SINGAPORE —  Increasing drug subsidies and having more types of drugs on the subsidy list will encourage more people to sign up for national health programme Healthier SG, family doctors and patients said.

Family doctors who spoke to TODAY also said that they will need to increase their resources to cope with the influx of new patients hoping to enrol at their clinics.  

On Wednesday (Sept 21), the Ministry of Health (MOH) submitted its White Paper on the Healthier SG programme where residents get to choose a family general practitioner (GP) to stick to and who would then manage their health throughout the rest of their lives.

The aim is to prevent people from falling ill in the first place, and to improve the overall health of Singaporeans by forging stronger patient-doctor relationships. 

Enrolment to the scheme will be opened to residents aged 60 years and above in the second half of 2023, followed by those in the 40 to 49 age group in the next two years.

HIGHER SUBSIDIES, MORE DRUGS SHOULD BE INCLUDED

As part of the initiative, MOH will introduce a new drug subsidy tier under the Community Health Assist Scheme (Chas) for drugs that are used to manage chronic diseases, so that their prices at private general practitioner clinics are comparable with those at polyclinics.

These include drugs that help with the management of diabetes and hypertension, for example. 

However, Dr Sunil Kumar Joseph, a GP who runs Tayka Medical Family Clinic, suggested that more chronic conditions and their medications should be included in the list. 

“There have been many additions made to the list over the years, including allergic rhinitis, which was added recently. But there are still many chronic conditions that are not in the list, for example, thyroid disorders,” he said.

Other doctors pointed out that although subsidies for medication for most chronic conditions would soon make the cost of drugs comparable at polyclinics and private clinics, the amount of subsidies for other drugs need to be increased to narrow the cost gap between the two types of clinics.  

Dr Alvina Nam, medical director and resident physician at Clinic@Costa, said that the success rate of the initiative would depend largely on this.

“If Healthier SG gives more incentives in the form of deeper discounts to the public, I am confident that more people will increasingly turn to GPs for closer care and better outcomes,” she said.

Doctors pointed out that patients usually want to see a medical practitioner whom they can trust and are familiar with — but many eventually choose a doctor based on cost of consultation and medication. 

Dr Fadzil Jaafar from Mission Hougang Medical Clinic said: “The financial gradient will be less steep with drug subsidies as part of Healthier SG. But I suspect there will still be a gradient, so only time will tell if the proposed subsidies are enough."

MORE RESOURCES NEEDED AT CLINICS 

Doctors also said that this new way of managing patients will require much more time and effort on their part for every patient, and they may therefore need to increase resources at their clinics, including hiring more doctors and nurses. 

Dr Fadzil, for example, said that GPs might have to reduce their load of contract cases — which refer to patients requiring medical leave and those in the younger age bracket — or hire a second doctor to increase his clinic's capacity.

“There will definitely be changes to the business models of GPs, depending on the case mix that they are currently seeing," he said, pointing out that most GPs already have a steady stream of regular patients to see.   

Doctors interviewed by TODAY welcomed the new funding that will be provided under the Healthier SG scheme as well.

An annual service fee will be given to GPs for each enrolled resident, with fees based on the health-risk profile of patients. The ministry has not stated yet how much funding will be given.

Dr Viknesh Shanmugam from Medstar Medical Clinic & Surgery said: “Ultimately, GPs need to stay afloat with rising costs of medications and this will go a small way to helping us stay afloat, because most GPs try their best not to transfer the rising costs to their patients."

DOCTOR-PATIENT TRUST NEEDED

Even with subsidies in place to make the scheme attractive, there still needs to be a certain level of trust and a strong relationship between doctors and patients for the scheme to ultimately work, the doctors said.

Dr Theresa Yap from Yang and Yap Clinic and Surgery said that patients who have longstanding relationship with their doctors will be open to confiding in them about their issues, which can then aid in preventative treatment. 

“I think having one GP to walk you through your health life with you is a very good system. It's somebody you trust, somebody you look up to, somebody you confide in. He knows your family, your medical history. He knows your situation better,” she said. 

Some patients who usually visit polyclinics for their healthcare needs said that they were open to making the switch to a private clinic.

Senior logistics officer Lim Keng Leong, 61, who usually buys his hypertension medication at a subsidised rate at a polyclinic, said that he would be happy to enrol in the scheme if his medication was the same price at a private clinic. 

“I am sure that more time will be saved and long queues can be avoided.”

Madam Rasimah Riduan, 63, who prefers seeing a family doctor because of the long queues at a polyclinic, said that she is also keen to enrol in the scheme.  

“I think that my knowledge of health will improve by adopting a health plan. It will help early detection of any health issues.” 

Cleaner Helen Elangovi, 70, who takes medication for diabetes, high cholesterol and high blood pressure, visits the polyclinic near her home regularly, but she is not sure if she would make the switch.

“My husband and I have been getting medicines at affordable rates in the polyclinics for a long time, and we do not see ourselves switching to a GP for this scheme unless we feel the benefits of switching are good enough.”