Singapore : New Medical Service Package Offers Subsidies for Cardiac Treatment/Devices

In an effort to ensure that Singaporeans receive quality healthcare at reasonable prices, Singapore’s Ministry of Health introduced the Medical Service Package (MSP) on July 2, 2004. The MSP, which took effect in all public institutions on July 5, 2004, will allow some patients to receive subsidies for medical care. The program will start by providing subsidies for a number of cardiac devices, including cardiac stents, defibrillators and pacemakers. If this program is successful, the Ministry of Health will consider expanding the program to other medical specialties.

The MSP will provide subsidies for patients in Ward/Class B2 and C (which have six or more beds per room and do not have air conditioning). Patients in Wards A1, A2 and B1 (which have four or fewer beds per room as well as air conditioning) are not eligible to receive subsidies. The MSP will cover cardiac medical devices, procedures, investigations and even some cardiac drugs. These services are grouped into three categories and are based on medical necessity. (1) The Basic service includes standard healthcare services, where the indications are not controversial. (2) The Extended service refers to newer or more advanced medical services, some of which are controversial. Extended service is only required in special circumstances for certain patients; or in a case where the indications are still evolving. (3) Excluded service consists of non-essential medical services, like cosmetic surgery or experimental treatments.

The main goal of the MSP is to ensure that patients are not “over-serviced” by healthcare providers. Therefore, the program has set up a system of peer review to make sure that patients receive the correct treatment, and are not subject to any unnecessary tests or treatment. However, the medical team in charge of treating a patient will make its treatment decision based on the patient’s needs, not the patient’s ability to pay. In the case where patients are still unable to pay their medical bills despite the subsidies, they will be referred to a medical social worker.