Extending Coverage of Community Health Assist Scheme

Mr Speaker, Sir, we have just enhanced the Community Health Assist Scheme (CHAS) in January this year to benefit more Singaporeans, especially those with chronic conditions, by lowering the age criterion for the scheme from 65 to 40 years old and relaxing the income criteria. We are monitoring the impact of these enhancements and will review the scheme again in due course.

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Since the enhancement of CHAS, we have seen about a 20% increase in the number of participating GP and Dental Clinics to the current 794 clinics. Over 220,000 Singaporeans are now CHAS cardholders, a seven-fold increase from about 34,000 a year ago.

MOH, together with the Agency for Integrated Care (AIC) and Health Promotion Board (HPB), will continue to engage private clinics to encourage them to come on board the scheme. We are also reaching out to the community with the support of local Advisors and grassroots leaders to increase awareness and participation in CHAS through various events and activities. Other engagement efforts include clinic visits, island-wide media campaign as well as setting up sign-up booths at our public hospitals and polyclinics.

I would like to ask the Minister: have increases in both the CHAS members as well as clinics on the scheme met the Ministry's expectations? And has the scheme eased the patient volume at polyclinics? Also, is there an annual budget set aside for the reimbursements to the private clinics for CHAS and what is the timeframe that the Ministry is adopting to assess the success of the scheme in order to consider whether to extend the scheme for patients below 40 years old?

As far as the number of patients is concerned, in the first six months of this year, we have seen about 31,000 patients who have made use of their CHAS cards in our various private clinics. That shows that these patients, who potentially could have been treated at the polyclinics, are now going to the private GP clinics. We hope to be able to reach out to more. Some of them have signed for the CHAS card but they have not used it because they are not due for medical review, and some of them may not have chronic diseases yet, but they want to have the card in order to be ready in case they need to use it.

We see the trend growing. This is a significant increase. Every year, we try to estimate how many patients are likely to make use of the card and what is the potential financial commitment from the Government. To date, we have disbursed a total of about $8 million under this scheme to provide for the subsidies. We had budgeted for a little more, just in case more-than-expected number of people are making claims. If we do not have enough budget, I am sure we can go back to the Minister for Finance to ask for more allocation in time to come.

As far as the timing is concerned, let us take this one step at a time. It has barely been one year, so let us review this in time to come. If need be, we will look at the various criteria and see whether we need to tweak them to keep the scheme effective and relevant.

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Thank you, Mr Speaker. I have a supplementary question for the Minister. Besides the income criterion which the Minister discussed, one of the criteria for CHAS benefits is the annual value of the property that a person lives in. Currently, there is a disqualification for Singaporeans who live in properties of annual value of more than $13,000. In effect, this will exclude most Singaporeans living in private homes. As we know, there are many elderly citizens living in modest homes which they inherited or they bought a long time ago, and they are not cash rich. I would like to ask the Minister whether in his review at some point in time, the Government would re-look at this property annual value criterion to enable some of these Singaporeans to benefit. Afterall, we are talking about healthcare benefits for senior citizens and not handouts.

Sir, CHAS is a Government subsidy scheme and, therefore, the primary target is still the lower income elderly group, is focused at chronic disease management. But I do take Ms Sylvia Lim's point. In fact, there are patients or residents who are living in inherited private houses who may not be of high income. We do consider on a case by case, especially for those who are at the borderline. If Members do come across cases that they think are deserving despite the fact that they live in private properties of annual value above $13,000, or if Members think these residents have big families or do not have high income and have difficulty meeting healthcare financial obligations, do come forward and let us know. We will review these on a case by case basis.

At the end of the day, even if they are not eligible for CHAS, they will still be able to receive subsidised treatment at the polyclinics. That will always be the last resort for our patients who cannot afford private clinics. CHAS is meant for use at private clinics. If you are not eligible for CHAS, you can still be eligible to be treated in our polyclinics. Of course, the purpose of CHAS is that we will hopefully be able to facilitate our patients to seek treatment with a subsidy at the private clinics.

So, we do take into account applicants on a case-by-case basis. Do let us know if Members do come across such cases, and we will review them.

Mr Speaker, I would like to check with the Minister the reasons that certain GPs are not participating in CHAS.

Sir, there are a variety of reasons. We have been engaging them. Some of them were concerned that there would be a lot of administrative work to be carried out especially in an area where they see there are not likely to have many such patients. From their point of view, it may not make sense for them to participate in the scheme, put themselves on the system, and then find that they are able to service only one or two patients. Not all of them will be coming on board.

From the numbers we have, we cover roughly a third of all the clinics in Singapore. This coverage is quite significant. This would work out to about 10 clinics for each constituency. The key now is distribution. The Ministry is looking at the distribution of these clinics. We have close to 800 CHAS clinics, but they are not spread evenly in all areas. In areas that are short of clinics, we try to reach out to them and engage them, and to encourage them to come on board so that we have a more even spread of clinics across Singapore.

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Is there a high number of appeals in terms of income criteria? Some of them are odd job labourers and they work piecemeal, so their income fluctuates. I would like to know if there is a high demand for appeals due to the income criteria.

Sir, I do not have the number of appeals at hand, but if you do come across deserving cases – whether they are odd job labourers or because their income is irregular – if they have been penalised unfairly, do let us know. We will then look into the details on a case-by-case basis, and if they are indeed eligible and ought to be helped, we will extend the help to them. The purpose of this scheme is really to help them, so if they deserve it, we will extend the help to them.

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