WHILE many general practitioners were enjoying their weekly day off, Singapore quietly ushered in a new era in managing chronic diseases like diabetes.

Starting yesterday, the onus for the day-to-day management of diabetes shifted from hospitals to GPs and for the first time patients were allowed to dip into their Medisave accounts to pay for this.

With hospitals worldwide striving to ease patient load, the move — if it proves successful — will go a long way in this direction. The GPs can shoulder some of the burden while hospitals can be utilised more efficiently.

Still, there will be some challenges to be overcome, said Dr Warren Taylor Jr, from the Northern California Kaiser Permanente Medical Group, a not-for-profit integrated managed care organisation, in the United States.

Said the medical director for Chronic Conditions Management: "In Singapore, you have this opportunity with this new Medisave shift to now allow people to be able to pay for appropriate care in an outpatient setting, hopefully, enlisting the help of GPs. With this care, these folks don't necessarily need to end up in the hospitals or the hospital specialist care."

However, he pointed out that while chronic care specialists and GPs in the US work closely with each other in the private sector, this is not the case in Singapore where a large number of specialists are in the public hospital setting.

"There is a challenge here because specialists are not directly connected to the primary care physicians," he said.

He also asked: "How do you set up the incentives for (GPs) to want to participate in this kind of process and take on that kind of care and do it appropriately?"

Dr Taylor, who was speaking at the National Healthcare Group's Annual Scientific Congress on Saturday, added that another "tricky" aspect would be overcoming the use of costly brand-name pharmaceuticals.

"The huge challenge right now is that there is no incentive for GPs to use generic or cheaper drugs. Why would they; they get paid more if they use a brand drug, particularly if they have some kind of arrangement with a pharmaceutical company."

"It doesn't make a lot of sense to see your GP and spend a whole more on drugs that you can't afford," he said, as people won't take them if they cannot afford them.

"Without the drugs you can't get the results and that can be self-defeating."

He also suggested that while Singapore has good facilities for face-to-face management of chronic illness, this was not efficient enough.

"We got over this idea that you have to see everybody and realised we could do it more effectively with different techniques."

Phone, web and email monitoring has allowed them to manage three-quarters of their hypertension patients today.

By Sheralyn Tay, Todayonline Oct 2, 2006 

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