Letters to the Editor
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"The Advent of Casemix Funding"
The Minister for Health Mr Yeo Cheow Tong has announced recently the advent of casemix funding for hospitals in Singapore. A pilot run was started in Changi General Hospital and the National Heart Centre in May this year with implementation in our public hospitals by the year 2000. Based on this experience, the Government will then adapt it to regulate private hospital charges in the future. The full text of the Ministers speech is published as the lead article in this issue of SMA News.
Professor Don Hindle, an architect of the Australian case-mix system observed recently in a paper entitled Casemix funding in Australia Time for a rethink? (MJA Vol 168 June 1st 1998) that no matter how enthusiastically it is applied, casemix, as implemented is not sufficient because it is unsuited to the task of management at a higher level than a single institution. Furthermore it does not deal with the problem of health gain; it says something about costs, but little about value.
Australian doctors too are grappling with the intricacies of case-mix as a funding tool since its implementation in some Australian States five years ago. What we have to be mindful of is that a DRG system based on the Australian model is an eventuality in Singapore.
It is important to recognise that case-mix funding is only a tool to implement the funding of in-patient care based on risk adjustments of standardised care. It may not address issues concerning quality and outcome of care unless they are specifically considered.
The Minister has called for "leadership and participation of all healthcare professionals" so that casemix can be implemented for the benefits of Singaporeans. In response, SMA has formed a task force on case-mix headed by Dr Lim Teck Beng, an obstetrician and gynaecologist in private practice and a former medical superintendent of a government hospital with experience in medical administration. Dr Lim has served at various times as the 1st, 2nd Vice-President and Treasurer in the SMA Council for the past six years. The task force will educate doctors and give feedback on the implementation of casemix funding in Singapore.
The Australian Medical Association with which the SMA has close ties has provided us some initial background materials, a compendium of which is published on page N5. The task force would announce its plan of action in the coming months. Please write to us if you have views and ideas to contribute on this subject. K
DR CHEONG PAK YEAN