Monday, January 7, 2013

Top 10 healthcare changes to note for 2013

The new year is beginning and the changes announced by the Government in 2012 will soon be rolled out.

Keep abreast of the latest developments by reading on the top 10 upcoming health care changes that all Singaporeans should know about:

Improvements to MediShield  

IN A NUTSHELL: From March, the Ministry of Health will introduce sweeping changes to the MediShield insurance scheme, the low-cost catastrophic illness insurance plan covering 92 per cent of the population which was introduced in 1990.

The maximum age covered by MediShield will be raised from 85 to 90 years, to ensure people will get health coverage even as they live longer.

The current maximum entry age of 75 will also be scrapped so that more healthy elderly people who are uninsured can join the scheme.

The maximum amount claimable each year as well as the lifetime claim limit will also be raised so that more exceptionally large bills are are covered.

Acute psychiatric hospital care and short stays in emergency departments will also be covered, so people do not miss out on timely and appropriate treatment of mental illnesses.

The changes followed public consultation in July and August last year.

SIGNIFICANCE: The enhanced MediShield covers more people for more types of illnesses for a longer time span. It offers a lifeline to those worried about hefty medical bills even as they live longer.

It is also good news to those who have difficulty upgrading to a more comprehensive insurance plan due to health reasons or because they had almost reached the benefit limits, as they should be able to enjoy improvements to their current plans.

But broader coverage means premiums will have to rise to meet the increased claim amounts and number of claims.

The premiums will increase by less than $10 per month for those aged 65 and below and up to $21 per month for those aged above 65.

To help with higher premiums and deductibles, the Government will give a one-off Medisave top-up of up to $400 to all Singaporeans insured under MediShield or Medisave-approved integrated shield plans. The money will be credited to the accounts from March.

In addition, 85 per cent of Singaporeans aged 66 and older will get a Medisave top-up of $250 to $450 every year under the Goods and Services Tax Voucher scheme. The scheme helps lower- and middle-income Singaporeans with their expenses.

With the top-ups, people aged 60 years and older, and those 20 years and younger, will pay lower premiums for the next two years.

New medical school 

IN A NUTSHELL: The new Lee Kong Chian School of Medicine will open this year with 54 students. The school, which will focus on "treating the patient and not the illness", is jointly run by the Nanyang Technological University and Imperial College London in Britain.

Tan Tock Seng Hospital will be the main training hospital for the students. They will start interacting with patients from the first year and track patients' progress from their time of hospital admission to their stays in a nursing home and outpatient rehabilitation.

SIGNIFICANCE: It will be the third medical school here, after the Yong Loo Lin School of Medicine at National University of Singapore and the Duke- NUS Graduate Medical School.

The three schools will eventually produce 500 medical graduates a year.

This would improve the ratio of doctors to patients here.

With 10,057 doctors on the registry in 2011, Singapore has one doctor for every 537 people. This is a far better ratio than the one doctor to 700 people in 2001, but it is still behind that of most developed countries.

The United States has one doctor for every 390 people, while Australia has one per 334 people. The need for doctors will continue to grow, given the new hospitals that are set to open in the next few years.

These include the 700-bed Ng Teng Fong Hospital in Jurong and the Integrated Building for Changi General Hospital and St Andrew's Community Hospital, both slated to open next year. By 2015, new community hospitals will also be built next to Ng Teng Fong Hospital and Khoo Teck Puat Hospital in Yishun.

A third community hospital will be set up next to the 700-bed Sengkang General Hospital, both of which are to be completed by 2018.

Ban on unhealthy food ads 

IN A NUTSHELL: Advertisements which make unhealthy food and drink appealing to children will be banned from early this year as part of Singapore's battle against obesity.

Topping the list of ads likely to be affected are those for sweet drinks and fast food which contain high amounts of oil and salt.

Announcing this last October, Health Minister Gan Kim Yong said the action is not targeted at specific brands, but at unhealthy food.

In the same month, 14 major food and beverage firms belonging to industry association Food Industry Asia pledged to cut back on advertising on unhealthy food to children.

The firms include Coca-Cola, Nestle, Ferrero and McDonald's.

The pledge covers products high in saturated fat, trans fat, sugar and salt.

Under this voluntary framework, firms will not advertise on television, in print and on websites where 35 per cent or more of the audience are aged below 12.

SIGNIFICANCE: The move is an important initiative because eating habits are formed at a relatively young age and Singapore is seeing a steady rise in obesity rates.

These rates have risen by 1per cent a year over the past three years. In Singapore today, 11 per cent of adults and 9 per cent of children are obese.

Half of these children will grow up to be adults with diabetes, which increases a person's risk of serious illness, including blindness, stroke and heart attack.

The proportion of adults aged 18 to 69 suffering from diabetes has grown from 8.2 per cent in 2004 to 11.3 per cent in 2010.

The experience in the West indicates that there will be a tipping point - when obesity affects 17 per cent to 18 per cent of the population - beyond which the rate rises even faster.

Hence, it is important to act now to prevent obesity from becoming a real epidemic.

S'pore to host first regional World Health Summit 

IN A NUTSHELL:  Singapore will host the first regional conference of the prestigious World Health Summit in April.

Its theme is health for sustainable development in Asia. The three-day event will be hosted by the National University of Singapore and MOH Holdings, the holding company for public health-care assets.

About 500 to 600 participants - including leaders in health care, policy and research - are expected.
The topics discussed will include health issues in the region, ranging from an ageing population to illnesses related to rising pollution levels.

SIGNIFICANCE:  This will be the first time that a regional version of the annual World Health Summit will be held outside Berlin, Germany, since the summit started in 2009.

Regional meetings have tended to be planning sessions for the Berlin event.

The regional summit will offer opportunities for Asian countries to take stock of the health challenges ahead and outline strategies to counter these threats.

IVF guidelines tightened 

IN A NUTSHELL:  By Tuesday, all assisted reproduction centres have to conform with standards established by Australia's Reproductive Technology Accreditation Committee.

Fertility centres now have to be recertified every two years.

There are 10 assisted reproduction clinics in public hospitals and in the private sector.

SIGNIFICANCE:  This latest measure follows revised guidelines on licensing terms and conditions of assisted reproduction centres implemented by the Ministry of Health last April.

They were aimed at boosting standards in clinical practices and workflow processes after an in-vitro fertilisation (IVF) botch-up at Thomson Fertility Centre in 2010.

A mix-up in sperm samples led to a woman having a baby, now two years old, with a stranger's sperm. Key additions include a list of proper laboratory practices and stringent counter-checking of specimen identification.

New ward at KTPH to ease bed crunch 

IN A NUTSHELL: A new 32-bed ward is expected to be ready early this year at Khoo Teck Puat Hospital (KTPH) in Yishun.

The 980 sq m area is being converted from a rooftop garden.

A new lift will also be added, since the current ones in Tower B, where the new ward will be, are already operating at optimum capacity. Construction started last July.

SIGNIFICANCE: The building of a new ward at KTPH will mean more beds for patients.

The need for the newest public hospital in Singapore, which opened in 2010, to expand, highlights how critical the public hospital bed crunch situation is. Alexandra Health group chief executive
Liak Teng Lit said he had expected to add more wards only after the hospital had functioned for five to 10 years.

KTPH is facing occupancy rates of more than 80 per cent, which is considered very high. Private hospitals prefer to keep occupancy rates in the low 70 per cent for a comfortable turnover of patients.

Changi General Hospital, Tan Tock Seng Hospital and, occasionally, National University Hospital, are experiencing an even bigger squeeze, with bed occupancy rates of more than 90 per cent.

The continued high demand for hospital beds has come as a surprise to many, since the opening of
KTPH added 550 more beds, bringing the total number of beds in public general hospitals to more than 5,800.

Part of the problem, it seems, is that families are often reluctant to take home elderly relatives who are recovering from illnesses.

Faster approval for high-risk medical devices 

IN A NUTSHELL: From this month, doctors and hospitals will be able to bring in many high-risk medical devices more quickly and cheaply.

These devices are categorised as Class C devices, such as X-ray machines and ventilators, and Class D devices, such as breast implants and intra-uterine devices. They account for roughly 40 per cent of all medical device applications.

Class C devices are now expected to be approved by the Health Sciences Authority (HSA) within 120 working days, at an evaluation fee of $3,000, down from 220 working days, at an evaluation fee of $5,700.

They have to be first approved by at least one foreign health authority recognised by the HSA.
The turnaround time for class D devices is now 180 working days, at an evaluation fee of $5,400, significantly less than the previous 310 working days, at an evaluation fee of $11,400 for the full evaluation route.

They have to be first approved by two or more foreign health authorities.

SIGNIFICANCE: These changes should make for speedier delivery of health care. Since 2010, the HSA has mandated that high-risk medical devices must be registered before they can be used here.

Last January, it extended this rule to include medium- and low-risk devices.

The move drew much criticism from doctors and importers. They questioned whether it was necessary for the HSA to assess devices which have been approved in other countries.

They argued that the high cost and complexity of registration and the time taken to process applications would push up health-care costs and reduce the number of devices in use here.

Within two weeks of these problems being highlighted last April, the HSA scrapped registration for about 4,700 class A or low-risk devices, such as wheelchairs, and cut the application time and fees for about 3,650 class B or low- to medium-risk devices devices, such as catheters.

Last August, the HSA cut the costs for devices brought in through the special authorisation route - items needed in a hurry, or for specific patients, exhibitions or training - from $500 to between $150 and $350.

Blueprint of genes linked to myopia mapped 

IN A NUTSHELL: A blueprint of the main genes linked to myopia will be unveiled by researchers here by the end of this year.

The project combined the results of three large studies on 5,000 myopic adults and children here, comparing their genetic make-up to that of those without the condition.

It has identified several genes associated with high myopia of 600 degrees and above.

The researchers hope to fine-tune, in a few years' time, a test to identify such sufferers for early treatment, before they become severely myopic and face the risk of going blind.

The massive research effort to uncover the genetic basis of myopia involves researchers from the Yong Loo Lin School of Medicine at National University of Singapore, the Duke-NUS Graduate Medical School, Singapore Eye Research Institute and the Genome Institute of Singapore.

SIGNIFICANCE: Short-sightedness or myopia, typically caused by an elongated eyeball, is the result of both genes and the environment.

A blueprint of the main genetic variants of myopia will allow researchers to develop predictive tools that combine gene tests with environmental factors, and recommend treatment for those who need it the most.

One of the leading causes of visual impairment and blindness, myopia poses a significant public health burden in Singapore and the region.

Asia is experiencing a myopia epidemic, particularly in its big cities. Rates of the visual defect have been rising over the past two decades.

In Singapore, the myopia capital of the world, eight in 10 people are short-sighted by the time they are 18.

New medical complex at Farrer Park 

IN A NUTSHELL: Connexion at Farrer Park (right), a development which includes a hospital, hotel and medical suites, is expected to open this year.

Built directly above the Farrer Park MRT Station, the six-storey podium with two 20-storey high-rise wings will have a medical centre housing more than 200 medical specialists in 189 consultation suites. It will also have a 83-bed private hospital with a luxury hotel and a shopping mall.

It is run by the Farrer Park Company, comprising private medical and hospitality specialists as well as foreign investors.

SIGNIFICANCE: Connexion at Farrer Park will open on the heels of Mount Elizabeth Novena Hospital, run by regional private health-care provider Parkway Pantai, and Fortis Colorectal Hospital, run by Indian private health-care group Fortis Healthcare. Both opened last July.

They could strengthen Singapore's position as a destination for medical tourism.

Already, foreign patients make up a significant number in some private hospitals here. For instance, at Mount Elizabeth Hospital, about half of its patients hailed from overseas, The Business Times reported last March.

Despite the economic boon of medical tourism, some experts have warned that excessive growth of the industry may put more stress on the health-care system and squeeze the supply of doctors here even further.

Heart centre moves to new home 

IN A NUTSHELL: The National Heart Centre Singapore will move into a new 12-storey, $266million building at the end of this year.

The new 8,800 sq m site will be just down the road - about 400m away - from the present four-storey building on the Singapore General Hospital campus.

The centre will operate on a new concept that wraps services around the patient. For instance, patients, who are often the elderly, can see a doctor and have a blood test and an electrocardiogram on the same floor, instead of having to walk from place to place for these services.

Other features designed with the elderly in mind include distinctly coloured signs with large font, non-slip vinyl floors and motion-sensor lights.

SIGNIFICANCE: The new building is designed with the growing number of patients at the centre - one in three of whom are aged 65 and above - in mind.

The centre treated 108,000 patients last year, a figure that is set to rise by 60 per cent in the next decade.

The number of first-time elderly patients has shot up by 44 per cent since 2002. There will be 38 consultation rooms - more than double the current 18.

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