Higher Medisave withdrawals for palliative care

Higher Medisave withdrawals for palliative care
Health Minister Gan Kim Yong, delivers a speech at the opening ceremony of the 6th Singapore Palliative Care Conference organised by the Singapore Hospice Council at Singapore Polytechinic Convention Centre.

SINGAPORE - Palliative care services for the sick and dying will be ramped up significantly over the next six years as Singapore's population ages.

There will be more hospice beds, home palliative care services and a new graduate diploma course to train more doctors.

People will also be allowed to use more of their Medisave money for these services, with no withdrawal cap for those who are terminally ill.

Announcing these plans yesterday, Health Minister Gan Kim Yong described palliative care as "a critical piece in our overall efforts to provide good and appropriate care to help patients age and die in place with dignity".

Speaking at the sixth Palliative Care Conference at Singapore Polytechnic, he said the Ministry of Health will invest in developing four areas of palliative care - improving the quality of care, expanding services, ensuring affordability and raising awareness.

Today, 5,000 people receive palliative care at home each year. By 2020, at least 6,000 will be cared for this way. The number of palliative care beds will also more than double from 147 today to 360.

On top of that, community hospitals will back up hospices by having beds for patients who take a sudden turn for the worse, or have other critical needs.

Two regional health-care groups, led by Tan Tock Seng Hospital and Khoo Teck Puat Hospital, will train staff at 14 nursing homes with a total of 2,800 beds in advance care planning, geriatric care and end-of-life care.

To make sure people can afford such care, the ministry will ease the current caps on Medisave withdrawals.

From Jan 1 next year, the daily withdrawal limit for palliative care will go up from $160 to $200 and the lifetime limit for home pallia tive care from $1,500 to $2,500.

But for patients with terminal illness such as cancer or organ failure, this cap will be lifted and there will be no restriction on the amount they can use from their Medisave accounts.

Mr Gan said that together with the 75 per cent subsidy for hospice care and 80 per cent for home palliative care, "we hope patients and their families need not worry about palliative expenses at a difficult time".

His ministry will also change how it funds organisations providing home palliative care.

Today, what they get depends on the number of visits they make.

But from next month their funding will be based on the number of patients they look after, reflecting a shift to focus on results.

"This new approach to funding will deliver a steady stream of financial resources, enabling providers to plan and deliver holistic, pa tient-centric services," said Mr Gan.

"It will also give greater flexibility to test out new models of care for the benefit of patients."

He told reporters later that care providers will be able to remodel the way they look after patients, by calling them on the telephone to check on their condition or to give advice, or by collaborating with doctors.

Health-care advocate Jeremy Lim, one of more than 500 delegates at the half-day conference, said the change in funding signals "a very important mindset shift".

Dr Mervyn Koh, co-author of the book The Bedside Palliative Medicine Handbook, said burn-out rates for people working in home palliative care are higher in Singapore than in many other countries - they end up emotionally exhausted, feel no personal accomplishment and start treating patients as just people waiting to die.

The reason is the shortage of staff, and some of these people regularly work 60 hours a week.

This article was published on June 29 in The Straits Times.

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