Broadening, Deepening And Transforming Healthcare

18 Aug 2008

By Khaw Boon Wan

Venue: NUH

Mr Joe Sim, Acting CEO, NUH

Ms Diana Chia, General Secretary, Healthcare Services Employees’ Union

Ms K Thanaletchimi, Chairman, NUH Branch Union

Friends and colleagues

1 Unlike previous years, there was a drizzle during the ND Parade this year.  But the sky cleared up quickly and the Singapore Spirit was not dampened.  Our economy this year is like the weather during the ND Parade: it is not as good as last year’s, but it is not bad.  4-5% growth for a mature economy is strong growth.  Many jobs continue to be created and unemployment remains low.

2 In fact in the healthcare sector, we are short of workers.  In this sector, foreign talent and foreign workers are greatly welcomed.  Without them, patient care will be affected; our own workers will have no time to sleep.  All over the world, the healthcare sector is expanding, faster than the general economy.  This sector had been described in the past as recession-proof and this description is likely to remain true going into the future.  In Singapore, we expect our healthcare sector to grow strongly for many more years.  Why?

3 First, our total population is growing rapidly.  From 1990 to 2000, we added 1 million to our population, from 3 to 4 million.  Since 2000, we have added another 0.5 million.  My working assumption is that we will add another million to our population by 2020. 

4 Second, our population is ageing rapidly.  The elderly needs more healthcare services than the young.

5 Third, we are improving the staff-to-patient ratio in the public sector.  This is to meet patients’ rising expectations and to reduce the patient load on our staff, so that they have more time for their patients.  This will reduce labour productivity but improve patient care.

6 The impact will be significant.  We are expanding our total pool of doctors, nurses, and other healthcare professionals by 40% over the next 5 years.  The budget is there, the political will is strong; we just need to get the bodies.  We are ramping up local training and we are recruiting foreign doctors and nurses.  We are making good progress on both fronts. 

7 Fourth, we have a strong healthcare system, equal in clinical standard to some of the best in the world and yet affordable to the people thanks to Medisave, MediShield and Medifund.  We have good hospitals and world-class specialists and nurses, in both the public and the private sectors.  We will continue to strengthen this core of our healthcare system.  But we are also broadening and deepening our capabilities beyond merely treating diseases when the patients turn up at our clinics.  We are systematically transforming our healthcare system and not merely doing more of the same.

8 Let me outline three important strategies, all of which mean more jobs and higher skills.

9 First, we are investing more in clinical research so that our teaching hospitals are also participants in the global search for better treatments, quicker diagnoses and more effective disease prevention strategies.  The formation of the National University Health System in the Kent Ridge Campus and the on-going transformation in the Outram Campus are developments that will allow us to find better ways to help patients get better and more cost-effective treatment.

10 Second, we are going beyond hospitals into the long-term care sector and seeking to integrate the services in a seamless way, so that patients can move from one sector to another without hassle.  This will particularly benefit the elderly patients and those with chronic diseases, like diabetes.  They can then get competent care at the lowest cost in the right place, with all providers working as one team, focusing on the health and welfare of the patients.   This is a major undertaking, comprising many initiatives: integration of care, right-siting, national electronic health record, disease-management, palliative care, home nursing, including end-of-life care.  It is challenging because we are involving many players from different sectors: the public, the private, the religious and the charity sectors, each with a different corporate culture and interests.  All countries talk about implementing a similar strategy, but there is yet to be a perfect model.  If we do it well, it will significantly improve patient care and our health.

11 Third, we are adding sophistication to our healthcare system, in line with changing needs, rising cost and greater sophistication of our patients.  A robust healthcare system is no longer merely about doctors, nurses and their patients.  It is now a highly complex system, comprising many players with many diverse skills.  We need to expand the pool of our healthcare professionals, both in numbers and diversity of expertise.  Beyond doctors, dentists and nurses, we need many more pharmacists, physiotherapists, occupational therapists, speech therapists, medical social workers, psychologists, counselors, radiographers, advanced practice nurses, dental therapists, dental hygienists, biostatisticians, research assistants, bioinformatics experts, bio-ethicists, healthcare administrators, and many, many more. 

12 We have historically largely invested only in clinician training; as a result, we have world-class oncologists, cardiologists, ophthalmologists etc.   We did train nurses for our needs, but only recently have we looked at training them to higher standards, as graduates, as Advanced Practice Nurses and some as post-graduates.  We have largely neglected the other supporting healthcare areas, so we are now short of all of these. 

13 Just last week, PS Yong Ying-I told me that the Harvard Public Health Faculty includes two philosophers, because healthcare policy and management is an area that relies heavily on ethics and ethos which in turn rely heavily on society’s values.  That is the sort of sophistication that the US healthcare system is acquiring.  Based on that benchmark, we are rather under-developed -- but at least we are starting to fix the inadequacy. As we offer scholarships and developmental attachments to our own people, we are recruiting foreigners to help out in the interim. However, we must recognize that western societies’ values may be built on different foundations from Asian ones; so, we need our own thinkers and experts.  How do we build such capabilities and where is our repository of such expertise?  These are interesting issues that we must find practical solutions to.

14 Transforming our healthcare system will require us to spend more on healthcare.  Today’s 4% of GDP on healthcare is adequate for today’s Singapore, but it will be too little for Singaporeans in 2020.  For a higher level of healthcare services, in keeping with rising expectations and sophistication, I believe many Singaporeans can accept the need to co-pay more, knowing that the bulk of the increased cost will actually be borne by the Government.  With Medisave, MediShield and Medifund, all Singaporeans will still find essential healthcare services within their means.  This is our promise.

15 On this note, let me wish all Singaporeans a Happy National Day.