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CHAS: Doctors voice concern over patients falling through the cracks

Some patients are unaware of limitations of Health Assist card, and cap amounts may be insufficient for larger bills, doctors say.

SINGAPORE: While the Community Health Assist Scheme (CHAS) has been of help to many in need, general practitioners (GPs) are concerned that some patients with special circumstances are falling through the cracks.

GPs reported that there are patients who are unaware of the limitations of the Health Assist card on the number of visits. Also, the cap amount for the scheme may be insufficient for patients with larger bills, while the administrative process doctors undertake for CHAS patients can be time-consuming, they said.

These were the key concerns cited at a dialogue on Wednesday (June 25) with about 50 GPs and assistants and Dr Amy Khor, Senior Minister of State (Health and Manpower), as part of the Ministry of Health’s efforts to engage GPs on the Pioneer Generation Package and, in particular, CHAS.

The scheme provides subsidies for lower- and middle-income Singaporeans at participating GPs and dental clinics near their homes, split into two tiers: Blue and Orange. There are about 650,000 Singaporeans on CHAS and more than 1,000 participating GP and dental clinics.

The cap limits per visit for Blue CHAS cardholders range from S$18.50 for common conditions to S$80 for simple chronic illnesses. During the dialogue, GPs suggested raising the limit for eligible bed-bound patients with chronic conditions. Home visits are more expensive, so these patients need higher subsidies, they noted. A simpler process for filing CHAS claims could also be introduced, they added.

Responding, Dr Wong Kirk Chuan, deputy chief executive of the Agency for Integrated Care, said the Government has been trying to simplify the process, but there are many legal considerations. He added that efforts were being made to address this.

Meanwhile, Dr Khor noted that creating more differentiation to meet different patient needs would be extremely difficult to administer. “I think there is a balance that we need to strike,” she said.

Speaking to TODAY, Dr Leong Choon Kit, a family physician from Mission Medical Clinic in Upper Serangoon who attended the dialogue, noted that the 15 chronic conditions eligible under the Chronic Diseases Management Programme, which CHAS covers, does not include common chronic conditions seen in the elderly such as osteoporosis and thyroid illnesses.

He has also encountered patients who were disqualified from the scheme, although they may still be in need of help. “One of my patients was disqualified from CHAS after he got retrenched and moved in with his sister. His total gross household monthly income exceeded the requirements to qualify for CHAS,” he said.

Dr Leong also agreed that the paperwork involved in handling CHAS patients can be challenging for small clinics in the heartlands. “Clinics in the heartlands can have about 10 CHAS patients a day, that will equate to about 300 to 400 CHAS patients per month. If one claim takes you about three minutes, the clinic will have to spend about 900 minutes every month to submit claims,” he said.

Speaking after the dialogue, Dr Khor said the Government would continue to study the bill sizes and the usage to ensure the majority would get subsidies so their medical costs are affordable. “When there is a need to revise it, we will do so,” she said.

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