MOH 2012 Committee of Supply Speech Healthcare 2020: Improving Accessibility, Quality and Affordability for Tomorrow’s Challenges (Part 2 of 2)

1. I would like to thank the Members for their thoughts and feedback.

2. Yesterday I spoke about the challenges facing us, and our efforts to expand healthcare infrastructure and the healthcare workforce, to support the expansion of services under our Healthcare 2020 plan. I will now talk about how we will provide Singaporeans with quality and affordable care.

Improving Quality of Care

3. Over the years, we have invested heavily in building up our acute hospitals. They have attained high standards of care, with some achieving peaks of excellence and earning themselves a global reputation. At the individual level, our healthcare professionals have also attained high levels of proficiency. But there is room for improvement, especially in building up the intermediate and long-term care sector and outpatient sector, as well as providing more integrated, patient-centric care. First, let me share our efforts to facilitate holistic management of patients to improve the care outcomes for patients.

Regional Health System

4. One of the key strategies to raise quality of care is to better integrate across different settings by re-organising our healthcare system into a more hassle-free, integrated and patient-centric Regional Health Systems. Each regional system would have an acute general hospital working in close partnership with community hospitals, nursing homes, home care and day rehab providers, as well as polyclinics and private GPs within the geographical region to provide seamless and holistic care for patients.

5. This way, patients can be assured that the different providers in each region are working together to better care for and support them, across different stages of their healthcare journey from diagnosis and treatment to post-discharge follow-up. It will also help patients navigate across providers more easily, enabling and empowering them to manage their own care needs more effectively – a point made by Associate Professor Muhammad Faishal. The Eastern Health Alliance, launched in November last year, was the first such multi-party collaboration.

6. The Regional Health Systems need to be supported by enablers, such as the Agency for Integrated Care, or AIC, which helps patients navigate the system and refers them to the most appropriate care provider, strong case management capabilities, to ensure that patients follow up after discharge, and national electronic health records to facilitate information flow.

7. Mr. Low Thia Khiang asked for a progress update on the NEHR. We are on track to rolling it out to all the public healthcare institutions and six community hospitals by Jun 2012, as well as two nursing homes, selected GPs and users from AIC. Mr. Low also raised concerns about patient confidentiality. Patient confidentiality is important and it is protected in two ways. Firstly, we have built the security framework in accordance to international standards to protect sensitive data. Secondly, an audit system is put in place for us to identify unauthorised entry. As a deterrent, stiff penalties are in place for those who violate IT security. We will continue to enhance our IT security in a practical way, striking a balance between regulation and operational flexibility.

Primary Care

8. As our population ages and the prevalence of chronic diseases increases, we can do more to support GPs and tap on them to better care for residents in their community in a more cost effective way.

9. Associate Professor Fatimah Lateef, and Mr. Heng Chee How asked how the new models of care that we have shared would increase the accessibility of care. The new models of care involve four key features:

9.1. Encourage GPs to set up Family Medicine Clinics (FMCs) to provide team-based care for patients.

9.2. Set up Community Health Centres (CHCs) to support GPs and provide allied health services for their patients.

9.3. Develop Medical Centres (MCs) to provide community-based services for patients who require day surgery and less complex specialist services.

9.4. Provide portable subsidy to patients under the Community Health Assist Scheme (CHAS) so that they can enjoy subsidised services at private GPs and FMCs.

10. With these new models of care, more patients can be cared for outside of the hospitals’ specialist outpatient clinics by GPs in the community. At the same time, through team-based care, we can help patients slow down their disease progression, reduce complication rates and in turn, minimise referrals to hospitals. We also hope to grow the capabilities to manage mental health conditions within the community and primary care, which MOS Amy Khor will be speaking on later.

11. We have been engaging interested parties to set up the first FMCs and CHCs. We plan to pilot four FMCs this year to test out the model, with more in coming years if it proves effective in managing patients with chronic diseases in the community. We are also engaging potential providers to set up three CHCs this year. Our hospitals are also studying the setting up of new MCs, which are more complex set-ups that will take a bit longer. I will update on our plans when the details are firmed up.

12. Associate Professor Fatimah Lateef asked how MOH was going to upgrade the skills, knowledge and attitudes of our GPs.

12.1. We recently improved the training of Family Physicians under the Family Medicine residency programme. We also have other training pathways for GPs to upgrade themselves.

12.2. To recognize doctors who have the necessary skills needed for family medicine, the Register of Family Physicians was set up in 2011, and made publicly available earlier this year. After eight months, we have 509, or 25% of GPs accredited. We aim to double this by the end of next year.

Palliative Care

13. Besides caring for the sick, we also need to ensure that those who are at life’s last stage die well. Ms. Ellen Lee asked how the Government will support this. Most people wish to die in the presence of loved ones and with dignity. We will help patients achieve that through good home palliative care.

14. MOH currently funds five home palliative providers, serving 3,800 patients each year. We are seeing how we can expand this. Part of dying well involves having one’s care preferences honoured at the end of life. Through Advanced Care Planning (ACP), we encourage patients, families and healthcare professionals to engage in discussions on care and treatment preferences. We are scaling up existing ACP programmes in the various Regional Health Systems.

Improve Affordability

15. Let me now turn to the issue of healthcare costs and affordability, which many Members have spoken on.

16. We have so far built a strong healthcare financing system. First, government subsidies help to significantly reduce the cost to the patient. Next, the 3Ms, that is Medisave, MediShield and Medifund, as well as ElderShield, come in to help the patient pay his share of the bill.

17. In the past, our financing framework focussed more on inpatient care. As an ageing population requires more frequent care in the outpatient and intermediate and long-term care settings, our financing framework must evolve to help Singaporeans meet the new realities.

18. We have thus increased the subsidies for chronic outpatient treatment at GPs and for intermediate and long-term care services to benefit not just low-income families, but also the middle-income by raising the income criteria. Let me elaborate.

Expansion in Outpatient Setting

19. Last August, we announced significant changes to the Primary Care Partnership Scheme, now known as the Community Health Assist Scheme (CHAS), which enables patients to receive subsidised care at GP and dental clinics. In January, the per capita household income criteria was raised from $800 to $1,500, and the minimum age lowered from 65 to 40. Middle-income households can now benefit from this scheme. These enhancements to CHAS have been well received. We have doubled the number of Singaporeans on this scheme, from 38,000 two months ago to 77,000 now. I expect applications for the scheme to grow further as we step up our outreach efforts. Ms. Foo Mee Har suggested simplifying the application process. We have kept the process simple and expanded the access points for applications to include polyclinics and GPs who are in the scheme. We will explore what more we can practically do to further simplify the process.

20. Together with the higher Medisave withdrawal limit for chronic disease treatment of $400, we have reduced patients’ cash outlay when they see GPs for their chronic conditions.

21. Associate Professor Fatimah asked how we can attract more clinics into CHAS. We now have 460 CHAS GP clinics compared to 420 in December. This is about one-third of all GP clinics. We are targeting to reach out to 1,000, or 70% of all clinics. We are exploring IT solutions to ease the admin load on clinics to make it easier for them to participate in the scheme. I know many MPs are helping us to spread the word on CHAS to all the clinics in their area.

22. Associate Professor Fatimah also highlighted the transaction costs incurred by patients when they make Medisave claims. This fee is imposed to recover CPF Board’s operational cost of administering the scheme. We will be mindful to ensure that it does not affect patients’ affordability.

Expansion in ILTC Setting

23. We recognise that outpatient care is not the only source of concern for Singaporeans. Many are also worried about the cost of intermediate and long-term care, especially for those from middle-income families who receive little to no subsidies. As their parents age and need more care and support, they too shoulder a heavy emotional and financial burden.

24. As announced by DPM Tharman, we are significantly expanding subsidies in the intermediate and long-term care sector, that is, for community hospitals, for residential long-term care services such as nursing homes, and for non-residential long-term care services such as home care and day rehabilitation centres. The Government will help patients afford these services.

25. We are raising subsidy rates for long-term care services, and extending the coverage from $1,400 to $2,200 per capita household income. Patients from a household of four with $8,800 total household income will still be eligible. Details have been announced earlier. With the changes, up to two-thirds of the households in Singapore will qualify for subsidies, benefiting not only lower income families but also many middle income families. As for the community hospitals, all patients regardless of income will be eligible for subsidies of at least 20%, higher for lower income.

26. To encourage and enable our elderly to age at home as far as possible, families who take care of their frail parents at home will receive greater government support, as well as a grant for the employment of a Foreign Domestic Worker.

27. As part of these changes, we are also simplifying the means-test criteria in the ILTC sector from per capita family income, which includes all immediate family members, to per capita household income, which includes only those family members that the elderly is living with. This reflects the elderly’s extent of financial support. We hope that this will simplify the process and also reduce the hassle for patients and their family members as well as the institutions.

28. These changes will come into effect third quarter of this year, and overall government spending on ILTC subsidies is expected to more than double by 2016.

29. Even as government subsidies are expanded, we also need to help Singaporeans better afford their share of the costs. Dr. Lam Pin Min and Ms Sylvia Lim suggested that ElderShield payouts be revised to help Singaporeans with the increasing cost of long term care. There has been increasing support from Singaporeans for ElderShield, with the opt-out rate at 8% for the cohort who turned 40 in 2011. With higher subsidies, a significant proportion of a VWO nursing home bill can now be covered by the basic ElderShield payout of $400. But this may not be sufficient for the elderly in future. We will have to revise ElderShield payouts in line with increasing costs. But I am sure Dr. Lam and Ms. Lim are mindful that better ElderShield benefits will necessitate higher premiums, so it requires careful study. We plan to review ElderShield next year to ensure that it remains relevant.

30. For those low income elderly and disabled who were unable to join ElderShield when it was introduced, they can apply for the Interim Disability Assistance Programme for the Elderly instead to receive disability payouts. We are increasing the monthly payout to provide more help and raising the per capita household income cut-off to $2,200 per month as well.

31.The changes to subsidies in the outpatient care and ILTC settings will help the low income significantly but they also signal a major shift towards providing some help for the middle income. By raising the income cutoffs, we are extending the healthcare safety net to better support the sandwiched class, who are supporting both children and elderly parents.

Subsidies in the RH/Is

32. Even as we increase subsidies in the ILTC sector for Singaporeans, we will widen the differentiation between the subsidy levels for citizens and PRs. PRs will receive a lower subsidy rate than SCs in the same income tier. The same principle will apply to subsidies at the restructured hospitals. However, we will be mindful of the impact on the affordability for low-income PRs, many of whom are close family members of citizens. My Ministry will release more details shortly.

33. I know many Singaporeans remain concerned about the cost of drugs, especially those required for chronic conditions, as their cumulative costs can be high over time. Ms. Sylvia Lim asked about drug subsidies. The Government provides drug subsidies to improve the affordability of commonly used medications. The list of subsidised medications, known as the Standard Drug List (SDL), contains drugs that have been assessed to be cost-effective and essential. Most SDL drugs are capped at a price of $1.40 per week for subsidised patients in the public sector, while the rest are subsidised at 50% of the retail price.

34. We recently raised the subsidy for some SDL drugs used in the treatment of chronic conditions to 75%, up from 50%, for patients with per capita household income of $1,500 or less, halving the cost for them. In addition, the Medication Assistance Fund (MAF) assists Singaporeans who need selected expensive drugs that are not on the SDL with up to 75% subsidy, also up from 50% previously. MAF has also been expanded to include other non-standard drugs, if they are assessed to be clinically necessary and appropriate for the patients.

35. Together, SDL and MAF help to keep drugs affordable for subsidised patients, often significantly below cost. We also constantly review the SDL to include more drugs. In fact, the House will be happy to know that we will be adding about 20 new drugs into the SDL and MAF during this year. This will include drugs such as Olanzapine and Quetiapine for the treatment of bipolar disorders, as well as the antibiotic co-amoxiclav, better known as Augmentin.

36. Ms. Sylvia Lim also asked about the pricing policy of drugs. Currently, our clusters purchase drugs through a centralised Group Procurement Office (GPO) where possible. However, some drugs are better purchased at the individual cluster or hospital-level for various reasons, for example, where quantities are small, or if the drugs are specific to that institution. Even for drugs purchased via the GPO, price differences could arise, because hospitals start on new tender contracts (with new prices) only after they have completed the contractual committed quantities of the old contract. This may happen at different times for different hospitals. In addition, the healthcare institutions have some autonomy in pricing to take into account their different clinical setups and cost structures, subject to general subsidy guidelines.

37. I would like to stress that contrary to what Ms. Lim said, our healthcare institutions are not-for-profit organisations. Whatever revenue that is generated from operations, be it from the sale of drugs or charges from consultations, is taken as overall revenue to the institution and used to partially defray costs, including operating overheads. These revenues are however insufficient to fully cover their costs. In FY2010, the public healthcare institutions incurred operating deficits of over $2 billion, before subvention from the government. 

38. Mr. Desmond Lee asked whether patients could fill their prescriptions at subsidised prices outside of the public institutions. Today, subsidised patients can obtain their medication at subsidised prices from the public institutions where they are being treated. A stable subsidised patient who just needs to fill his remaining prescription without visiting the specialist may take advantage of the home delivery service introduced by our institutions. My Ministry will be reviewing alternative, more convenient options for our subsidised patients to fill their prescriptions of commonly available drugs nearer their homes.

MediShield

39. Let me now turn to MediShield. As an insurance scheme, Medishield works on the basis of risk-pooling and helps patients pay for their hospital bills, providing peace of mind for many Singaporeans.

40. Several Members have called for better coverage and benefits for MediShield. We agree and are indeed reviewing the scheme to help Singaporeans better protect themselves against catastrophic costs. But additional coverage and benefits will need to be supported by higher premiums paid by policyholders. Hence, we need to weigh the costs and benefits carefully.

41. One area is coverage for congenital and neonatal conditions. Today, conditions such as holes in the heart and cleft palate, and medical treatment for newborns, such as jaundice or infection, are not covered under MediShield to keep the premium low. But parents have given feedback that this is an area of worry for them. 

42. By covering congenital and neonatal conditions under MediShield, we would be able to reduce parents’ financial burden and give them greater peace of mind. But doing so will also impact the Medishield premium that they would have to pay for their children at the younger ages. We hope to avoid the situation where some parents who expect their children to be healthy choose to opt out of the scheme and apply for insurance coverage for them only later to avoid the higher premium, which could undermine the scheme over time. I also note Dr Janil’s suggestion to extend MediShield coverage only to some congenital conditions, which we will study further with the medical experts and actuaries.

43. I am encouraged to hear the support from Members in this House for the extension of MediShield coverage to congenital conditions. We will be consulting the public shortly on this, and hope to receive strong public support for this pro-family measure.

44. We will also explore if there is strong public support for MediShield to cover inpatient psychiatric treatment. Such an extension will be in line with our efforts to enhance the affordability of mental health treatment. Finally, we are also reviewing the policy year and lifetime claim limits, to help the small number of Singaporeans who exceed these limits today.

45. As part of the MediShield changes, we will have to update our premiums in line with claims experience to keep the scheme solvent. As MediShield premiums are set to be sustainable for a five-year period and the last increase was in 2008, we are due for the next update soon. The premiums need to be adequate to sustain MediShield members’ claims and to fund future liabilities under the scheme. On the whole, MediShield has paid out 21% more in claims each year between 2008 and 2011, which benefits policyholders, while the premiums collected grew by only 10% per annum.

46. Based on our preliminary estimates, to keep MediShield sustainable and support the extension in benefits, a 45 year old may see a premium increase of $7 per month, with the younger age groups seeing a smaller increase. On the other hand, an older policyholder at 75 could see an increase of $20 per month.

47.To offset these increases, DPM Tharman has announced a one-time Medisave top-up of up to $400, or $33 per month, for all Singaporean policyholders, to help cushion the impact of the premium adjustment.

48. In addition, most older policyholders who are beyond the re-employment age of 65 will receive direct and long-term assistance via Medisave top-ups under the GST Voucher scheme, of up to $450 a year or $37.50 per month which can offset the premium increase in full. Those aged 50-60 will also see a higher contribution to their Medisave accounts due to the higher CPF contribution rates.

49. Mr Gerald Giam asked if some of the MediShield reserves can help to offset these premium increases. These reserves are crucial in ensuring the long-term sustainability and viability of the MediShield Fund. Their main purpose is to provide an adequate capital buffer in accordance with MAS’s guidelines, and to fund other liabilities, such as future treatment costs and premium rebates for policyholders when they age, which I will explain later.

50. Ultimately, MediShield operates on a not-for-profit basis, with premiums actuarially calculated to cover expected payouts and meet the MAS risk and reserve requirements. The reserves ensure that MediShield will be able to honour policyholders’ future claims. We have instead addressed potential affordability concerns through the targeted Medisave top-ups.

Elderly

51. Several Members highlighted the challenges faced by the elderly and vulnerable in particular in paying for their healthcare expenses. We have paid special attention to ensuring that the elderly can afford healthcare services.

52. First, to strengthen protection for the elderly, we will be extending MediShield coverage from 85 to 90, given the longer life expectancy today. This will ensure that Singaporeans will be covered by MediShield for most, if not all, of their lives.

53. Some MPs have asked whether we can extend beyond 90 and maybe provide lifetime coverage. It is something that is very attractive, but we must be cautious about doing so, as there is limited riskpooling at ages far beyond life expectancy, which currently stands at 82. Although Dr Fatimah mentioned that she had met quite a few such seniors, the total number in Singapore remains quite small. With the small number of policyholders in those age groups with a high risk of claims, premiums would tend to be expensive and unaffordable for many, with some dropping out of the scheme. Nonetheless, we will study how we can help those above 90 in other ways.

54. Mr. Gerald Giam asked if MediShield premiums can be increased for working adults to offset the increases for the elderly. In fact, MediShield was designed to have an element of this, where policyholders “pre-pay” a bit more when they are young, and this amount is then held within the MediShield Fund to support premium rebates in their old-age. This forms part of the reserves I mentioned earlier. By paying more today, younger policyholders will pay less in premiums when they are no longer working.

55. If Mr Giam is asking that we ask the younger generation to support the older generation, that could be problematic. Increasing premiums for the younger generation to cross-subsidise claims by the elderly, as Mr. Giam suggested, may not be viable in the long-term. With an ageing population, each young policyholder will face increasingly higher premiums in order to support the growing number of elderly policyholders. This may not be acceptable to them and they may choose to opt out, affecting not only the older generations but also themselves.

56. With the GST Voucher for Medisave and the one-off top up just announced in this Budget, the government is stepping in in a bigger way to help older Singaporeans afford healthcare costs, without adversely affecting the younger ones.

Low-income

57. Through the MediShield review, we hope to address the needs of a few vulnerable groups, be it the elderly, those with congenital conditions, or those who require inpatient psychiatric care. Let me now turn to the low-income, which is another vulnerable group in our population. Mr. Gan Thiam Poh suggested that we extend free MediShield coverage to them.

58. I am not sure that’s the best approach. Low-wage workers who qualify for the Workfare Income Supplement Scheme, or WIS, can get an average of $1,000 in payouts, which is paid partly in cash and partly into their CPF accounts, including Medisave. The total of the WIS payout into Medisave and the worker’s own Medisave contribution from his salary, is more than sufficient to pay for the MediShield premiums for himself, his non-working spouse and 2 children. For a 51-year old earning $1,500 per month, he would have a total Medisave contribution of $1,700 per year, compared to total premiums of $516 for his family. This approach encourages self-sufficiency while supporting their basic healthcare needs, including premium payment for Medishield. For those who are unable to afford them, we will look at other means to support them, such as Medifund.

59. With the various support measures through Medisave, we have achieved 92% MediShield coverage of the population, surpassing the target of 90% that we set in 2008. We will continue to reach out to as many Singaporeans as possible. However, there will always be some who opt out of MediShield because of various reasons, some of which are sensible. For example, they may have other medical benefits or coverage.

Medisave

60. Dr. Chia Shi-Lu asked the Government to liberalise the use of Medisave, especially for more outpatient treatments, while Associate Professor Fatimah Lateef asked to raise the Medisave $400 limit to $500. Both Medisave and MediShield are primarily designed to assist with larger healthcare bills, for inpatient care and selected expensive outpatient treatments such as chemotherapy. We recently raised the annual Medisave withdrawal limit for chronic diseases to $400. We must be mindful not to deplete Singaporeans’ Medisave balances prematurely and affect their ability to meet their post-retirement healthcare needs. It is also important for the elderly to maintain sufficient Medisave to pay for their MediShield premiums, and stay insured as long as possible. Hence, while we understand Ms Tin Pei Ling’s concern that some elderly prefer to use their own Medisave monies first before asking for financial assistance, we must maintain safeguards on Medisave use to prevent premature depletion. We prefer to see how we can help them directly, such as through Medifund, which we will assess on a case by case basis.

61. As Singaporeans build up more Medisave balances, we can study how Medisave can be gradually extended to cover other healthcare expenses.

Medifund

62. For those who still face difficulties with their healthcare bills despite subsidies, MediShield and Medisave, Medifund will be available. DPM Tharman announced a $600m top-up to Medifund which will increase the total annual quantum of grants available from $80 mil to $100 mil. This will allow us to help more needy Singaporeans, including the middle-income with larger bills.

63. One such patient whom we helped was a middle aged mother of one with leukaemia. She eventually needed a bone marrow transplant last year, and accumulated more than $130,000 in hospitalisation bills over two years as she also developed complications. Post-transplant, she also had to take a powerful and costly cocktail of immunosuppressants to avoid rejection of the donated bone marrow. Insurance and Medisave covered $100,000 of the inpatient bills, and the patient received $13,000 in Medifund assistance to help with the remaining bill even though the husband was earning above median income, in view of her large expenses. To date, the patient has received further Medifund assistance of more than $10,000 for her outpatient treatment.

Empowering Patients

64. Mr Sam Tan spoke about how patients need to be better educated so that they make good decisions – both in terms of the treatment outcomes and finances. I agree that we need to find ways to better empower patients to make informed decisions concerning their care.

65. MOH will work with the community to step up our public education efforts and improve Singaporeans/ financial literacy about healthcare.

66. Mr. Sam Tan asked whether we can reintroduce fee guidelines and improve financial counselling for patients. We agree that greater transparency on fees is essential. This empowers patients and allows market forces to work more efficiently. MOH currently requires clinics to display their charges, and also provide bill size comparisons on the MOH website. All hospitals are required to provide financial counselling upfront to help patients estimate their bills.

67. We are exploring how we can do more, through various means. One possibility is to publish more information on the professional fees that our public sector doctors have charged for their services. Another possibility is to require hospitals to give their patients a comparison of their estimated charges against the published fees in the MOH website, as part of the financial counselling process. We are studying the options.

Sustainable Healthcare Spending

68. Even as we expand the healthcare safety net for Singaporeans to bring about a more affordable and equitable healthcare system, it is important not to lose sight of the fundamentals that will keep healthcare affordable in a sustainable way over the long term, and yet produce good outcomes in terms of accessibility and quality of care. Mrs Lina Chiam suggested cost benchmarking to compare ourselves with other countries. We will study it but there are some limitations as different countries will have vastly different healthcare systems and hence different cost structures.

69. Mr. Sam Tan rightly stressed that it is not about how much healthcare spending is raised, but how it is spent, while Dr. Teo Ho Pin urged the Government to manage overall healthcare costs for Singaporeans more efficiently. Mr. Gerald Giam also asked us how we intend to be more efficient and better optimise our existing manpower resources. Underlying all these questions is this – how do we make sure that we make the best use of the resources that we have, and that whatever we spend now is sustainable in the long term?

70. A key driver for the increase in healthcare costs is improvements in medical care – new and improved drugs, better treatments, breakthroughs in surgical techniques – that improve quality of life and extend life. This is good for patients and their families. However, as a society, we cannot afford to support and subsidise all new treatments “at all costs”. New does not necessarily mean better. We need to consider what appropriate and cost-effective treatment is.

71. As a system, we need to do our best to bend the cost curve – to reduce inefficiencies and discourage over-consumption. Let me share two key fundamental principles that will serve us well. First, we must always strive to innovate, increase productivity and develop new and more cost-effective models of care. Wherever we can, do more with less. One of the ways we achieve this is through technology. Take tele-ophthalmology, which allows ophthalmologists, located in the hospitals, to “look into” the eyes and the retina of patients in the polyclinics. The optometrists in the polyclinic prepare the images which are transmitted to the hospital ophthalmologists for assessment. Those with minor conditions such as dry eyes can receive the medication that they need at the polyclinic, and only those with more serious conditions will need to be referred to the eye specialist clinic for further assessment. This brings care to the community level, and cuts down unnecessary visits to specialists, saving costs for patients and freeing up resources at the hospitals.

72. To improve efficiency and productivity in our healthcare system, we will set aside $20m for a fund called Healthcare Productivity in Acute Services Scheme (Health-PASS). The hospitals can make use of this fund to pilot and implement projects that improve productivity and efficiency. A similar scheme will be introduced in the ILTC sector.

73. Co-payment by patients is another fundamental principle to prevent unnecessary over-consumption of healthcare services which will drive up costs. Through co-payment, the patient shares part of the responsibility of spending his health dollar smartly. He is more likely to weigh the treatment options or choices of drugs and choose a more cost-effective option. It will also ensure that healthcare providers are more cautious in prescribing treatment to ensure patients can afford the co-payment. We want to avoid the pitfall of countries where healthcare is virtually free, resulting in an insatiable demand from patients for healthcare services, runaway healthcare spending and an increased fiscal burden that is eventually borne by taxpayers.

Conclusions

74.I have shared with members the key strategies of Healthcare 2020. How we will build capacity to improve access, how we will introduce new models of care to improve the quality and outcome of healthcare services, and how we will enhance our financing framework to keep healthcare affordable to all Singaporeans, not just for the low income, but also the middle income families.

75. Ultimately, for Healthcare 2020 to succeed, we need to move upstream to help Singaporeans stay healthy and prevent illnesses from setting in or progressing. To do so, we must re-emphasise personal responsibility for health and well-being: to lead a healthy lifestyle, get screened, and comply with medical treatment. We must continue with public education to help Singaporeans make informed healthcare choices and spend their health dollars wisely. With the Government enhancing the healthcare system and each Singaporean taking personal responsibility, I am confident that Singapore will continue to have a good healthcare system into the future. Healthcare 2020 will ensure that Singaporeans always have access to good quality and affordable health care. After all, this is integral to an inclusive society.