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Archive for September 4, 2013

Health Ministry shares details on key policy shifts to alleviate medical costs


Health Ministry shares details on key policy shifts to alleviate medical costs
Part of new healthcare financing framework which emphasises collective responsibility

1.    Today, Health Minister Gan Kim Yong shares details on key policy shifts to give Singaporeans greater assurance over healthcare costs. Even as each citizen and his family continue to do their part to stay healthy and save for their future, we will strengthen collective responsibility for healthcare costs, with Government doing more to keep healthcare affordable for Singaporeans.  The two key thrusts in this package of measures are – cheaper outpatient care, including preventive care, and MediShield Life, to provide enhanced, life-long coverage to all Singaporeans.

2.    The Minister’s announcement follows months of policy reviews and engagement sessions.  In March 2013, Minister Gan had indicated that the Government would increase its share of healthcare spending so as to take on a greater burden of rising healthcare costs.  Minister Gan had then also reiterated the need for “healthcare policies to evolve as we prepare for the future and the new challenges”, but noted that what will not change is the emphasis on individual responsibility for one’s own health and the principle of co-payment.  The Ministry of Health (MOH) has received useful feedback from Singaporeans via the Our Singapore Conversation process, as well as the Government Parliamentary Committee for Health and Members of Parliament. These included suggestions to make MediShield compulsory, extend Medisave to cover more chronic diseases and ideas on adopting a healthier lifestyle.

(A)  Cheaper outpatient care

3.    Outpatient costs will be made more affordable through the expansion of Government subsidies and Medisave use, to reduce cash outlay for patients. Key initiatives (details in Annex) are:

  • More Singaporeans to benefit from Community Health Assist Scheme (CHAS).  From 1 Jan 2014, the qualifying age for CHAS (40 years old and above) will be removed.  This will enable all Singaporeans in lower- and middle-income households to access subsidised medical and dental care at over 800 private clinics. In line with the latest data, MOH has also updated the income and property Annual Value criteria for CHAS.
  • Better coverage for chronic diseases, via CHAS and Medisave use.  Medisave use will be extended for the outpatient treatment of five more chronic conditions under the Chronic Disease Management Programme (CDMP), bringing the number of chronic conditions under CDMP to 15. The additional conditions covered are: osteoarthritis (degenerative joint diseases), Benign Prostatic Hyperplasia (enlargement of the prostate gland), Anxiety, Parkinson’s disease, and Nephritis/Nephrosis (chronic kidney disease).  In line with this, treatment of these 5 new chronic conditions can also be subsidised under CHAS, at up to $480 per year.  This will enable chronic patients to reduce their cash payment, and will also take effect from 1 Jan 2014.
  • More subsidies for recommended screenings, via CHAS.  From 1 Jan 2014, CHAS cardholders will be able to enjoy subsidies for the recommended screening tests under the Integrated Screening Programme (ISP). They will also be able to enjoy subsidies for consultation with a GP for the screening, and to review the screening test results. The recommended screening tests under ISP are screening for obesity, diabetes, hypertension, lipid disorders, colorectal cancer and cervical cancer.
  • As part of an ongoing review, Medisave use will be extended for the following vaccinations and outpatient screening on 1 Jan 2014, subject to the prevailing withdrawal limit of $400 per Medisave account per year:

– Pneumococcal and influenza vaccinations for high-risk groups, such as the very young, elderly, persons with chronic medical conditions and those with poor immune function.

– Recommended neonatal screening tests for newborns.
4.    MOH will also lower charges at Specialist Outpatient Clinics (SOCs) in public hospitals by enhancing subsidies for lower- and middle-income groups.  Details will be announced in the first quarter of 2014.

MediShield Life for greater assurance and a more inclusive society

5.    To provide all Singaporeans with greater peace of mind and assurance against large bills, and in line with the shift towards a more inclusive society, MOH is considering enhancements to MediShield:

  • Enhanced MediShield benefits to better cover large bills.  This will be achieved by raising claim limits, and reducing the co-insurance borne by patients for large bills.   MediShield will remain as a catastrophic insurance scheme with focus on covering large bills.
  • MediShield to provide life-long, universal coverage.  The maximum coverage age of 90 years will be lifted, to provide lifetime coverage.  All Singaporeans, including those who are currently uninsured, will also be brought under MediShield coverage and enjoy the assurance of protection against large bills.

6.    The enhanced scheme will be renamed MediShield Life.  To ensure that premiums for MediShield Life remain affordable, even as benefits are enhanced and payouts rise, additional Government support including for the less well-off will be provided.  For the current elderly, the Ministry of Finance and MOH will consider how they can be supported for their MediShield Life premiums through a Pioneer Generation Package.  MOH will also review how premiums can be better spread over one’s lifetime, to help moderate premium increases after retirement.

7.    MOH will hold a public consultation in the fourth quarter of 2013 to seek feedback on the proposed major shifts for MediShield Life.  We will be reaching out to Singaporeans via several channels ranging from dialogue sessions, focus groups discussions, web chats and online polls.  The Ministry will also be engaging key stakeholders including private insurers, who administer Integrated Shield Plans.


8.    These measures aim to strengthen basic protection for all Singaporeans, and improve affordability of outpatient services, especially through CHAS.  With the removal of the age floor for CHAS, and subsidies to cover five more chronic conditions and recommended screenings under the scheme, more Singaporeans, including younger family members of current Health Assist cardholders, will stand to benefit.  The changes answer the calls made by many Singaporeans and MPs through their feedback to MOH and during the OSC process.  We will strengthen the role of all partners – the individual, his family and the community, and the Government – in ensuring peace of mind for Singaporeans.

9.    MOH will continue to partner with Singaporeans as we work on other measures to strengthen our healthcare financing framework, including exploring further changes to Medisave use and contributions and the affordability of long-term care.

29 AUGUST 2013

via Health Ministry shares details on key policy shifts to alleviate medical costs | Ministry of Health.

Loneliness of dementia revealed

Two-thirds of people with dementia live in the community


Communities need to look after people with dementia because too often they feel trapped and cut off from everyday local life, a charity says.

One in three people over the age of 65 develop the disease, but the Alzheimer’s Society says this large group is neglected by society.

It sought the views of 510 dementia patients and their carers.

A third of the patients said they left their home just once a week, and one in 10 said they got out only once a month.

You can’t just turn your back on people when they have dementia”

Lorraine BotbolCarer

Almost half avoided getting involved with local life because they felt they were a burden, and less than half felt part of the community.

A separate YouGov survey of more than 2,000 adults found most thought dementia patients’ level of inclusion of in the community was fairly or very bad.

The Alzheimer’s Society is campaigning for towns and cities to become “dementia-friendly”.


This includes opening up leisure activities to people with dementia and ensuring local transport services cater for their needs.

Shops and businesses should also train their staff to recognise and deal with customers who have dementia.

Lorraine Botbol, who cares for her mother who has dementia, called for more understanding about the disease.

“We took Mum out recently to a local supermarket because she used to love shopping,” she said.

“We always have a problem when we get to the cash desk.

“Mum is sometimes vocal and it often irritates people in the queue or sometimes even the cashier.

“This time, my mum got upset, and the cashier said she’d rather be dead than have dementia.

“It really upset me.

“You can’t just turn your back on people when they have dementia.

“My mum still enjoys activities and I wish people would wise up and understand you still need to value person when they have dementia.

“They’re still there, they just express themselves differently.”

Jeremy Hughes, chief executive of the Alzheimer’s Society, said it was shocking and saddening that so many people with dementia felt trapped and cut off.

“By committing to change, communities can give people with dementia the confidence to be part of local life and stay independent for longer.

“It’s vital that people sign up to the recognition process to kick-start this movement and help change attitudes and behaviour.”

Health Secretary Jeremy Hunt said the government was committed to backing initiatives to help manage dementia.

In December, the UK will use its presidency of the G8 to hold the first global dementia summit.

Two-thirds of people with dementia live in the community, and a third of these are living on their own.

The number of people with dementia is increasing because people are living longer.

It is estimated that by 2021, there will be about a million people with dementia in the UK.

via BBC News – Loneliness of dementia revealed.

Nurses warned about nail extensions

Guidance says nurses should not wear nail extensions


Nurses have been warned about wearing nail extensions and using nail polish after a poll suggested infection control was being put at risk by fashion-conscious NHS staff.

Guidance states that fingernails should be short and free of varnish.

But an online poll of nearly 500 student nurses found lapses were commonplace with 60% reporting nail extensions and polish being used.

The Royal College of Nursing said the findings were “worrying”.

The survey was carried out by Cardiff University and London’s City University.

Overall each of the 488 students who took part reported seeing at least one breach in infection control rules by health staff once other problems, such as a failure to wash hands as well as breaches of nail care were taken into account.

The researchers, writing in the American Journal of Infection Control, said the survey showed lapses were widespread.

Tom Sandford, of the RCN, added: “Fingernails should be short and free of nail varnish. False nails should not be worn.

“Nail varnish and extensions harbour bacteria and prevent good hand hygiene.

“Health organisations should uphold clear local policies on uniforms and work-wear and their implications for infection control and health and safety.”

via BBC News – Nurses warned about nail extensions.

‘Brain window’ implant devised

The transparent “brain window”


A “window to the brain” implant which would allow doctors to see through the skull and possibly treat patients has been devised by US researchers.

It uses a see-through version of the same material used for hip implants.

The team at University of California, Riverside, say it could allow lasers to be fired into the brain to treat neurological disorders.

The implant was reported in the journal Nanomedicine: Nanotechnology, Biology and Medicine.

The researchers say emerging laser-treatments in stroke and cancer care and brain imaging require access to the brain.

However, they are limited as a part of the skull needs to be removed and replaced each time a treatment is performed.

Instead the team of scientists have devised a transparent implant that would replace a small section of the skull.

They have converted a material – yttria-stabilized zirconia that is used in some ceramic hip implants and dental crowns – to make it transparent.

They argue the material would be safe to implant, but would also provide a window onto the brain.

Professor of mechanical engineering, Guillermo Aguilar, said: “This is a case of a science fiction sounding idea becoming science fact, with strong potential for positive impact on patients.

“This is a crucial first step towards an innovative new concept that would provide a clinically-viable means for optically accessing the brain, on-demand, over large areas, and on a chronically-recurring basis.”

Prof John Duncan, a brain expert a University College London, said: “Access to the brain for minimally invasive surgery would be a major step forward.

“This research appears to provide a very encouraging step in this direction.”

via BBC News – ‘Brain window’ implant devised.

Mammals harbour at least 320,000 new viruses

The flying fox is one of many mammals that carry viruses that spread to humans


There could be at least 320,000 viruses awaiting discovery that are circulating in animals, a study suggests.

Researchers say that identifying these viral diseases, especially those that can spread to humans, could help to prevent future pandemics.

The team estimates that this could cost more than £4bn ($6bn), but says this is a fraction of the cost of dealing with a major pandemic.

The research is published in the journal mBio.

Prof Ian Lipkin, director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health in the US, said: “What we’re really talking about is defining the full range of diversity of viruses within mammals, and our intent is that as we get more information we will be able to understand the principles that underlie determinants of risks.”

Flying fox

Nearly 70% of viruses that infect humans, such as HIV, Ebola and the new Middle East Respiratory Syndrome (Mers), originate in wildlife.

But until now, the scale of the problem has been difficult to assess.

The idea is to develop an early warning system”

Professor Ian LipkinUniversity of Columbia

To investigate, researchers in the US and Bangladesh looked at a species of bat called the flying fox.

This animal carries the Nipah virus, which if it spreads to humans can kill.

By studying 1,897 samples collected from the bats, scientists were able to assess how many other pathogens the animal carried.

They found nearly 60 different types of viruses, most of which had never been seen before.

The team then extrapolated this figure to all known mammals, and concluded there were at least 320,000 viruses that have not yet been detected.

The researchers said that identifying all of these would be crucial to keeping one step ahead of diseases that could become a threat to human health.

Nipah virus
Identifying all novel viruses in animals could take years and costs £4bn ($6bn)

Prof Lipkin said: “Obviously we cannot survey every animal on the planet, but we can try and map as best as we can using a concept referred to as hotspots.

“We look at areas where we know, based on previous experience, there is a high likelihood that new infectious agents will emerge or will pose considerable threat to human health.”

He said that this would take 10 years and would cost billions of dollars.

But he added: “Despite what looks like an extraordinary expense to pursue this kind of work, it really pales in comparison with what one might learn that could lead to very rapid recognition and intervention that could come to the fore with a pandemic risk.

“The idea is to develop an early warning system.

A related project called PREDICT has so far discovered 240 new viruses in areas of the world where people and animals live in close contact.

Commenting on the research, Prof Jonathan Ball from the University of Nottingham, said: “The authors focussed on bats because they have been the original source of a number of virus outbreaks in people.

“But we should remember, bats adopt a lifestyle that’s particularly helpful to viruses – they live in large communities, they are dispersed throughout the world and they fly very large distances.”

“Whether or not other mammals carry a similar array of viruses is an important question to ask, and no doubt one that the researchers are looking into,” he said.

“Will larger-scale studies like this help us predict or better control future virus outbreaks?”

He added: The number of potential virus reservoirs is huge – there are more than a thousand different species of bat alone – and adequately screening these and other animals for viral threats would be challenging to say the least.”

via BBC News – Mammals harbour at least 320,000 new viruses.

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