Health inequalities by SES

Name and Constituency of Member of Parliament
Ms Anthea Ong
Nominated MP

Question No. 1704

To ask the Minister for Health for each of the last three years, comparing between Singaporeans in the highest 20% and lowest 20% income group (a) what is the difference in life expectancy; (b) what is the difference in percentage of Singaporeans who suffer from (i) one chronic illness and (ii) two or more chronic illnesses respectively; (c) what is the difference in the acute hospital 30-day readmission rate; (d) how does the Ministry measure health inequalities in Singapore; and (e) whether Singapore has made progress in tackling health inequalities.

Written Answer

1     Data on life expectancy, hospital 30-day re-admissions and prevalence of chronic conditions by income groups is not available.

2     There are many factors that influence hospital re-admissions.For example, the patient’s age, presence of any pre-existing conditions, reason for initial hospital admission, quality of inpatient care, transition to community care, and follow-up care. Home environment and family support are also important contributing factors.Public hospitals have introduced various programmes to reduce re-admissions.This includes the Hospital-to-Home (H2H) programme, which supports patients’ transition home and links patients and care-givers with appropriate community-based services.The H2H programme has served more than 14,000 patients.

3     For chronic conditions, using educational levels as a proxy for socio-economic status (SES), men with primary education and below were more likely to have diabetes (1.3 times), but less likely to have hypertension (0.9 times) or high cholesterol (0.6 times) when compared to men with post-secondary education. However, for women with primary education and below, the chances were higher at 3.4 times for diabetes, 1.9 times for hypertension, and 1.4 times for high cholesterol compared to those with post-secondary education.^[1]

4     Persons in the lower SES group with chronic diseases have good access to healthcare services and health outcomes. Among Singaporeans with primary education and below who have chronic conditions like diabetes, hypertension and high blood cholesterol, more than 90% had visited their doctor in the previous year for their condition. They had comparable disease outcomes with better educated Singaporeans in managing their blood sugar and cholesterol levels, although less so for blood pressure control.

5     Individuals can achieve good health outcomes by taking charge of their health, seeking timely treatment and adopting healthy lifestyles.MOH facilitates this by reducing cost barriers to healthcare. For example, on health screening, subsidies under Screen for Life were enhanced in September 2017. Under this revised scheme, Pioneer Generation pays $0 for screening whereas Community Health Assist Scheme (CHAS) blue/orange cardholders (as well as Merdeka Generation since Nov 2019) pay only $2, and all other Singaporeans pay $5.This payment covers screening tests, doctor’s consultation as well as the first follow-up consultation at CHAS GP clinics.

6     MOH will continue to monitor health inequalities and put in place measures to ensure that all Singaporeans have access to quality and timely healthcare.

^[1] Chronic condition prevalence data is from the National Health Survey (NHS) 2010.  The NHS 2010 data is currently the most reliable estimate of chronic condition prevalence in Singapore. A reliable estimate should combine data from both Household Interview (self-reported) and Health Examination (measured). Findings from the National Population Health Survey (Health Examination) are not yet available and will only be released by the first quarter of 2021 as the plan is to report based on a two-year survey cycle so that there will be a larger sample for detailed data analysis.