MEDIFUND use may be tweaked to help middle income patients pay for very expensive drugs - a major shift from its current stand of helping only the very poor.

Health Minister Khaw Boon Wan floated this idea yesterday, as a way to help people pay for new and expensive drugs.

Currently, the ministry subsidises almost 1,000 drugs including more than 30 for the treatment of cancer.

The system has worked well for the majority of medicines.

But there are also very expensive drugs which, if added to the subsidised drugs list, would draw rich patients who are well able to pay for such treatments on their own. New cancer drugs, in particular could cost tens of thousands of dollars.

"First line essential drugs arenot a problem. They've been heavily subsidised all these years," said Mr Khaw.

"But some patients sometimes do require very expensive cancer drugs. I've been thinking about this for quite some time. How do we help them?"
 
He now thinks Medifund could be the answer. Instead of subsidising such drugs and making them available to all he prefers that patients go through a means test and dip into Medifund instead.

Medifund was set up in April 1993 to help needy Singaporeans who could not afford to pay their medical bills. It draws on income from a capital sum of $1.6 billion which is supplemented in years when the Government has a budget surplus.

Medifund covers all medical treatments, except for HIV/Aids. But this will change from next month. To cater to the pool of HIV/Aids patients, the Government is pumping in an extra $8.5 million into Medifund.

To qualify for Medifund now, hospital medical social workers look at a patient's family income, home ownership and Medisave money. They will then advise the hospital's Medifund committee on whether the patient is eligible, and if he should be given full or partial subsidy.

In the last financial year, $59 million was given out to help 370,000 patients.

Extending Medifund use to middle-income patients would require a different wealth criteria, said Mr Khaw. He gave the example of someone earning $5,000 a month who could be considered a middle-income earner.

"If his drug costs $5,000 a month, it would wipe out his whole salary," he added.

The minister gave the assurance that the criteria, if Medifund is extended to cover expensive drugs, will be "very loose". He added: "If you need help, you will get help."

Using both outright subsidy for some medicines and means testing for more expensive drugs is "skilful play with the tools in our toolbox", he said.

When contacted, the Singapore Cancer Society said it gets about 40 requests a month from patients who need help paying for their treatment.

Its chairman, oncologist Koo Wen Hsin, said he welcomes any proposal to extend Medifund help so long as proper guidelines and frequent reviews are in place to "prevent wastage of precious public funds on treatment that is futile".

Some cost-benefit analysis would have to be done. For example, $100,000 to cure a child's leukaemia is better value for money, than $10,000 to prolong a 70-year-old lung cancer patient's life for two months."

Likewise, Madam Halimah Yacob, an MP for Jurong GRC, welcomed the proposed change as "middle-income earners too need help with expensive drugs".

But she added: "The wider argument really is how much of our GDP are we prepared to set aside for health care."

She said current government spending, at 4 per cent of gross domestic product, "is not sustainable with a rapidly ageing population".

Unless this goes up, "more people will find health care becoming unaffordable", she said.