Managing chronic diseases can be costly. But the cost of ignoring them is even higher. This article discusses the essential aspects of effective management of one or more coexisting chronic conditions. We will also cover the latest chronic disease management subsidies and financial schemes available in Singapore, including MediSave500/700, CHAS Chronic Tier and Healthier SG Chronic Tier.
Table of Contents
1. What is a Chronic Disease?
According to CDC, chronic disease is understood as a health condition that lasts one year or more. It requires ongoing medical attention and limiting activities of daily living. Often, it can be managed but can't be cured.
Most of us are familiar with the “three highs” as common chronic diseases. However, many more other illnesses are categorised as chronic. Some chronic illnesses can linger throughout an individual’s life but are not always the cause of death, for example, arthritis. Others persist over time and require comprehensive management, such as type 2 diabetes. A number of chronic diseases can result in life-threatening situations such as stroke or heart attack.
The common chronic diseases are:
- Cardiovascular: Stroke, heart failure, heart attack
- Cancer
- Diabetes
- Joint/Bone Diseases: Joint pain, arthritis, rheumatoid arthritis, osteoarthritis
- Mental Health/Brain Disorders: Depression, schizophrenia
- Neurological Diseases: Dementia, Parkinson’s disease
- Others: Hypertension (high blood pressure), hyperlipidaemia (high blood cholesterol), obesity, chronic kidney disease (CKD)
Chronic diseases can have a significant impact on one’s life. Its consequences go far beyond frequent visits to the doctor and recurring medical bills. Over time, chronic diseases can exert severe side effects, causing or worsening other diseases, resulting in loss of productivity, impaired physical and mental health, and even disability and premature deaths.
2. Comorbidity Of Chronic Diseases
Comorbidity is defined as a group of two or more diseases or conditions that occur in an individual at one time. Comorbidity complicates treatment plans and puts extra burden on the patient’s treatment outcome, healthcare cost and even mortality, especially among the elderly. Understanding the risk and existence of comorbidity can improve treatment, management, and prevention of chronic diseases.
In some cases, a chronic disease acts as a risk factor or a precursor for other chronic conditions. For example, hypertension and diabetes are known to be a major contributor to the development of cardiovascular disease and kidney disease. Similarly, people with asthma are at greater risk of having chronic obstructive pulmonary disease.
In other cases, two or more chronic diseases occur as a result of the same risk factors. They are associated, but unrelated. For instance, obesity can lead to arthritis due to wear and tear. Furthermore, obesity can lead to cardiovascular disease due to increased risk of diabetes, hypertension and hyperlipidaemia.
3. Chronic Disease among the Elderly
Elderlies are disproportionately affected by chronic conditions. Globally, 80% of adults over the age of 65 suffer from at least one chronic condition, while 68% suffer from two or more. In Singapore, the number of seniors suffering from three or more chronic illnesses almost doubled in Singapore from 2009 to 2017, a worrying fact highlighted in a local survey. The same study found that an increasing number of seniors struggled with activities of daily living (ADL) such as mobility, eating and showering.
Although the numbers are worrying, researchers hypothesise that it does not reflect a worsening health condition. Instead, this could be the result of greater access to healthcare and better health screening for Singaporeans in their senior years. More elderlies are aware of their chronic conditions now compared to 10 years ago.
Nevertheless, it is essential to note that elderlies need long-term support from family and healthcare professionals to manage their chronic conditions, overall health and daily activities. In the following sections, we cover treatment plans for chronic illnesses, including the role of home care, family support and financial assistance.
4. Treatment For Chronic Diseases
The most important aspects in the treatment plan include an individualised approach to treatment, prevention of complications, and care coordination.
Individualised Approach
There is no one-size-fits-all solution when it comes to the treatment of chronic illnesses. It is because a person with chronic disease may experience different symptoms or may be in a different stage of the disease compared with others.
For elderlies with two or more chronic conditions, the use of multiple medications poses the challenge of drug interactions, side effects, and the need for regular medication reviews by their GP physician. This is why a highly tailored care plan is required for successful management of chronic diseases.
Prevention of Complications
Treating chronic conditions isn't just about managing symptoms as they arise. Another crucial part is to prevent complications that can make things more difficult in the future. For example, uncontrolled diabetes can cause debilitating complications such as heart disease, nerve damages, kidney issues and eye problems. Such complications lead to more medications, more treatments, and higher medical bills. Above all, it jeopardises the senior's health condition and their ability to be independent and active at home and in the community.
A complication prevention strategy for a person with chronic disease often involve:
- Regular follow-up and screening with a GP: this is to ensure early detection and treatment of complications.
- Self-management of medication at home by the patient
- Lifestyle changes, including incorporating healthy diet habits and regular physical activities into daily routine
- Vaccinations and preventive treatments: As aging is associated with reduced immune function, your doctor may also recommend vaccinations like the flu vaccine and pneumonia vaccine and preventive treatments depending on your overall health condition to aid with complication prevention.
- Self-education: Understanding your chronic disease and health matters can help you recognise the signs of complications and empower you to take action early.
Care Coordination
Most chronic diseases will need medication. However, other therapeutic options may be needed such as physiotherapy, psychological therapy, or specialist care. This underscores the importance of coordinating care from different players, part of which can be supported by the regular GP doctor. However, the patient and/or their primary caregiver plays a central role in ensuring necessary information on different treatments is shared and updated to the healthcare providers involved.
5. The Role Of Home Care In Chronic Disease Management
Research shows that a patient's active involvement in managing their own chronic condition can make a significant difference in treatment effectiveness and outcome. Much of this involvement happens at home, from taking medications, monitoring symptoms to daily decisions of what to eat and how much to move.
Think of the patient's participation as 'homework' for successful management of one's health. As challenging as it may sound, "there are ways to make this 'homework' easier", advised Dr Choo Wei Chieh, Home Care Doctor and Co-founder of Ninkatec. These may include having the necessary tools handy (such as glucometer for people with diabetes or blood pressure monitor for people with hypertension), setting up your home environment for success (e.g., stocking healthy food in the fridge), and assigning a family or friend to be your homework buddy (e.g., having a family member to remind you to take medications or a friend to work out with). For more tips on managing chronic conditions at home, check out our interview with Dr Choo Wei Chieh here.
For seniors with limited mobility, access to home care services can play an even more significant role in managing chronic conditions. Those who need help with ADL's can get support from occupational therapists and professional caregivers to make their daily life easier. Advances in medical technology such as wearable devices to track heart rate, blood pressure, and other vital signs also help improve treatment effectiveness and the quality of life of patients opting for home care for their chronic condition.
6. Pain Management for People with Chronic Diseases
Pain is one of the most prevalent symptoms among people with chronic conditions. Studies reveal that despite its prevalence, patients may be hesitant to discuss pain with their doctors and seek treatment. However, if not properly managed, it can affect your everyday activities and mobility, lead to dependance on pain relievers and compromise your overall physical and emotional well-being. It is crucial to seek professional help if you suffer from pain due to a chronic disease (or even without a known cause).
Managing pain doesn't always aim to eradicate it completely. Rather, the goal is often to reduce pain to a level that can allow for comfortable daily tasks. Consider the following measures for pain management:
- Consult your primary doctor about pain management strategy
- Ask your doctor about physiotherapy and other complimentary therapies such as acupuncture or massage
- Commit to the treatment prescribed and lifestyle modifications that are recommended to manage your chronic disease
- Comply with check-up and follow-up schedule
- Report promptly to your doctor any symptoms and developments related to your pain issue or chronic condition.
Palliative care specialises in pain management, among other aspects. Palliative care can be beneficial for you or a loved one in the following cases:
- The chronic condition is serious or at a serious stage, such as heart failure, chronic obstructive pulmonary disease (COPD), kidney failure, late-stage Alzheimer’s disease, Parkinson's disease, or advanced cancer.
- Pain is accompanied by other distressing symptoms, such as shortness of breath, nausea, persistent fatigue.
- Pain does not improve with existing pain management strategies, or the side effects of these treatments are intolerable for you.
- You experience severe or progressive pain that significantly impacts your quality of life.
To learn more about palliative care and its focus on pain management, check out our guide to palliative care in Singapore here.
7. Saving Cost when Managing Chronic Disease
The Chronic Disease Management Programme (CDMP) offers a way to tap into your MediSave to manage chronic conditions. You can claim up to $500 from MediSave per year per person when you visit public hospitals, polyclinics and thousands of participating GP and private specialist clinics nationwide for 23 chronic diseases. Individuals with complex chronic conditions can claim up to $700 per patient year. The MediSave claim is subject to a 15% co-payment in cash. In addition to MediSave 500/700, CHAS and Pioneer Generation or Merdeka Generation cardholders are eligible for further government subsidies of up to $500 per year and $540 per year respectively.
Most recently, another important subsidy scheme was introduced to make chronic care more affordable for Singaporeans as part of the bigger Healthier SG program. Under Healthier SG Chronic Tier, people with chronic disease can enjoy up to 87.5% subsidies on selected chronic medications, with the balance payable by MediSave. In an illustration published on Healthier SG website, this can save a patient with hypertension and high cholesterol over $100 per doctor visit, compared to using CHAS blue card.
If you are eligible to multiple subsidy schemes, make sure you discuss with your doctor which one benefits you the most and apply for it. Beating chronic disease doesn't have to break a bank.
Below is the list of 23 chronic conditions covered under CDMP:
Metabolic conditions:
- Diabetes Mellitus/ Pre-diabetes
- Hypertension
- Hyperlipidemia (Lipid Disorders)
- Stroke
Respiratory conditions:
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Allergic rhinitis
Mental health conditions:
- Schizophrenia
- Major Depression
- Bipolar Disorder
- Dementia
Other conditions:
- Osteoarthritis
- Benign Prostatic Hyperplasia
- Anxiety
- Parkinson's Disease
- Chronic Kidney Disease (Nephrosis/Nephritis)
- Epilepsy
- Osteoporosis
- Psoriasis
- Rheumatoid Arthritis
- Ischaemic Heart Disease
- Gout
- Chronic hepatitis B.
8. Takeaway Message
Having one or more chronic diseases is undoubtedly taxing. But active management, combined with effective home care and self-management can improve your quality of life and health while reducing your chances of getting other chronic diseases. It is also advisable to keep in touch with a regular family doctor for guidance and medical intervention when required.
As one of the leading home care solution providers in Singapore, Ninkatec brings chronic disease management service to your doorstep, so you can heal in the comfort of your home and the care of loved ones. Check out our services related to management of chronic diseases at home. For a private and personal consultation, reach out to us via phone, WhatsApp or website contact form below.
