Streamlining of MediFund Application Process to Allow Approval to be Accepted Across Healthcare Institutions

7 Dr Tan Wu Meng asked the Minister for Health (a) since 2021, how many Singaporeans have successfully applied for MediFund at one healthcare institution and have at least an annual appointment at another healthcare institution (i) within the same cluster and (ii) in a different cluster respectively; (b) how many of such patients have successfully applied for MediFund across all healthcare clusters they have been to; and (c) whether the MediFund application process can be streamlined to support needy Singaporeans who cannot afford their healthcare bills across different healthcare institutions.

The Minister for Health (Mr Ong Ye Kung): Sir, around 30% of the MediFund beneficiaries received MediFund assistance from more than one institution within the same public healthcare cluster, and around 40% received MediFund assistance from more than one institution across public healthcare clusters. The Ministry of Health (MOH) has devolved MediFund approvals to the MediFund Committees of individual healthcare institutions. This is to enable the Committees to exercise greater discretion in assessing MediFund applications and, thereby, improving their accessibility to these funds. However, this also inevitably leads to multiple assessments for the same patients across institutions: you transfer from acute hospital to community hospital, you go through one more round of assessment, and that adds to their inconvenience.

We need to strike a balance between these two objectives of flexibility and convenience. In line with that, MOH has reviewed the MediFund application process to make it more seamless with limited impact on the flexibility and discretion of the MediFund Committees. And we will be implementing the following changes by March 2024.

First, a mutual recognition arrangement between acute hospital and step-down care. This means that when a patient benefiting from MediFund is transferred from an acute hospital to step-down care, he or she will continue to benefit from MediFund without having to re-apply again. As the medical bills, social and financial circumstances of patients may vary over time as they transfer from one institution to another, this automatic extension of MediFund will be for three months or until the receiving institution reassesses the patient’s eligibility for continued MediFund assistance.

The second change is a mutual recognition arrangement within the same healthcare cluster for outpatient treatment. For example, if a patient is receiving MediFund at an outpatient institution, say, a polyclinic, and he goes to another MediFund institution within the same healthcare cluster, say, a specialist at a Specialised Outpatient Clinic, he will automatically receive support from MediFund and does not need to re-apply for his outpatient bills another time. This automatic support will be valid for a year from the time MediFund is first extended to him at the outpatient setting.

Last, more support for ComCare graduates. Today, MediFund assistance is automatically extended to needy patients who are under ComCare assistance. MediFund assistance is withdrawn when the patients graduate from the ComCare scheme. So, there is a bit of a cliff effect. So, to strengthen support for these ComCare graduates on their journey to self-reliance, MediFund support will continue for three months after graduation from ComCare.

I should clarify that under the law, MediFund Committees of each healthcare institution continue to have full discretion over the application outcome and extent of support, to prioritise support towards those who need it the most. Notwithstanding, MOH has been engaging them to agree to support the changes that I just mentioned. MOH will be issuing these guidelines to the MediFund Committees. These enhancements should help smoothen the experience for MediFund beneficiaries as they transfer or seek care in different healthcare settings, and we expect them to come into force by March 2024.

Mr Speaker: Dr Tan Wu Meng.

Dr Tan Wu Meng (Jurong): I thank the Minister for his answer. I declare that I am a medical doctor at a public healthcare institution.

Eleven years ago, a number of young healthcare workers, including myself and others, had advocated for such improvements within the same healthcare institution campus. In 2016, seven years ago, I had asked a Parliamentary Question on how we could smoothen that journey across different hospitals across Singapore. These are welcome developments, and I would like to ask the Minister two supplementary questions.

Firstly, we have some elderly residents who are less mobile and who are worried about having to make additional appointments to see a medical social worker, whether it is for review or renewal of their support. A less-mobile resident who needs a caregiver to accompany, this has implications for the caregiver, too. Can I ask the Minister, are there ways we can better resource our medical social worker (MSW) departments so that more patients can have the assessment and review with an MSW on the same day that they come to the clinic or for treatment at the hospital?

Secondly, can I also ask the Minister, given there are some patients who have great difficulty getting out of the home, would MOH consider working with either the SSOs or the local family service centres to help engage local teams who might be able to visit a less-mobile patient at home, so that the patient does not have to go and make an additional trip purely for the purpose of means testing?

Mr Ong Ye Kung: I thank the Member for asking all these questions on behalf of your Clementi residents. [Laughter]. It is, right? He did not say that? Okay. But I thank the Member for the persistence and I know Dr Tan Wu Meng has been knocking on this door for a long time.

Like all policies, it takes time for us to look at it and find ways to implement it in a way that everyone can accept. So, I think persistence does pay off and I know Dr Tan has also been equally persistent in asking for the elderly who are immobile, in terms of the portability of their subsidy as well of their MediFund eligibility.

These are valid suggestions. We will have to look at them. One way is to go digital and make things easier, but that also introduces its own impediments. But it will be a useful channel for the immobile or home-bound patients to also apply for medical and financial assistance.

The other is that we have now implemented Healthier SG and also Age Well SG with a whole network of active ageing centres (AACs) throughout our communities. We want to double the number, expand the network, deepen the kind of help they can extend to our aged residents. So, they can also be a channel from which I would not rule out that, in time to come, they can also be a channel for us to guide our aged and seniors to apply for assistance there.

So, these are all the possibilities. We will take them in. Persistence does help. So, keep on putting forward such suggestions to us.