One in five patients with chronic conditions fails to keep up with his medication because he cannot afford it.
This disturbing finding came through in a recent informal survey of more than 200 patients by Tan Tock Seng Hospital.

But by cutting back on how often they buy or take the drugs to save money, these patients - suffering from diabetes, hypertension or heart conditions - may well be saddled with bigger health and money woes down the road, say doctors.

Dr Soon Puay Cheow, head of the endocrinology department at TTSH, said: 'Many patients who cannot afford think that if they take less or spread out the dosage, they will be almost as healthy. Most often it does not work that way.'

One such person is Madam Yue Chin Mei, 46, a housewife. She has been suffering from a whole host of chronic conditions for about 10 years, including diabetes and osteoporosis.

Her husband, Mr Alvin Lim, 52, works on an ad hoc basis as a freelance headhunter, so financially, the couple are 'quite strapped'.

'I spent up to $300 a month on my diabetes alone. The money went to needles, alcohol swabs, syringes and three different types of insulin,' she said.

Not understanding the importance of checking her sugar levels and wanting to save on cost, Madam Yue sometimes cut down on testing herself or giving herself her thrice-daily insulin shots.

'It resulted in her fainting four times. Fortunately for her, I arrived in time to call the ambulance to take her to the hospital,' Mr Lim added.

Being warded at the hospital meant the Lims had to find more money.

'We spent a total of $50,000 already,' he said.

But the problem is not peculiar to TTSH or to Singapore for that matter.

A 2002 study, published in the Archives Of Internal Medicine in the United States, showed a similar trend.

Lead researcher Dr John Piette told The Straits Times that of the 660 American patients who had cut back on their medications because they could not afford them, two-thirds never told their doctors, for fear of getting scolded.

'Those who didn't bring up the uncomfortable issue of cost weren't likely to get asked,' he said.

Dr Piette was invited by the National Healthcare Group (NHG) - which runs half of the public hospitals and polyclinics here, with the SingHealth cluster managing the rest - to share his experience with general practitioners who work with the group and to help manage chronically ill patients.

Some of the strategies adopted by NHG include putting up signs in the waiting room, and testing blood pressure and sugar levels before the patients see the doctors.

'And doctors are encouraged to broach the subject of cost when the condition they are treating is not being managed to the optimal level,' Dr Piette said.

An NHG spokesman said the group also conducts weekly workshops over six weeks to help patients manage their chronic conditions such as diabetes, hypertension, osteoporosis and heart conditions.

Although public hospitals and polyclinics here prescribe affordable generic medicines, in some cases, patients do not know or are unwilling to ask for help available at the medical institution or in the community to pay their medical bills.

Madam Yue has since started talking to her doctor and nurse educator of her plight and sought help from the Diabetic Society of Singapore.

'Also with the help from TTSH Endowment Fund, I now pay only $48 a month for my diabetes medication,' she said, instead of the $300 she used to pay.

Her doctor has also given her the green light to work and she is giving tuition at home to supplement her family's income.