Outpatient Reimbursement for Mental Illness

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

The Chronic Disease Management Programme has been extended to cover the outpatient treatment of two more chronic diseases, namely Schizophrenia and Major Depression.

Recent developments

With effect from 1 October 2009,  the use of Medisave has been further liberalized to cover outpatient treatment of Schizophrenia and Major Depression. Medisave withdrawal rules under the Chronic Disease Management Programme (CDMP) will remain unchanged, i.e. withdrawals are capped at S$300 per Medisave account per year, and the existing deductible of S$30 and co-payment of 15% will also apply.  

The Ministry of Health (MOH) has developed a new disease management guideline which provides detailed guidance on the treatment of these two psychiatric conditions, as well as identified clinical care indicators which it will track under MOH's quality assurance framework. It has also produced educational booklets on schizophrenia and major depression meant for patients' and caregivers' reference. These booklets contain relevant information on the disease symptoms, the treatment and help available and what one can do to help loved ones cope with these two diseases.

General practitioners (GPs) who are interested to treat patients with schizophrenia or major depression will be required to participate in a Shared Care or GP Partnership Programme with a public sector hospital. This is to ensure quality and continuity of care for patients. Under this partnership programme, local hospitals will support GPs in training, professional support from nurses or psychologist and periodic review by psychiatrists. 

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

• Providers

• Patients, Consumers

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Polyclinics	very supportive		strongly opposed
Providers
Private Providers	very supportive		strongly opposed
Patients, Consumers
General public	very supportive		strongly opposed
current    previous

Actors and influence

Government
Ministry of Health	very strong		none
Polyclinics	very strong		none
Providers
Private Providers	very strong		none
Patients, Consumers
General public	very strong		none
current    previous

Positions and Influences at a glance

Adoption and implementation

The Medisave for Chronic Disease Management Programme is a national effort spearheaded by the Ministry of Health (MOH) to radically change the way chronic diseases are treated in Singapore. The aim is to shift the focus away from sub-optimal, episodic, or reactive care of symptoms, towards a paradigm of life-long holistic care that emphasizes prevention and health maintenance.  

Under the Chronic Disease Management Programme (CDMP), Medisave use was liberalized to include the treatment of four chronic diseases, i.e. diabetes, hypertension, lipid disorders (e.g. high cholesterol) and stroke. In April 2008, asthma and chronic obstructive pulmonary disease (COPD) were added to the list.  

There is a comprehensive support structure for this programme, including web-based IT systems that make it convenient for the doctors to submit Medisave claims and relevant patients' health outcomes to MOH.

Monitoring and evaluation

The Ministry of Health (MOH) has identified clinical care indicators which it will track under MOH's quality assurance framework.

Expected outcome

Schizophrenia, a chronic psychiatric disorder that requires long-term treatment, is estimated to affect nearly 1% of the population. Major Depression is a serious form of mental illness causing significant distress or impairment in daily activities, but is highly treatable once diagnosed. It is hoped that managing these conditions in the outpatient setting will minimize potential relapse or complications and reduce costly hospitalization later on. 

The extension of CDMP to these illnesses will potentially benefit many patients with Schizophrenia and Major Depression who can be managed effectively in the community by GPs and psychiatrists. With the establishment of evidence-based treatment and adequate support from caregivers and the community in their journey of rehabilitation, most patients can maintain and lead a near normal functioning or productive life. 

Patients welcomed the idea as it will help reduce out-of-pocket payments. Since its inception, 90,000 patients have enrolled in the program. In 2008, S$18 million had been withdrawn from Singaporeans' Medisave accounts under the scheme.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high
current    previous

References

Sources of Information

• MINISTRY OF HEALTH Press release. Extending Medisave Use To Schizophrenia And Major Depression. 25 SEPTEMBER 2009

Reform formerly reported in

Chronic disease management program Process Stages: Evaluation

Author/s and/or contributors to this survey

Lim Meng Kin

National University of Singapore

Suggested citation for this online article

Lim Meng Kin. "Outpatient Reimbursement for Mental Illness". Health Policy Monitor, October 2009. Available at http://hpm.org/survey/sg/a14/2