Service fee paid to GPs will be based on patients' conditions

The annual service fee paid to general practitioners involved in the Healthier SG scheme will have different base rates for patients with and without chronic conditions, regardless of whether they comply with their health plans.

Senior Minister of State for Health Janil Puthucheary announced this on Wednesday in Parliament during the debate on the White Paper on Healthier SG, and gave more details on how the fee model will work.

The White Paper states that GPs will be given an annual service fee to care for and manage each enrolled resident, with the payment tiered based on the health risk profile and scope of required care.

Dr Lim Wee Kiak (Sembawang GRC) and Mr Gan Thiam Poh (Ang Mo Kio GRC) had said GPs have questions on remuneration, and are worried they would be penalised if patients refuse to stick to their health plans, which may lead GPs to cherry-pick patients.

The MPs said GPs are also concerned about the impact on their business when drug prices are made more comparable to those at polyclinics.

Dr Janil noted GPs have said that educating and encouraging Singaporeans to turn up for screening requires time and effort.

He added that the design of the service fee addresses this and minimises the impact of cherry-picking. This fee is on top of existing government subsidies and patient revenue that GPs already receive.

Dr Janil said: "GPs can also expect more revenue from these patients, with the increased uptake of recommended preventive care services which will be fully subsidised. The more comparable drug prices will help patients who may have otherwise visited polyclinics to see their GPs instead.

"Taken together, GPs will be fairly remunerated for the care they deliver under Healthier SG."

He also said that additional payouts are given upon the completion of critical care components recommended in the GPs' care protocols and patients' health plans. "For example, have patients with diabetes gone for their annual eye and foot screenings? At the start, doctors will be paid, not on the basis of whether blood pressure or blood sugar levels have come down, but whether the patient has engaged with the interventions that will help bring down the blood pressure and blood sugar."

Dr Janil also responded to suggestions by Workers' Party MP Gerald Giam (Aljunied GRC) to fully lift annual MediSave withdrawal limits for patients under chronic disease management, especially those above 60, to encourage people to see their doctors early and stay on their disease management plan.

Said Dr Janil: "We have limits on the use of MediSave to ensure Singaporeans have sufficient savings to meet their various healthcare needs throughout their lifetime. We will continue to review the adequacy of each MediSave limit."

The Health Ministry regularly reviews the list of conditions on the Chronic Disease Management Programme, and recently expanded it to include gout, allergic rhinitis (a type of nasal allergy) and chronic hepatitis B, bringing the number of diseases covered to 23.

In a speech, Second Minister for Health Masagos Zulkifli said Singapore's chronic disease prevalence rate has risen. The proportion of the population with high blood pressure has risen to 32 per cent in 2020, from 20 per cent in 2010, and to 37 per cent from 26 per cent for high blood cholesterol.

While life expectancy here at 85 years is one of the highest in the world, the health-adjusted life expectancy is 75 years, meaning that Singaporeans spend about 10 years in ill health, Mr Masagos said. "We want to reverse these trends and empower residents to lead active and healthy lives, surrounded by people whom they love and can support them in their journey towards better health."