Chronic Disease Management Program

Thought I'll post something useful, for once and maybe the last time, on something that is seriously misunderstood by many Singaporeans.

Chronic Disease Management Program (CDMP): a program intended to shut the mouths of Singaporeans who keep lamenting that their money is growing mould in their Medisave accounts. This program allows the patient to use the money in their Medisave account to pay for part of their medical expenses. However, please note, CDMP is only for diabetes, hypertension (technical name for high blood pressure), hyperlipidemia (technical term for "high cholesterol"), and stroke; data is correct as of 1st Jan 2007. So stop asking if your child's growth hormones etc, or your medicine for osteoporosis treatment can be claimed under Medisave, and DO NOT question me on why your medicine cannot be claimed using Medisave. I do not take too kindly to being blamed for things that are not decided by me. If there is somebody you want to flame, go flame Khaw Boon Wan.

Anyway, if you are a first time participant of this program, a staff will have to sit down and go through with you on all the details of this program. After the explanation, you have to sign on the form affirming that you understand everything that was explained to you. However, past experience tells me people will just sign whether they understood or not. They just want to use their money, pronto. When problem crops up later, they yell at the staff claiming they where not told of this, not told of that. Hmm... maybe a ghost moved the pen to forge a signature on the form...

So how exactly does CDMP work? Every year, you are allowed a $300 withdrawal limit from your Medisave account to pay for your consultation, medicines, and any other diagnostic tests required in the course of the consultation. You whine, "But that is so little. $300 for the whole year?!" So MOH allows you to draw from a max of 10 different Medisave accounts. Here's the catch: you can only use the Medisave accounts of your immediate family members, and by that MOH means your spouse, your child(ren), your parent(s), and your grandchild(ren). No, your "spouse" from extra-marital affairs, love child(ren), cousin(s), uncle(s), and aunt(s) do not count.

Next, let's look at the mathematics part of the program. Before I start, understand that the government is not deviating from its policy of wanting its citizens and permanent residents to be responsible for their health, so CDMP is intended to be a co-payment program. I am not going to explain what is "co-payment", if you have a limited vocabulary please look up a dictionary. Back to the mathematics.

There are 2 main components a participant needs to understand.

1. There is a deductible of $30 + administrative fee for each visit. The $30 is set by MOH, whilst the administrative fee is set by the institution. The $30 deductible simply put is the first $30 of your medical bill for each visit. This, you have to pay upfront whether you like it or not. It also means if your total medical bill for that visit is less than or equals to $30, you basically would not touch a single cent from your Medisave account.

Next, the admin fee. Why pay an admin fee? Because manpower is required in creating a special claims account for the institution to post in your Medisave claim, and CPF board charges the instituition for each claim made. The money has to come from somewhere and since it is the patient who wants to make the claim, then the patient has to fork out the admin fee.

2. This is where the copayment comes in. There is a 15% co-payment, meaning you have to make an upfront payment of 15% of the medical bill, after lessing $30. The remainder 85% will be deducted from the Medisave account. Hold on. Shouldn't it be 15% of the medical bill after lessing $30 + admin fee? No. The admin fee is not part of the medical bill. However, there are times when you have to pay more than the 15%. Remember the annual withdrawal limit of $300? It's annual limit, not per visit limit.

To make things clearer, let's do some actual mathematics.

Assuming the following is the cost for a single visit...
Consultation bill= $30
Medicine bill= $100
Total medical bill = $30 + $100 = $130

To calculate the amount patient has to pay upfront...
Medical bill after lessing the $30 deductible = $100
15% co-payment by patient = $100 x 0.15* = $15
Amt deductible from Medisave = $100 - $15 = $85
Total upfront payment by patient = $30 + $15 + admin fee

This is all very nice if the patient has not exceeded the annual limit and has enough in the Medisave account for deduction. Assuming if this same patient has made prior claims and there is only $80 left of the Medisave annual limit, then the following changes would occur:

Amt deductible from Medisave = $80
Total upfront payment by patient = $30 + $15 + $5 + admin fee

*In case you wonder how I derived the 0.15, 15% = 15/100 = 0.15

Common misunderstandings:

The $30 deductible + admin fee is a once off payment. WRONG! You pay the $30 deductible + admin fee at each visit/ claim. Yes, including the admin fee. Did I not mention CPF board charges the institution for each claim made? That means if you wanted us to do a partial supply of your medicine and wanted to collect the balance on another day, you have to pay the $30 + admin fee again. It is considered as a separate visit/ claim.

I only need to fill in the Medisave forms once and I am in the CDMP forever. WRONG! You need to fill up a new form each year to renew the use of your Medisave account for CDMP. This includes all the other people whose Medisave accounts you are using. If you lapse in doing the necessary paperwork, do not come and blame us for not allowing you to claim through Medisave.

For Goodness Sake, This is A Hospital!

It started with the new year. Patients came to me asking if the hospital is giving out free calenders. No, of course not! This is a hospital, not some commercial companies trying to woo you into buying their products or using their services. Besides, if the hospital has so much money to print calenders for patients, it should first pay us a fatter year-end bonus.

Now with Chinese New Year round the corner, there are progressively more and more patients coming to the pharmacy asking if we give out complimentary red packets. When I told them the hospital never gives out complimentary red packets, they started asking for the red packets that we used to decorate the pharmacy. Just exactly where do these idiots think they are? The bank?! And what's the big idea asking for the red packets that we used for decoration?! Go buy them yourselves, and stop wasting time asking stupid questions.

Listen To Me!

I'm not being narcissistic, but I do get irritated when patients are not paying attention to what I am telling them. Do you think I like repeating myself 24/7 on how to take the medicine and what side effects to watch out for? I would love to just collect the money from you and send you on your way without any counseling if you much prefer talking on your cell phone. Or if you prefer to zone out and go on some space adventure give me Scotty's number, I'll get him to beam the medicine to you. However, it is mandatory for pharmacists to provide counseling for the medicine we dispensed, so I am bounded by law. Since I do not have a choice, then the least you can do is to show me some respect by listening to what I have to say about your medicine.

I don't care if it is just the usual cough and cold medicine. You might have forgotten that some of them may cause drowsiness and you really should not be driving, or operating machinery. I've just saved your life or your limbs. I don't care if it is just painkillers. You need to know which is for what level of pain, which are the ones to take after meals, and which ones not to mix. I've just saved you from paracetamol overdose, and experiencing gastric pain. I don't care if it is medicine you have been taking for the past one year. Just listen to me go through your medicine because you might have missed out on any changes in your drug regime during the consultation. Or other times, you remembered the doctor telling you of the changes, but the doctor in his/her hurry did not update the drug regime in the prescription. I've just prevented you from over/underdosing.

If all these still cannot convince you, then let me tell you a real life story, that was related to me by somebody, of how a man from Singapore died. This man was on insulin for his diabetes and was okay until one day he decided to jab himself with insulin just before boarding the plane, and went into a hypoglycemic episode. Stupid. You should know your regular insulin starts working in 15-30 mins' time, and no flights serve meals that soon. And this is not the first time you were traveling on a plane. Stupid. When counseling patients on insulin, we always tell them to carry hard candies, or a juice box where ever they go. Reason: in case of hypoglycemic episodes they can load themselves with sugar and temporarily relief the hypoglycemia, after which it MUST be followed by a proper meal. Stupid. If you were already hypoglycemic, and without your juice box, get help from the flight attendants immediately. Not wait till you were almost going into a coma. Stupid. You already had a close call with death, but you had to go jab yourself with insulin and forget to take your meal. And this time you were at home!

Anyway, the story ends here. This stupid man met his maker, and to be frank, I do not feel sorry for him. All the above things I've mentioned are things we always tell patients on insulin. We teach them the signs and symptoms of a hypoglycemic episode. We teach them what to do if they are hypoglycemic, and we remind them again, and again, that they must remember to take their meals after jabbing themselves with insulin. See all the important things you will miss if you do not pay attention to your pharmacist?