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‘Flat fee’ funding for doctors under Healthier SG will not inflate healthcare demand like ‘pay per service’: Ong Ye Kung

SINGAPORE — The Government's Healthier SG scheme will pay General Practitioners (GPs) a base standard fee per enrolled patient, because alternative models such as co-funding every consultation "no questions asked" could result in demand for healthcare to balloon, said Health Minister Ong Ye Kung on Monday (Oct 10) evening. 

Minister for Health Ong Ye Kung (right) with a doctor at a private clinic during a media event in May 2022.

Minister for Health Ong Ye Kung (right) with a doctor at a private clinic during a media event in May 2022.

  • Under the Healthier SG programme, the Government will pay family doctors a base standard fee for each enrolled patient
  • Questions were asked at an Oct 10 event about whether this funding model could lead to patients being under-served when doctors, clinics or hospitals seek to save costs 
  • Health Minister Ong Ye Kung said other options such as co-funding every consultation without question may cause demand for healthcare to balloon
  • He also said that mental health treatment is not yet part of the nationwide Healthier SG reform, but will be in the future

SINGAPORE — The Government's Healthier SG scheme will pay general practitioners (GPs) a base standard fee for each enrolled patient, because other subsidy options such as co-funding every consultation "no questions asked" may quickly inflate the demand for healthcare, Health Minister Ong Ye Kung said on Monday (Oct 10). 

He also said that mental health was left out of the healthcare reform for a start not because it was any less important than physical health, but because mental health treatment required a more "sophisticated and comprehensive response" before coming up with a protocol for GPs. 

Mr Ong was speaking at the President's Speaker Series event in Yale-NUS college, where he delved into the nationwide Healthier SG programme that was endorsed by Parliament this month. He also reflected on his time in various government ministries over the past two years of the Covid-19 pandemic. 

The Healthier SG White Paper outlines how the Government plans to carry out a multi-year reform of the healthcare sector to focus more on preventive care over acute care.

The plans are estimated to cost S$1 billion over the next three to four years, with another S$400 million going yearly towards recurrent costs.

As part of the changes, Mr Ong said in Parliament earlier this month that the funding model for healthcare clusters will shift from a workload-based model to one that is capitation-based, where clusters get a predetermined fee for every resident assigned to them based on geographical boundaries

A member of the audience at Monday’s hybrid event said that the differing health-risk profiles of patients would mean that patients' healthcare spending would differ from case to case, and asked Mr Ong how the capitation-based model will account for this. 

Mr Ong said that the opposite approach, which is to "pay per service", would not be ideal. 

"When you pay for every service, and especially with no question asked, especially if it's 100 per cent funded, the demand balloons," Mr Ong said. "Even the doctor will say, 'I don't know whether you should take the test but the Government's paying for it; okay, just go'." 

On the other end will lie the model that will be adopted, one he called a "flat-fee" model, which also comes with its own challenges.

"You run into the other problem — that different people really have such different risks; a young 30-year-old versus a 70-year-old, the risk is so different," he said. 

"What we land on is a flat fee, but beyond that, if you do extra things, we can give additional funding, but by and large, it is a flat-fee model." 

The event moderator, Assistant Professor Jean Liu from the social sciences (psychology) department at Yale-NUS College, asked Mr Ong if patients may be under-served with the capitation model, which could limit the access to treatment. With a flat fee, doctors or medical establishments may not be incentivised to treat patients.

Mr Ong said that this risk has been seen in other countries that adopt capitation funding, where hospitals under-serve patients because the fewer patients they treat, the more the flat fee may cover the costs. 

In the Singapore context, though, it is different, he added.

For many of the countries that adopted this policy, their hospitals are "already overloaded". 

"By and large, Singapore residents who seek healthcare, (they) can get healthcare without having to wait a year, two years, which is the case in many countries.

“Therefore, for us, when we come up with a capitation funding, it is really purely to shift the focus to preventive care.

"But we will have to watch, to make sure that the pitfall of under servicing does not become a problem." 


Responding to a question from the audience on why mental health was not addressed in the care protocols for GPs in the Healthier SG White Paper, Mr Ong said that this was because more research and outreach has to be done before it is eventually included into the programme. 

Members of Parliament already noted during a debate last week that among the first 12 care protocols being rolled out to family doctors in the White Paper, those dealing with mental health were not among them

Mr Ong said on Monday that Healthier SG starts off by prioritising the prevention of chronic illnesses, but "that doesn't mean that mental health is not important". 

"The mental health issue requires... a more sophisticated and comprehensive response first, before we even come up with a protocol.

"We intend to have a protocol for the GPs, but are GPs ready to roll it out? They may not be ready." 

Mr Ong added that the Ministry of Health has been working on how to tackle the issue of mental health "as long as we have been working on Healthier SG", and it will involve measures such as expanding clinical capacity for mental health treatment, expanding community outreach, and increasing awareness of mental health in schools. 

"I think we will have to tackle mental health issues from that angle first, and then work it into Healthier SG, which we intend to do so."

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healthcare doctor Ong Ye Kung subsidy funding Healthier SG

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