NATIONAL INTEGRATED SCREENING PROGRAMME

NATIONAL INTEGRATED SCREENING PROGRAMME:

(Effectiveness): 1.

Assoc. Prof. Paulin Tay Straughan asked the Minister for Health (a) how many Singaporeans above the age of 40 years have been screened under the National Integrated Screening Programme (ISP) since its inception; (b) whether the health screening behaviour is sustained and has resulted in regular annual screenings with follow-up treatment; and (c) whether the Ministry has plans to incorporate early screening for colorectal cancer into the ISP package as it is the leading cancer in Singapore.

The Minister for Health (Mr Khaw Boon Wan): The National Integrated Screening Programme (ISP) started in June 2008, two years ago. It targets Singaporeans aged 40 years and above. More than 35,000 Singaporeans have benefited from this programme so far.

As the recommended screening frequency for diabetes, high blood cholesterol and cervical cancer is once in every three years, it is too early to say if it has led to sustained screening behaviour. We plan to roll out a national colorectal screening next year.

Assoc. Prof. Paulin Tay Straughan (Nominated Member): It was such a brief response I am not even prepared, Sir. One supplementary question. Could the Minister share with us if he has noticed a trend from those groups that have not attended the screening programme? And if so, what measures has MOH taken to encourage these Singaporeans to step forward for health screening?

Mr Khaw Boon Wan: Purely empirical and based on what we observe, I would say that, generally, majority of Singaporeans do go for screening. Where is the evidence? In the latest National Health Survey, one of the questions posed to the targeted group – the elderly and those aged 40 years and above – was "Have you got yourself screened in the last three years for diabetes, blood cholesterol?" Majority said "yes". Relying on memory, I would say more than 60% or 70%.

For basic health screening, I would say the outreach is not bad. However, at 70%, it still means that 30% out there have not been screened, at least in the last three years. They may have been screened before that. Hence, the efforts to reach out and educate the public must continue. There are other programmes organised jointly with, for example, Minister Lim Boon Heng's Committee on Ageing. It has started the "Wellness Programme" at the constituency level that targets Singaporeans above 50 years of age. Through the programme, we reach out to the elderly to get them screened. More importantly, we get those who are in the high risk groups to follow up when their risk factors have been picked up. In the pilot programme, we have injected resources to call up those with abnormal results and we nag at them to see the doctors. And many do. The following step, which is even more uphill, is to get them to change their lifestyle, "eat less, move more". That is trickier. We must continue to press on.

Mdm Halimah Yacob (Jurong): One supplementary question. I would like to ask the Minister whether ISP screening is free. If it is and even if it is not, will the Minister consider allowing Medisave to be used for screening? Not only for the three illnesses mentioned but other major illnesses as well.

Mr Khaw Boon Wan: The tests in the ISP for the lower-income group are free. We have contracted more than 700 General Practitioners (GPs) to carry out the screening services. They are quite spread out across Singapore. The consumers only need to pay the consultation fees to the GP. It is not completely free. I think it is important that we do not make it completely free so that the consumer has to make some cash payment. But we pay for the tests on behalf of the lower-income group.

Will Medisave be used for health screening? I raised this topic in response to some proposals by MPs, like Mdm Halimah, some time ago. We have been studying this. I see it as a two-stage approach: the first stage is to decide on the basic screening package for each age group that we should promote. There is a wide range of screening tests out there – some are very expensive and offer marginal benefits. If we blindly promote screening, we may end up with a lot of over servicing and abuses with little benefit or, sometimes, even with slight harm to the patients. We have to be careful how we do this. What we have done in the last few months is to task the Academy of Medicine to set up a Committee of Experts to help us sieve through all the available tests in the marketplace and then draw up a list of recommended screening packages, by age group and by gender. That process is about to be completed. When the Committee has completed its report, we will publicise it. We will then take a look at funding. If they are inexpensive tests – and Members know my philosophy – we should not touch Medisave for these tests. Anything less than $100, that costs $20 or $30: I would say let the consumers pay out of their pocket. But if some of the recommended screening tests were to be rather expensive – for example, I expect colonoscopy may be included as one of those evidence-based and time-tested tests that should be done for those above 50 years old. There could be some problems with funding. We would then see whether current Medisave rules need to be tweaked to allow for this. Give me a few more weeks or months to settle this.