Long-term Affordability for Mental Healthcare Treatments

9 Ms Nadia Ahmad Samdin asked the Minister for Health whether beyond the current utilisation limits for outpatient counselling and inpatient hospitalisation, the Government intends to further tackle the issue of longer term affordability and consistent accessibility for those seeking treatments and medication relating to mental health conditions given that the COVID-19 pandemic has had an adverse impact on our people's mental health and insurance options for mental health conditions are limited.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Madam, the Ministry of Health (MOH) has put in place various support measures to ensure access to affordable mental health services.

At our public health institutions (PHIs), eligible patients can receive up to 80% subsidies for inpatient mental health treatment. They are also covered under MediShield Life and can tap on MediSave to offset their remaining bills, up to prevailing limits. For outpatient treatments, eligible patients can receive up to 75% of subsidies at polyclinics and public specialist outpatient clinics. Patients can also enjoy subsidies of up to $500 per year at participating private general practitioner (GP) clinics via the Community Health Assist Scheme, for the management of mental health conditions under the Chronic Disease Management Programme (CDMP). In addition, patients can also tap on their MediSave to pay for their outpatient treatment of mental health conditions under the CDMP. Those who are 60 years old and above can additionally tap on the Flexi-MediSave scheme for outpatient expenses.

To ensure that no Singaporean is denied access to appropriate treatment due to inability to pay, MediFund is available at PHIs as a safety net to assist Singaporeans who are unable to afford their mental health treatments despite Government subsidies, insurance and MediSave.

MOH reviews the various financial schemes regularly to ensure they meet the needs of Singaporeans. For example, the MediSave annual withdrawal limit for patients with complex chronic conditions was increased from $500 to $700 from January 2021. The annual limit for Flexi-MediSave was also increased from $200 to $300 from June 2021. Since 1 March 2021, the MediShield Life claim limits for inpatient mental health treatment has been raised to $160 per day for up to 60 days per policy year, from the previous $100 per day for up to 35 days per policy year, which will help to improve patient affordability.

Mdm Deputy Speaker: Ms Nadia Ahmad Samdin.

Ms Nadia Ahmad Samdin (Ang Mo Kio): Mdm Deputy Speaker, I thank the Senior Minister of State for his response.

Encouraging help-seeking behaviour is an important part of any mental health strategy. Affordability and the stigma around seeking help are two factors of the many which affect an individual's decision whether or not to reach out for help. For some, the treatment required may be prolonged over several years and can be very expensive. I have two points.

The first is, many young working adults have come up to me and they are worried about the impact of seeking help and having mental health records and how this may affect their career prospects in the future. While there are many good psychiatrists and counsellors in the public health sector, there remains a segment who fear that their mental health records, will be accessible by Government agencies as well as employers. And so, they postpone seeking help because private help remains out of reach. What is the Ministry's assurance and clarity on this point?

The second point is, turning to insurance; Will the Government consider working more closely with private insurers to encourage the provision of affordable and comprehensive mental health coverage for Singaporeans, just like any other medical and surgical coverage? For example, legislation like the Mental Health Parity and Addiction Equity Act in the US?

Dr Janil Puthucheary: Mdm Deputy Speaker, I thank the Member for her questions. Let me answer the second point. As far as working with insurance companies to further optimise the coverage process and ensure affordability, that is an on-going piece of work. It will continue and the Ministry is committed to working with the stakeholders in order to ensure that it happens. So, the short answer is yes.

To her first question, if I understand her question correctly, it is about the issue of health records and the confidentiality of health records. I think she had asked about the difference in the confidentiality of health records between private practitioners and public practitioners. We should be clear that your health record is held in confidence by your medical care provider, regardless of whether it is a public practitioner or a private practitioner. We have a fair amount of regulation and legislation in order to protect and reinforce that process. I hope I have understood her question correctly.

Mdm Deputy Speaker: Ms Raeesah Khan.

Ms Raeesah Khan (Sengkang): I thank the Senior Minister of State. I have two supplementary questions. I am glad to hear that the withdrawal limit for inpatient treatment is now $160. But the withdrawal limit for physical treatment is $455. Is there going to be a review to, hopefully, equalise this amount?

Secondly, we know that the pandemic has exacerbated a lot of mental health issues. Are there any plans for establishing another tertiary psychiatric institution?

Dr Janil Puthucheary: Mdm Deputy Speaker, I thank the Member for her questions. The withdrawal limits are always under a regular review. The principle is not so much to make sure that there is a completely flat equivalence for all conditions and for all circumstances, but what is the outcome in terms of access and affordability, both bill size, out-of-pocket and the number of incidents of care-seeking behaviour within a period of time for an individual. So, I think it is the outcome that we want to drive in terms of setting withdrawal limits, together with the outcome of a sustainable healthcare system.

As for the provisions of infrastructure in terms of dealing with the pandemic and its effects on mental health, this is a matter that the COVID-19 Mental Wellness Taskforce is looking at, as well as the new Inter-Agency Taskforce on Mental Health. We will be looking at the infrastructure and the service provisions that we need for our mental health needs.

As to whether provision for an extra tertiary hospital is necessary, it is one of the possibilities that the Member has suggested. It is not going to be the only issue that we will be studying. So, it will be looked at and reviewed.