Is it really a good deal for patients?

sgCR wonders if patients really benefit from this scheme...
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Feb 22, 2007
Heart pill: Pay $1,000 less the NUH way
When discharged, patients get one year's supply, covered under Medisave, insurance

By Health Correspondent, Salma Khalik

FOR subsidised heart patients in need of potentially life-saving medication, where they get treated could mean a difference of more than $1,000 when footing the bill.

At the National University Hospital (NUH), a patient gets a year's supply of medicine when they are discharged, covered by Medi- Shield or Medisave. At the National Heart Centre (NHC), however, a patient gets only three months' worth of drugs. After that, they have to pay for it out of their own pockets.

About 5,000 people here are fitted with stents each year. More than half get drug-eluting stents (DES), devices that slowly release medication to prevent the artery walls re-thickening. But they increase the risk of getting blood clots.

So such patients are usually given two antiplatelet drugs for at least a year to prevent the formation of blood clots that could cause a fatal heart attack.

One of the drugs is simple aspirin, which costs only a few cents per pill.

The other, Plavix, costs about $4 each. No generic brands are available for this; neither is there a subsidy for the medicine once the patient leaves the hospital.

But NUH provides a whole year's supply of Plavix when patients are discharged, so it forms part of their hospital bill.

This means that they can claim the cost of medicine against any hospital insurance they may have, or from their Medisave account, so long as it is within their claim limits.

At NHC, the same patient will get only three months' supply of medicine on discharge.

NUH's Associate Professor Tan Huay Cheem told The Straits Times: 'It's such an important medicine, I don't want patients to miss out on it because they can't afford to pay.'

He sees nothing wrong in adding it to the hospital bill for insurance claims, as 'it is part of the medical treatment and there is a real danger if patients stop taking it'.

For Mr Ong Wee Chai, 43, who had a DES inserted at NUH last month, having a year's supply of medicine with him is a real blessing.

'That pill (Plavix) costs more than my lunch,' said the senior petroleum storage technician.

Married with a 10-year-old son, his salary of $2,600 a month is comfortable. But his sudden illness and the need to take five different types of medicine a day could prove a drain on his resources if he needs to pay for it all with cash.

Over at NHC, Associate Professor Koh Tian Hai said only 1.3 per cent of patients with the DES get blood clots within nine months of getting stents inserted. Of these, one in four gets clots because the patient had stopped taking medication.

But he said that with the expansion of Medisave - the portion of CPF used to pay for treatment of serious medical problems - from last month to cover chronic heart problems, patients can draw on their accounts for up to $300 a year.

While this is not enough to cover the additional nine months' supply of Plavix, patients can also draw on the Medisave accounts of family members.

Explaining why patients are given only three months' supply, Prof Koh said their cases have to be reviewed to see if it is safe for them to continue taking the medicine.

He added: 'Furthermore, drug potency is ensured when medication stocks are not kept for excessively long durations by patients.'

Prof Tan assured patients that NUH ensures that drugs given for a year are within the expiry period, so potency is not affected.

Madam Halimah Yacob, who heads the Government Parliamentary Committee (GPC) for Health, feels strongly that the Government should subsidise drugs that are a necessary part of treatment.

Failing that, she said the heart centre should follow NUH's practice: 'NUH did the smart thing. That's what doctors are trained to do, to keep patients alive.'

salma@sph.com.sg