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Polyclinic rejects 73-year-old patient saying subsidies not allowed as referral came from GP

Referral by a general practitioner classifies the patient as a private one and therefore unable to use subsidy cards

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A local polyclinic reportedly did not allow a 73-year-old patient who underwent two X-rays to use her Medisave funds or her Pioneer Generation card or Community Health Assist Scheme (CHAS) card for subsidies – all because the patient had been referred to the polyclinic by a general practitioner (GP).

The elderly patient, Yeo Saw Hua suffered from a persistent cough for months and visited the Pasir Ris Polyclinic and saw a doctor there. The doctor prescribed some cough mixture to Yeo.

When the cough medicine did not relieve her cough, Yeo visited a GP at a CHAS-registered private clinic who sent her back to the polyclinic for an X-ray, since he suspected her condition was more serious.

Yeo underwent two X-rays at the polyclinic, which revealed fluid in her lungs. Mdm Yeo’s condition became so serious that she was admitted to a hospital a mere two days later.

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Yeo went to make payment for the two X-rays at the polyclinic, she was charged $91.10 to be paid in cash. Confused, she asked why she was charged GST and why she could not use her Medisave or subsidies.

The polyclinic responded that this is because she is considered a “private patient” since she was referred by a GP from another clinic.

If a polyclinic doctor had ordered the X-rays, she would be charged much less and would have been able to use her Medisave.

Yeo’s husband, 73-year-old Charlie Lim who earns between $800 and $1,000 a month by driving a taxi two days each week, asked reporters: “Why does the Ministry of Health ask us to use the Chas card to see a GP when we can’t get a subsidy or even use our Medisave  when we need to get an X-ray?”

A GP at the CHAS-registered clinic Yeo visited, Dr Joshua Lim, told ST that he has raised the issue of polyclinics charging CHAS cardholders private rates when they are referred by a private GP, to the Agency for Integrated Care.

The Government authority apparently responded that this is the way things are.

Dr Lim indicated that a GP could refer patients to a public-sector doctor first, so that the patient could receive a subsidy, but this would delay the process for patients to receive appropriate treatment.

Yeo’s husband appealed to their MP, Pasir Ris-Punggol GRC’s Zainal Sapari.

Zainal raised the issue in Parliament last month and asked why polyclinics charge CHAS card-holding patients private rates when they are referred by CHAS-registered clinics.

Health Minister Gan Kim Yong responded in a written reply. He said: “Some private GPs today refer their patients to polyclinics for specific services, such as X-rays or tests.

“As these patients are not assessed by polyclinic doctors, our doctors are unable to determine whether the ordered tests or investigations are appropriate. Therefore, they are considered private healthcare services, for which polyclinic subsidies do not apply.”

The Minister promised that the Ministry of Health (MOH) will review how it can better support CHAS patients who see GPs at CHAS-registered clinics. He said that MOH will also look into “ways to improve access to clinically appropriate subsidised tests and investigations.”

On Facebook, Zainal said: “I believe MOH, as a matter of professional courtesy and trust in the Chas GPs, should consider any follow-up tests/investigations ordered by the Chas GPs as necessary and appropriate.”

Noting that GPs send their patients to polyclinics since they do not have equipment to order tests like X-rays, he added: “Since, Chas patients were means-tested, they should be given the subsidised rates at polyclinics for follow-up tests or investigations ordered by private Chas GPs.

“Otherwise, it would not incentivize Chas card holders to seek treatment at Chas GPs and (they would) continue to go to polyclinics.”

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