SPEECH BY MR GAN KIM YONG, MINISTER FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2021, ON FRIDAY 5 MARCH 2021

CONTINUING THE FIGHT AGAINST COVID-19 – ANNOUNCEMENTS AND OVERALL UPDATES ON COVID-19

Mr Chairman, I would like to thank members for their speeches and their remarks. Mr Yip Hon Weng and Mr Ang Wei Neng asked about the COVID-19 situation. Let me provide a brief overview.

2. Globally, the number of new cases and deaths continue to trend down, although there was a spike in the last week of February so we need to watch this. Within Singapore, the COVID-19 situation has stabilised, with 1 or 2 new community cases on some days. Imported cases are isolated on arrival and the risk of transmission to the community is low. However, the World Health Organization has just warned that we need to stay vigilant as the pandemic is not likely to be over within this year.

3. I want to thank everyone - Singaporeans, healthcare workers, businesses, enterprises, government agencies - for playing your part this past year. Your sacrifices have helped Singapore weather this storm.

4. Mr Ang Wei Neng asked about the impact of COVID-19 on our infrastructure projects. As I informed the house earlier, the pandemic has delayed many of our healthcare infrastructure projects by up to a year or so. Construction works have since been ramping up progressively and we are working on contingency measures to ensure we are able to meet the needs of our people.

5. We are making steady progress in our vaccination programme. As of 4 March, more than 350,000 Singapore Residents have received their first dose, including some 80% of our healthcare workforce, and 215,000 have received their second doses.

6. We have started with our seniors too. I would like to thank our community volunteers from the People’s Association and Silver Generation Ambassadors who have worked hard in reaching out to our seniors and helping them to make their appointments. Over 40,000 seniors aged 70 and above have received their first dose. We will soon begin the vaccination of seniors aged 60 and above.

7. Mr Chairman, allow me to say a few words in Mandarin please.

8. 年长者若感染冠状病毒就可能会引发严重的病症。因此，年长者将优先接种疫苗。获准在新加坡使用的疫苗都符合严格的安全和效益标准。所以我呼吁国人放心积极接种疫苗。

9. 一些患有慢性病的国人担心是否能够接种疫苗。不必担心，因为我们会安排医护人员在场评估您是否能够安全接种疫苗。其实大多数都能安全接种疫苗, 包括那些患有糖尿病，高血压， 高胆固醇，气喘，慢性肺病， 心脏病， 及在癌症复原中的患者。因此我鼓励患有这些疾病的国人在受邀后尽快登记接种疫苗。

10. Let me emphasise that only COVID-19 vaccines that meet strict standards of safety and effectiveness will be used in Singapore for our Singapore residents.

11. We will monitor the development of the COVID-19 pandemic and adjust our measures accordingly. We will also continue to strengthen our defences for future health system crises, such as Disease X. SMS Janil will share more.

STRENGTHENING OUR HEALTHCARE SYSTEM FOR THE LONG-TERM – OVERALL UPDATE ON THE THREE BEYONDS

12. Even as we mobilise the nation to fight COVID-19, we have to remain focused on several long-term issues. 

13. Members may recall our Three Beyonds to meet our challenges in the future. Beyond Hospital to Community, to provide better care closer to home; Beyond Quality to Value, to help Singaporeans stretch their dollar; and Beyond Healthcare to Health, to help Singaporeans stay healthy.

14. We will continue to anchor care in the community by strengthening primary care. We will be building 12 new polyclinics, bringing the total to 32 by 2030. The Community Health Assist Scheme (CHAS) has been expanded recently to allow more Singaporeans to receive subsidised care from private GPs, who are our key partners in primary care.

15. We are also expanding community care, especially for our seniors. We have expanded the Community Nursing teams to cover 29 regions across Singapore since September 2020, with a total of 185 Community Nursing Posts to make care more accessible to our seniors. We will add new Community Nursing Posts where needed.

16. Our second thrust is to stretch your health dollar. Dr Lim Wee Kiak and Mr Leong Mun Wai asked about how we manage healthcare costs. We keep care affordable and sustainable through a multipronged approach. 

17. First, we leverage risk pooling. Insurance plays a useful role in helping us stretch our resources through pooling, so that those who are ill can tap into the pool to pay for the healthcare services they need. That’s why we introduced MediShield Life. But insurance has an inherent risk of over-consumption. This is because of “OPM syndrome”. What is “OPM”? Other people’s money because through insurance, we are pooling resources and we are tapping on other people’s money in the pool to pay for our healthcare services. So we need safeguards, to encourage prudence when deciding on healthcare services.

18. Dr Tan Yia Swam asked about Integrated Shield Plans (IPs). I agree with Dr Tan that we can all benefit from more information-sharing and a better understanding of insurance products. Towards this objective, the Ministry of Health has facilitated several engagement sessions with insurance providers and professional bodies to foster a better understanding of the parties’ concerns.

19. Dr Tan was present at these sessions and we benefited significantly from her contributions. We have resolved some issues, not all, but discussions are still ongoing. An important progress we have achieved is the establishment of a multilateral platform comprising Life Insurance Association, Academy of Medicine, Singapore, and Singapore Medical Association. This platform will allow discussions to resolve issues of common concern.

20. We are also setting up a claims management mechanism to facilitate resolution of claims related matters. Our common objective is to ensure patient care is not compromised and allow patients adequate choice, while ensuring that fees and claims remain reasonable. I am confident that with this common understanding, we can find workable solutions that will benefit all parties, insurers, doctors, as well as patients.

21. Ms Hazel Poa asked whether IPs can be made fully portable. As IPs are commercial products, their features and pricing are ultimately determined by private insurers. But what is important is that all Singaporeans are covered under MediShield Life, regardless of their medical conditions.

22. Second, we will continue to improve the healthcare system’s cost effectiveness and efficiency. As Minister Lawrence Wong mentioned, the Agency for Care Effectiveness has enabled us to save $300 million since 2016, and benefitted over 375,000 patients. The Agency for Logistics Procurement and Supply (ALPS) has also achieved cost savings of about $180 million in two years by driving economies of scale through group procurement.

23. Even with our best efforts, we will still be spending more on healthcare over time given an ageing population and increasing consumption of healthcare services. The government continues to bear a significant and growing share of the National Health Expenditure, from 40% in 2013 to 46% in 2018.

24. We want all Singaporeans to be healthy and have access to good and affordable care. We pay particular attention to lower income households as Mr Leon Perera highlighted, and provide them with additional support to ensure healthcare, including preventive health, remains affordable for them and that they can improve their health outcomes.

25. Health outcomes are influenced by multiple factors, including social, biological, cultural preferences and environmental factors, in addition to social economic status (SES).

26. Local studies showed that adults with lower SES do have differences in chronic diseases prevalence. We have been publishing health data regularly. More data has been collected in the last two years, including breakdown by education as a proxy for SES and the data will be published later this year. We will continue to refine the data we publish. From local studies, we also know that adults with lower SES do have good access to care and are able to control their health conditions well. Again, using educational attainment as a proxy for SES, among persons diagnosed with diabetes, hypertension, and high blood cholesterol, over 90% of those with below secondary school education had visited their doctor for their condition at least once in the preceding year. Further, the proportions of those with acceptable control of their medical conditions are close to the national averages. Nonetheless, we must continue to support them to improve health outcomes, and we will need to start from young, which I will talk about in a short while.

27. Through enhancing our healthcare financing system over the years, we have kept healthcare affordable, especially for the lower income patients.

28. In fact, the lowest income quintile’s share of total subsidies was 37% in 2018, the highest across all income quintiles. Our healthcare financing framework is a progressive one, overall. Further, the amount of subsidies received per household for the lowest income quintile has increased by over 70% from 2013 to 2018.

29. Overall, government spending on healthcare has grown year after year and is likely to continue to increase. But as Dr Tan Yia Swan mentioned, government subsidy is a finite thing. That is why we have to be prudent in how we allocate limited resources, to ensure that the support we provide is more targeted to benefit those with greater need.

30. This is our third effort – to better target subsidies, such that those with less will receive more, healthcare is kept affordable for all, and patients can be cared for at the most appropriate facilities.

31. We have recently enhanced the subsidies for low income patients at the public Specialist Outpatient Clinics (SOCs).  We will further adjust subsidies at the SOCs by introducing two new tiers of 30% and 40% subsidy for higher income patients. This will enable more subsidies to be channelled to those in greater need.

32. With more targeted subsidies at the SOCs, we can now allow private patients discharged from our acute hospitals to choose subsidised follow-up care at the SOCs. Currently, they are treated as private patients at the SOCs.

33. Next, we will align the means-testing basis in the acute hospitals to per capita household income which is more reflective of patients’ means, similar to the basis used for most healthcare schemes, rather than rely on the personal income of the patient today.

34. Lastly, we will also enhance subsidies at community hospitals, to keep them more affordable and facilitate the flow of patients from acute hospitals.

35. Taken together, these moves will ensure more targeted use of our healthcare resources, stretch our healthcare dollars, and encourage appropriate care. Senior Minister of State Koh Poh Koon will go into greater detail in his speech.

36. In the longer term, the best way to manage healthcare costs is through our third thrust - staying healthy. We encourage all Singaporeans, young and old, to partner with us on this journey: attend your recommended health screenings regularly, go for vaccination, and adopt healthy living habits.

37. I encourage all to also continue the good fight to win our ongoing War on Diabetes, and keep chronic conditions at bay. Parliament Secretary Rahayu will share more on this, as well as our other health promotion efforts.

TRANSFORMING AND MAINTAINING A FUTURE-READY HEALTHCARE SECTOR

38. Earlier I talked about the 3 key thrusts, better care, stretching your dollar, and staying healthy. These are not isolated initiatives. All our policy and measures work together to take care of the health of every Singaporean, starting from birth and throughout their life journey, keeping them as healthy as possible, for as long as possible.

39. The best place to start is right at the beginning. Minister Masagos will share our thinking on improving child and maternal health, how to better support our children and their families, and to bring agencies together to co-deliver services and solutions for better outcomes.

40. Our care transformation journey will continue. As we plan for our future health system, we will study how we can develop a longitudinal system of care services and programmes, to journey with you and design programmes with a life-course approach, taking care of each Singaporean from birth and throughout their life. The National Healthcare Group has in fact developed a River of Life framework to test this approach.

41. As staying well often involves not just health but also social and other factors, we will also explore how we can pull in resources across agencies and service providers to support your overall well-being. SingHealth, for example, has started trials to prescribe not just drugs but also social programmes, such as diet, exercise, and social activities. Dr Tan Wu Meng would be glad to know that they too have care coordinators

42. Finally, the built environment also plays a key role in nudging our choices. Therefore, the built environment should be designed to promote healthy living and digital tools can also be used. The National University Health System is working on this with the various agencies. We will share more on these efforts at a later stage.

43. Anchoring all these transformation efforts are our healthcare staff who will continue to play a central role in our future health system, much like how they have been at the frontline in our battle against COVID-19. We are blessed with a very dedicated, driven, and professional team. They are our most precious resource, and we will continue to provide them with better progression, more training opportunities, and greater recognition of the work and risks they undertake. Senior Minister of State Koh Poh Koon will elaborate on this.

Conclusion

44. To conclude, it has been - as PM Lee said - a year of uncertainty, anxiety and fear. Many of us would have emerged slightly different from how we first entered. A little more tired, more stretched, perhaps a little tougher and I hope a little wiser.

45. Partner with us as we journey forward and as we transform our healthcare system to be future-ready. Let us work together, and help all Singaporeans to stay healthy, and live well, every day of your life. Thank you.