Review on CHAS Visit Cap for Chronic and Mental Health Follow-up Care at Specialist Outpatient Clinics Versus GP Clinics
Ministry of HealthSpeakers
Summary
This question concerns whether the CHAS visit cap makes follow-up care at Specialist Outpatient Clinics (SOCs) cheaper than at GP clinics for stable chronic and mental health cases. Mr David Hoe asked if the Ministry of Health would review subsidy differentials and consider parity to support the right-siting of patients to primary care. Minister for Health Ong Ye Kung explained that CHAS subsidies for private GPs use fixed dollar caps, while public SOCs utilize percentage-based subsidies without annual caps to manage varying costs. He noted that these distinct funding models for private and public settings are designed for different clinical complexities and inevitably result in cost disparities. Consequently, while stable patients should be managed by primary care, there is no strict nexus between costs in these two different healthcare environments.
Transcript
14 Mr David Hoe asked the Coordinating Minister for Social Policies and Minister for Health (a) whether the Ministry is aware that the visits cap for CHAS may render patient follow-up care at Specialist Outpatient Clinics cheaper than GP clinics even for stable chronic and mental-health cases; and (b) whether the Ministry has reviewed and quantified the differential in subsidies and considered parity subsidies for the two types of outpatient care to support right-siting.
Mr Ong Ye Kung: Patients should be referred to Specialist Outpatient Clinics (SOCs) from their primary care physician only when they require specialised assessment or treatment for their condition. Conversely, medically stable patients requiring follow-up will be discharged from SOCs to primary care for management.
However, that does not mean that there will be a strict nexus between the cost of seeking follow-up care at General Practitioner (GP) clinics and SOCs. This is because the two are very different settings.
This is because GPs are private primary care providers. The Ministry of Health has included them into the public health system, through the Community Health Assist Scheme (CHAS). The chronic subsidies claimed under CHAS are for more common chronic conditions with costs that are not widely variable. To keep charging at clinics simple, subsidies are capped at a specific dollar limit for each visit and subject to an overall maximum cap per year.
On the other hand, SOCs are part of public health institutions. A wider range of chronic conditions are seen at SOCs, with more widely varying costs. SOC subsidies are based on a percentage of the bill, with no maximum cap whether per visit or per year.
The difference in approaches between a funding scheme for private GPs, and institutional funding for public SOCs, will inevitably result in some disparity in cost of healthcare between the two settings.