I was asked by a journalist to comment on the Singapore Community Health Assist Scheme (CHAS) and the impact on polyclinic consultation volumes. Below are the queries and responses.
Other than providing subsidised care in the community, another purpose of CHAS is also to ease the patient load of polyclinics. However, despite the significant increase in the total number of attendances under CHAS, total polyclinic attendances has also increased. Possible to share your thought on this? What might be some of the potential reason for the continue increase in the number of polyclinic attendances? Higher medication subsidy etc? Is CHAS still serving its primary purpose?
1. With lower price to patients through CHAS, polyclinic subsidies etc, we can expect as the data shows, that more patients will access services. The key questions then revolve around whether this increase is appropriate and I hope the MOH is studying this issue.
2. On reducing the volumes to polyclinics, it would be more useful to look at the rates of increase in polyclinic volumes over the years. With aging and population growth, the consult numbers should increase. What’s important then firstly to examine whether the overall population increase in consults is commensurate with the drivers like aging, population growth etc, and secondly to explore whether the increases have been absorbed more by CHAS clinics or by polyclinics.
3. Finally, further drill down on the CHAS numbers would be useful to assess the success of the scheme. Data showing the number of private clinics enrolling in CHAS, the number of unique patients and consults per patient, would be valuable. Finally, beyond process metrics like number of consults, we should look carefully at the quality of care and clinical outcomes.
I further clarified that the appropriateness of the increase in both CHAS and polyclinic consult volumes could relate to two factors:
a. Low price to patients reduces financial barriers to appropriate and necessary care
b. Low price to patients at the same time also encourages consults for frivolous, minor or self-limiting conditions.
My suspicion is that it would be a bit of both but the data should be interrogated fully to get a better picture.