care.

I just have a quick question: would the Ministry consider expanding the qualifying criteria for, let us say, Medifund, for these services for those who are truly in financial need?

I think the philosophy would be that no one who needs such care will be deprived of the care, and if they are assessed to be in need, even after the subsidies they are not able to pay, firstly, many of these homecare service providers are VWOs and they do have charity dollars that they could apply to assist such patients. But if this is not available, we will look at how we can assist the patient.