We know that health screening is useful for early detection of chronic diseases and other illnesses like cancer. This can enable early treatment which means a better chance of recovery. The Health Promotion Board has been sending out letters to all Singapore residents aged 40 and older to attend health screening, yet from the Minister’s reply to my parliamentary question on 21 October 2013, it appears that the participation rate is quite low, and even MOH agrees that there is room for improvement. Here is my PQ and the Minister’s answer.
What can we do to increase the participation rate?
Mr Gerald Giam Yean Song asked the Minister for Health from 2011 to 2013 to-date (a) how many invitations have been sent annually to residents of 40 years old and older to go for health screening under HPB’s Integrated Screening Programme (ISP); (b) how many residents took up those invitations in each of those years; (c) what are the charges for such screenings; (d) what is the rationale for charging such screenings; (e) what are the KPIs the Ministry uses to measure the success of the ISP; and (f) how does the Ministry rate the success of the ISP.
Mr Gan Kim Yong (Minister for Health):
The nationwide Integrated Screening Programme (ISP) offers affordable and convenient screening for high blood pressure, high blood cholesterol and diabetes, as well as breast, cervical and colorectal cancers to Singapore residents for the recommended age-groups. Under the ISP, Singapore residents who reach 40 years of age receive invitation letters to go for the various ISP screening tests at GP clinics. Those who are screened receive rescreen invitations according to the recommended intervals in subsequent years for the various screening tests. To enhance accessibility, the Health Promotion Board (HPB) collaborates with partners such as People’s Association as well as companies, to bring subsidised health screening to residents in the community and workplaces.
The total number of residents aged 40 years and older who received 1st invitation letters and rescreen invitations were 490,000 in 2011 and 200,000 in 2012. In 2011, 36,000 people attended health screening under the ISP and 19,000 people in 2012. The total number of invitations and residents who attended health screening was higher in 2011 because 365,000 invitation letters were sent to women aged 50 and above who were due for their mammogram screening in conjunction with the launch of the Celebrate Wellness (CW) programme, a HPB partnership initiative with WINGS and Toteboard.
Costs for screening services under the ISP have been kept affordable. For example, the cost of the blood tests in the GP clinics to screen for diabetes and high blood cholesterol is $8, the cost of Pap smear to screen for cervical cancer is $15, and the cost of the Faecal Immunochemical Test (FIT) which screens for colorectal cancer is $30. This is in addition to the GP consultation fees. Lower-income Singaporeans receive all these tests for free and only need to pay GP consultation fees. For community based screening, the cost of blood tests to screen for chronic diseases is $2 to $5.
Under the ISP, GPs can refer women for mammography for breast cancer screening at Breast Screen Singapore (BSS) centres at 16 polyclinics, at a subsidised cost of $50 for citizens. Women aged 50 and above can use Medisave to pay for mammograms at all Medisave-approved screening centres, including the BSS centres.
Patients are charged for screening under the ISP as the health of an individual is a shared responsibility. We have also targeted government subsidies at those who need help most. To make screening even more affordable and accessible, the Community Health Assist Scheme (CHAS) has been enhanced to increase the coverage of subsidies for screening tests under the ISP. From 1 January 2014, the recommended tests will be fully subsidised by the government for CHAS patients at accredited GP clinics. They will also enjoy subsidies for GP consultation charges of up to $18.50 per visit, for their screening and subsequent follow-up consultations, up to two times a year.
The results have been encouraging. In the National Health Survey 2010, among Singaporeans aged 40 to 69 years, 71% had been screened for high blood pressure in the past year; and 61% and 64% had been screened for high blood cholesterol and diabetes respectively in the past three years, in accordance with the recommended frequency of screening. In terms of cancer screening, 48% of women aged 25-69 years had undergone the Pap smear test within the past three years; and 10.3% of Singapore residents aged 50-69 years had a Faecal Occult Blood Test (FOBT) within the past one year.
Nevertheless, there is room to further improve the screening participation rate. My Ministry will continue to look into how we can encourage more Singaporeans to undergo appropriate screening, and make screening even more convenient and affordable.