Forum: Help more patients accept palliative care via greater public awareness and insurance support
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I am encouraged by the emphasis that Health Minister Ong Ye Kung placed on palliative care, including inpatient hospice services (Woodlands Hospice opens; plans for 70 beds to serve palliative care needs in the north, Aug 3).
As a private specialist, I frequently refer patients with terminal illnesses to palliative and hospice care. While these services have expanded significantly, there are still hurdles that prevent them from being more widely used.
Challenges stem from the widespread misconceptions surrounding palliative care.
First, palliative or hospice care does not mean “letting patients die”. Rather, the focus shifts from invasive interventions to comfort, dignity and symptom relief, with the aim of maximising quality of life.
Second, a referral to palliative care does not mean that doctors have given up on their patients. It simply means that there are no further disease-modifying treatments for conditions such as advanced cirrhosis or metastatic cancer.
Palliative care teams continue to manage chronic illnesses such as diabetes, hypertension and coronary artery disease, while also treating acute conditions such as urinary tract infections, pressure sores and other reversible medical problems.
Another important issue is financing. Not all private Integrated Shield Plan insurers provide coverage for inpatient or outpatient hospice care.
Without clear and adequate insurance reimbursement, some terminally ill patients with Integrated Shield Plans may choose to remain in acute hospitals until the end of life instead of receiving more appropriate hospice care. This not only deprives patients and their families of the benefits of specialised palliative care, but also places additional demand on acute hospital beds.
The Ministry of Health should work with private Integrated Shield Plan insurers and other stakeholders to address these reimbursement gaps. Better alignment of insurance coverage with Singapore’s palliative care goals would enable more patients to receive appropriate end-of-life care in the most suitable setting.
As Singapore’s population ages and the number of people living with advanced chronic illnesses continues to rise, palliative care will become an increasingly important part of the healthcare system here.
Greater public awareness, together with appropriate insurance support, will ensure that more patients can spend their final months with comfort, dignity and the right care in the right place, while making better use of Singapore’s healthcare resources.
Desmond Wai Chun Tao
