First National Disease Management Conference

25 May 2001

By Mr Lim Hng Kiang

Theme : The challenge of keeping healthcare cost affordable

Distinguished guests

Ladies and Gentlemen

It gives me great pleasure to be here today at the opening of Singapore's First National Disease Management Conference. The focus of this conference is on the holistic and effective management of chronic illnesses, such as diabetes and hypertension. The presence of a significant number of foreign participants at this conference underscores the attention this subject is receiving from healthcare professionals the world over.

Disease management covers disease prevention and control through health promotion and screening, the use of evidence-based clinical practice guidelines, and a patient-centred and self-management approach, within a seamless continuum of care from preventive to rehabilitative care. Effective disease management is therefore, an important tool in our goal to keep our population healthy and healthcare cost under control. Let me elaborate on three major factors that have spurred the development of disease management in Singapore.

Rising healthcare cost is of increasing concern

Firstly, healthcare cost. Rising healthcare cost is a universal concern of all countries in the world today. The World Health Organisation (WHO) has reported that healthcare expenditures have risen from 3% of world Gross Domestic Product (GDP) in 1948 to about 8% today. In the developed countries, spending on healthcare has reached about 14% of GDP in the US and 6% in the UK.

In Singapore, our healthcare spending is still relatively modest, at only 3% of GDP currently. While this seems low compared to most other countries, the overall health status of Singaporeans is good and the standard of our medical care is high. In last year's WHO World Health Report, Singapore's healthcare system was ranked 6^th among 191 countries. This is an indication that the healthcare delivery system for Singaporeans is cost-effective, and has minimal wastage.

Throughout the world, medical advances have resulted in prolongation of life and better control and cure of many diseases. Over the years, the life expectancy of Singaporeans has progressively increased. Last year, our life expectancy at birth was 80 years for women and 76 years for men, which puts us on par with developed countries like US and UK. However, longevity, coupled with low fertility rates is giving rise to a rapidly aging population. Last year, 7% of the total population was 65 years or older. This proportion is estimated to nearly double to 13% by year 2020. In other words, in year 2020, one in eight Singaporeans will be aged 65 years or older. As the likelihood of illnesses and chronic diseases tend to increase with age, the level of healthcare consumption and expenditure will increase as the population ages and longevity increases.

The fields of life sciences, drug development, bio-medical engineering and related disciplines are advancing at a spectacular pace. While these will revolutionise the treatment of diseases, it is also likely that they will also drive healthcare costs up significantly.

It is thus important that strategies like disease management be adopted at this early stage to help ameliorate the predictable impact of these factors and of chronic diseases on overall health care costs.

Disease management as a means for improving health

While cost is a major concern, the second, more important factor, for the development of disease management in Singapore lies in the potential for better clinical outcomes.

The advantage of using the disease management approach is that equal emphasis is given to each stage of a disease condition - both before its onset and after. The large proportion of our currently healthy population will benefit from strategies to prevent the onset of chronic diseases.

In Singapore, three chronic disease conditions - cancer, heart diseases and stroke - already account for more than 60% of all deaths. Medical advances have improved our understanding of these diseases and their treatment options for more effective control of the conditions and the prevention of debilitating, irreversible complications. For example, we know that poor compliance to hypertensive drugs can lead to stroke, and uncontrolled diabetes can result in blindness, kidney failure and limb amputations. Unhealthy habits such as smoking, excessive drinking, obesity and lack of physical activity all contribute much to the development of these chronic conditions.

We recognised the importance of lifestyle and behaviour in affecting health. The result was the National Healthy Lifestyle Programme, which was launched in 1992 as a multi-sectoral, community-based effort to provide Singaporeans with the information, skills and a supportive environment to lead a healthy lifestyle. Much has been accomplished, but more needs to be done.

We will continue to emphasise that each and every individual must take personal responsibility of his or her own health and well being. My Ministry set up the Health Promotion Board (HPB) in April this year to lead in this effort. However, HPB cannot do this alone. Aggressive and well-conceived ongoing efforts are required in the areas of health education, health screening, wellness programmes and behaviour modification. I would say that all doctors, nurses, healthcare professionals and providers play a critical role in this respect. They need to think beyond healing into the realm of preventive, community and public health, and the promotion of good health. Health care professionals are in the best position to influence an individual's behaviour and his locus of control to prevent the onset of such lifestyle diseases and their risk factors.

A patient-centered focus to avoid fragmentation of care

The third driver for disease management is the trend towards greater specialisation and subspecialisation among healthcare professionals. This subspecialisation itself is being driven by the explosive advances in knowledge and medical technology. However, one unintended consequence of such subspecialisation can be the fragmentation of patient care.

Let me elaborate. A person with diabetes, high blood pressure and heart disease may have several appointments with his general practitioner, endocrinologist or cardiologist depending on his condition. Not only will his total medical bill size be increased - he will have to pay each time he visits each specialist - he will also be burdened with the logistics of travelling to different clinics. Blood tests and other investigations may be repeated unnecessarily. There is also the increased potential for confusion about medications and other treatment.

Disease management attempts to bring about a more patient-centered focus for chronic diseases such that expertise and skills are re-organised to the patients' benefit.

I am pleased to note that the two clusters are actively addressing this issue. For example, under the NHG Cancer Programme, NHG institutions are working with general practitioners to provide integrated and well-coordinated services and care covering the whole continuum, from prevention and treatment to rehabilitation and palliative services.

Conclusion

To summarise, the challenge for us is to prevent disease, detect disease early to prevent complications, manage those with chronic diseases well and maintain their quality of life. In short, to promote, restore and maintain health. In Singapore, we strongly believe in this holistic and integrated approach. We initiated the Community Health Screening Programme for our senior citizens last year. We encourage those with chronic illnesses to manage their conditions by enrolling in the Comprehensive Chronic Care Programme at the polyclinics. We re-organised our service delivery system into two clusters to provide a seamless integrated service. Together with the Voluntary Welfare Organisations and other community organisations, we co-operate to provide an Integrated Care Framework for the Elderly. All these programmes put into practice, the basic principles embodied in disease management.

I therefore commend NHG for taking the lead in organising this first National Disease Management Conference. It is a timely initiative, reinforcing our conviction that effective disease management can enhance medical outcomes and increase the cost-effectiveness of healthcare services. I am happy to see that we have conference speakers and participants from various countries including our friends from the US, Malaysia, Hong Kong SAR, and Australia. I am confident you would have a fruitful and enjoyable conference.