HEAD O - MINISTRY OF HEALTH

Head O – Ministry of Health

Dr Lam Pin Min (Ang Mo Kio): Sir, I beg to move,

That the total sum allocated for Head O of the Estimates be reduced by $100.

Sir, there are many different types of healthcare models, ranging from those completely operated by the Government to others based entirely on private enterprises. Some offer free national healthcare coverage, some rely on health insurance, and others require patients to pay all bills out-of-pocket at the time of service.

There is no one size fits all solutions. Our system of healthcare when transplanted into another country such as the United States or United Kingdom, may not yield the same results and satisfaction for the Americans and the British respectively, as it does in Singapore. Singapore has come a long way from a very basic healthcare system half a century ago to one of sophistication and envy of many nations.

I was reading this article in the Straits Times last Friday, extracted from an article published in the Washington Post . The title of the article reads: "US can get pointers from Singapore's healthcare system". Let me quote from the article:

"Singapore, a poor country a few decades ago, now boasts a higher per capita income than the United States. And here's the astonishing fact: Singapore spends less than 4% of its gross domestic product on healthcare. The US spends 17%. Singapore achieves world-class results, thanks to a bold, unconventional synthesis of liberal and conservative approaches. The island's real ideology is pragmatic problem-solving."

7.00 pm

Indeed, Singapore's healthcare system has been rated by the World Health Organization as the best in Asia and the sixth best in the world in year 2000. Our 3Ms, namely, Medisave, MediShield and Medifund, as well as our 3Es framework, namely, Eldersave, ElderShield and ElderFund, have ensured that our healthcare services remain affordable and that no Singaporeans will be deprived of the medical care that he or she needs. However, while Singaporeans enjoy a world-class healthcare system, we should not rest on our laurels, as there are still many areas that require further improvement. Our healthcare system must continue to evolve with the times to stay relevant to the changing needs of Singaporeans.

So, what constitutes an ideal healthcare system? In my opinion, the characteristics of an ideal healthcare system can be illustrated by the acronym SAFE – S for Seamless, A for Affordable, F for Fast and E for Efficient. When all the key qualities are achieved, the result is a safe and high quality healthcare system for all Singaporeans. Much has been debated in the past about affordability and the provision of timely, quality medical services. I would like to take this opportunity to discuss how we can work towards propelling our healthcare system to the next level of excellence.

The recipe for a seamless healthcare system will include the following ingredients:

(i) information technology (IT) infrastructural support;

(ii) physical infrastructural development;

(iii) building our medical manpower resources; and last but not least

(iv) patient responsibility.

First, IT infrastructural support. Imagine walking into any healthcare institution in Singapore, whether it is a public or private hospital, polyclinic or GP clinic, step-down care or nursing home, pharmacy or blood test laboratory. Your entire medical history, from the time you are born till you reach a ripe old age, is available to any healthcare provider, with just a push of the button or just reading the microchip in a national medical identity card. The cornerstone of a seamless healthcare is an efficient, effective IT infrastructure. There should be a national healthcare IT network to integrate all healthcare entities in the country. Beyond just simple connectivity, it demands a system that inter-operates seamlessly to reduce duplication, errors, waiting times and management overhead or costs, resulting in cheaper, safe and faster healthcare services.

Second, physical infrastructural development. The provision of physical healthcare infrastructure, such as hospitals, step-down care, nursing homes and primary healthcare facilities must be adequate to meet the increasing demand from the increased population and ageing population. The recent newspaper reports of shortages of hospital beds, patients waiting for prolonged periods at the Emergency Department before admission and the "alleged" premature discharge of unwell patients from hospital to free up beds are consequences of the inadequacy of healthcare infrastructure and, to a certain extent, a mismatch in the demand and the provision of medical services. We can have the best surgeons, best physicians, best nurses and the most conducive clinics. But if patients are made to wait long hours to be admitted, with long periods for their medical records to be traced and investigations repeated due to lack of integration with other healthcare entities, the whole patient experience of a seamless and efficient healthcare system will not be realised. Without meeting the basic infrastructural requirements of a world-class healthcare system, we can never attain the goal of achieving a seamless healthcare system.

I would like to ask the Minister for an update on the infrastructural development in the next 5-10 years, and whether these facilities will be able to cope with the increasing population, both residents, non-residents as well as medical tourists in Singapore.

Third, building our medical manpower resources. The health workforce faces the challenges of a greying population as well as new technologies, lifestyle medicine and higher expectation, and demand for good medical care. There are shortages of healthcare providers in certain medical disciplines that will have to be filled. At the same time, the growth of the private sector may lead to higher attrition from the public sector. High quality care will be delivered by healthcare professionals who are trained in a holistic way to meet the standards of care in a changing, more sophisticated population. The challenge is to ensure adequate numbers of such healthcare professionals trained in different disciplines, especially in those healthcare disciplines that are currently under-subscribed, such as geriatric medicine, occupational speech and physiotherapy, just to name a few. Can the Minister elaborate on the Ministry's medical manpower build-up strategy to cope with the current shortfall and to address our long-term needs?

Fourth, patient responsibility. The patient forms an important part of the equation of achieving a seamless healthcare system. Patients must actively manage their own health, taking personal responsibility in staying healthy by exercising and watching their diet. Each Singaporean should also have a family physician to look after his physical and mental health. It is through self-discipline and responsibility that wastages can be minimised, and the limited healthcare resources be channelled to areas which need it most. May I ask the Minister for an update on the Ministry's "One Singaporean, One Family Physician, One Electronic Medical Record" strategic thrust?

In conclusion, I am glad that the MOH has already taken steps to make our healthcare system more integrated and seamless through the Electronic Medical Records Exchange (EMRX) initiative, and the new regional cluster model where regional hospitals will be given more autonomy in day-to-day operations, manage polyclinics and their own network of general practitioners and a step-down care facility in their respective zones. However, more must be done to further integrate the public and the private healthcare sectors. I am sure, with determination and visionary leadership, Singapore can strive to have the best healthcare system in the world.

The Chairman: Dr Fatimah Lateef, take your two cuts together.

Healthcare of the future

Dr Fatimah Lateef: Sir, first, on the future of healthcare. Healthcare systems are subject to powerful forces that can override rational priority setting and policy formation, sometimes pulling them away from the intended direction. Three issues of concern in healthcare today are, first, disproportionate focus on specialists and hospital centrism; second, fragmentation and lack of coordination to make a seamless system; and, thirdly, rising healthcare cost. These can cause the system to be viewed as sources of inefficiency and inequality.

For the future, the healthcare system must be able to respond faster and better to challenges of a changing world. This calls for, firstly, the need to strengthen and enhance our primary healthcare with greater empowerment of family practitioners. This will involve more training, skills upgrading, change of mindset and a more collaborative partnership of family practitioners in the regional healthcare cluster that we are forming.

Secondly, ensuring sustainable and suitable healthcare insurance for every family based on needs, income, etc. MOH will have to assist with monitoring, recommendations and public education as well.

Thirdly, keeping healthcare at affordable cost through surveillance and regulation of commercialisation as well as the factors that interplay both public and private. What steps will MOH embark on to meet these expectations and demand for healthcare of our future?

Healthcare manpower

My second cut is on healthcare manpower. Trained and skilled manpower is a precious commodity to a country like Singapore. With increasing workload in the public sector, staff continue to be lost to the private sector, overseas institutions and other non-healthcare related areas. We have a first-world healthcare infrastructure and we also need to meet first-world manpower standard. Eventually, they will have effect on efficiency and affordability. What are our plans in terms of meeting our manpower needs for the future?

Policy matter

Dr Lily Neo (Jalan Besar): Mr Chairman, Sir, Singapore has a world-class healthcare system, and our policies have served us well all these years. However, going forward, we need to continually tweak them so as to cater to the growing needs and expectations of our people.

Sir, healthcare affordability has been a major concern for many Singaporeans, and this concern will perpetuate because of expected escalation of healthcare costs in lieu of advances in medical technology and of increasing numbers of aged folk. May I ask the Minister for Health whether Singapore's national healthcare expenditure, at the current level of health care servicing, will escalate quickly, and how will this affect patients in sharing healthcare costs? As our national healthcare expenditure proportion is borne two-thirds by the people (or the private share) and one-third by the Government, will this situation be sustainable in the long run? How will this impact the people, especially the low and middle-income Singaporeans, in view of the continuing escalation of healthcare costs?

Our 3M system will need continual review to accommodate the longer lifespan of people in an ageing population. Public education on our 3M system will address the concern of many on the affordability of healthcare. May I ask the Minister whether there is a plan to increase the take-up rate of MediShield and Eldershield further? How adequate is Eldershield in serving its intended purpose in terms of its accessibility, quantum and tenure of payout?

Sir, it is understandable that in any ageing population, many more people in our population will worry about their own health. Many, especially those near or in the silver generation, feel that they may not only be unwanted but, more importantly, that there may be inadequate facilities to help care for their needs.

May I ask MOH what are its proactive plans in meeting the new challenges of a ballooning demand for healthcare services due to the increasing life expectancy of people and the ageing population? How is MOH strategising to meet this demand in terms of both infrastructure and medical expertise? How adequate are our present healthcare facilities? Are there any projections done on the imminent need for acute hospital beds, nursing homes, community care homes, dementia homes, etc, in the near future? What is the progress made for seamless step-down care to alleviate the expanding need and dependence on acute hospital beds?

Sir, there is a need for improvement in the coordination and implementation of our various healthcare services, especially in integrated discharged hospital services to community-care and nursing homes. How are we doing presently in this area, especially in affordable step-down care beds? Are we on target with expansion of such step-down care services and on our medical staff requirement in general? Is geriatric medicine being prioritised presently? And are there adequate affordable ambulance services?

Sir, elderly care is more than just about health promotion and the prevention and treatment of diseases and disability in the elderly. Elderly care is complex and needs a multi-disciplinary approach to ensure adequate care. Dementia and depression are on the increase. Distress arising from having to care for their elderly sick at home with challenging resources is common too. In this regard, it may be helpful for our Government agencies to consider the social issues involved and to provide training and support for home-care providers.

Lastly, it is important for our Government to periodically inform our people on the work we have done in preparing for the onslaught of a greying population, so as to allay people's concerns in this area.

The Chairman: Order. It is 7.15 pm.

Thereupon Mr Deputy Speaker left the Chair of the Committee and took the Chair of the House.