NKF Centre Opening And Donor Appreciation Ceremony

06 Oct 2001

By Mr Lim Hng Kiang

Venue: NKF Centre

Mrs Goh Chok Tong

Patron of the National Kidney Foundation

Mr Richard Yong

President and Chairman of the National Kidney Foundation

Distinguished Guests

Ladies & Gentlemen

Introduction

I am pleased to be with you this afternoon for the opening of the NKF Centre.

First, let me congratulate NKF on this special occasion. I would also like to thank the five donors - The Shaw Foundation, Mr Tay Choon Hye, the Lee Foundation, Singapore Pools, and the Singapore Buddhist Welfare Services - for having contributed generously to NKF to build this Centre.

NKF Centre

NKF is a positive example of how a voluntary welfare organisation (VWO), guided by its sense of mission and social responsibility, has grown from strength to strength. From its first dialysis unit at Kwong Wai Shiu Hospital catering to about 40 patients, NKF has expanded its network to include 20 dialysis centres all over Singapore. With its considerable network, NKF is able to provide high quality and subsidised dialysis care to over 2,100 patients, or about 70% of patients who require renal dialysis in Singapore.

NKF provides more than dialysis care. Over the years, it has developed a comprehensive range of services that assists dialysis patients in a holistic way. These include medical counselling, dialysis diet counselling, rehabilitation and job placement programmes. In recent years, NKF has also focused on preventative programmes including regular health screening and health education on disease prevention and organ donation.

I understand that NKF also conducts clinical research on kidney disease patterns and treatment methods, so as to enhance and improve its treatment and rehabilitation programmes. In addition, NKF runs Renal Nursing Training Programmes that offer continuing education and clinical training for nurses.

The opening of the NKF Centre today is a significant milestone. It encapsulates the comprehensive programmes that NKF provides to Singaporeans. At the NKF Centre, patients are able to access a comprehensive range of services ranging from renal dialysis to rehabilitative programmes. The NKF Centre also houses the NKF's clinical and research units.

End Stage Renal Disease in Singapore

In Singapore, renal disease has been among the top 10 leading causes of death since 1960. We have one of the highest incidence rates of end-stage renal disease in the world. The incidence rate for Singapore was 210 per million population in year 2000, whilst that for Hong Kong was 112 and Australia was 90. With our rapidly ageing population and rising prevalence of diabetes, our incidence rate is projected to reach 220 per million in year 2010.

We face a formidable challenge to reduce the incidence of end stage renal disease in Singapore. To do so, my Ministry has embarked on a national disease management plan, with primary prevention as the main focus. Two major causes of renal failure are diabetes and hypertension. Good control of these conditions can significantly delay or even prevent the onset of chronic renal disease and end-stage renal failure. Therefore, the national disease management plan coordinates and focuses the efforts of the different agencies and professionals towards achieving this aim.

To enable early detection of diabetes and hypertension, a 3-year nationwide community health screening programme was launched last year for those above 55 years of age to screen for diabetes, hypertension and high blood cholesterol. We have also piloted the comprehensive chronic care programme or CCCP at 2 polyclinics. This is a structured regime of management aimed at optimising the control of diabetes and hypertension in patients treated in our polyclinics. My Ministry is also funding the establishment of specific renal disease retardation clinics in SGH and NUH, which would provide intensive management for patients with early renal failure to delay or prevent the development of end-stage renal failure.

Unfortunately, despite all these efforts, there will continue to be patients who would develop end-stage renal failure. The number of patients suffering from end stage renal disease is expected to double from the current 3,000 to 6,000 in the year 2010.

Dialysis Treatment

Patients suffering from end stage renal disease can undergo either renal dialysis or have a kidney transplant, which is the best form of treatment for patients with end stage renal failure. However, the number of cadaveric kidneys available is not sufficient to cope with the demand. To increase the pool of donor organs, my Ministry is currently looking into the possibility of allowing altruistic living-unrelated transplants.

While we can do more to encourage organ donation, the sad fact is, today, most patients with end stage renal failure have to resort to dialysis. There are two forms of dialysis treatment - haemodialysis and peritoneal dialysis.

Patients on haemodialysis need to go to a dialysis centre and have their blood cleansed by a dialysis machine for about 4 hours, 3 times a week. Such a schedule makes it more difficult for the patient to be employed full time on regular hours. The cost of haemodialysis is also higher, at about $1,800 to $2,000 a month because of the overheads in facilities and clinical assistance provided.

In contrast, patients on peritoneal dialysis are taught to perform dialysis themselves. There are two types of peritoneal dialysis. Patients on continuous ambulatory peritoneal dialysis or CAPD would need to take about half an hour to exchange the dialysis solution four times a day, every day. Many do it in their offices or at home. Patients on automated peritoneal dialysis or APD, uses a machine to do dialysis through the night. APD is the least disruptive form of dialysis, as it allows the patient to work during the day and be dialysed at night. APD costs about $1,700 a month, while CAPD costs about $1,300 a month.

Our local experience indicates that the survival rates on both modalities are good, with a 4-year patient survival rate of 87% for patients on peritoneal dialysis, compared to 85% for patients on haemodialysis. For elderly patients with significant heart or peripheral vessel disease, peritoneal dialysis is often the preferred modality since it is less stressful on the cardiovascular system.

Today, more than 80% of patients suffering from end stage renal failure in Singapore opt for haemodialysis. I understand that peritoneal dialysis was less popular in the past because some patients were fearful of infections associated with peritoneal dialysis. However, with medical advances, the infection rate associated with peritoneal dialysis has dropped substantially. In addition, these infections can be readily treated if they are detected early.

The National Committee on Renal Care has therefore recommended that the peritoneal dialysis programme be expanded in Singapore. MOH has accepted this recommendation and is working with the renal professionals to promote peritoneal dialysis as the dialysis modality of choice.

There is scope for us to encourage greater use of peritoneal dialysis. As I mentioned earlier, in Singapore, the prevailing mode here is haemodialysis - only 17% of our patients are on PD. In contrast, in Canada it is 36%, UK 37%, New Zealand 55% and in Hong Kong 80% of the patients is on PD, the reverse of the situation here.

Financial Assistance for Dialysis

The second challenge we face is how to ensure that patients with end stage renal failure are financially supported so that they can sustain their dialysis treatment for as long as they need it.

This requires the combined efforts of everyone involved. For the patient, this may mean opting for peritoneal dialysis so that he can stay gainfully employed. The cost of peritoneal dialysis is also lower.

To help patients suffering from end stage renal failure, my Ministry has increased the monthly Medisave withdrawal limit for dialysis from $400 to $450 in May this year. I have also recently announced that we would be increasing the basic MediShield payouts for renal dialysis from $700 to $1,000 per month and the policy lifetime limit from $80,000 to $120,000 with effect from 1 December 2001.

Today, I am happy to announce that my Ministry would introduce a new financial assistance scheme for renal dialysis.

Broadly, under the new subsidy scheme, the Government will provide financial assistance of $200 per month for patients on dialysis treatment. With $200 per month from the Government and MediShield paying up to $1,000 per month, a patient on CAPD who can continue to work and contribute towards his Medisave, would be able to pay the remaining $100 from his Medisave. Therefore, he would not have to fork out any out-of-pocket payment at all.

My Ministry would also like to encourage patients to go on APD, although it is slightly more expensive than CAPD, so that they can hold regular jobs. The Government will therefore provide more funding through the VWOs to build up the capacity for APD treatments and make the charges for APD comparable to CAPD.

For patients on haemodialysis who need financial assistance, the Government will also give a subsidy of $200 per month. Because haemodialysis costs about $1,800 to $2,000 per month, MediShield and Medisave would not be sufficient to fully cover their bill. VWOs like NKF will continue to have a key role in providing low cost good quality dialysis services and financial assistance to the deserving.

The new subsidy scheme would take effect from 1 December 2001. With the new subsidy scheme, we expect to spend up to $8 million in the first year of implementation. In addition, the payouts from MediShield is expected to increase from $6 million last year to $11 million under the new rules.

With this financing structure, we hope that financing renal dialysis treatments is now on a more sustainable basis.

NKF and the other VWOs have done excellent work in raising funds to help patients pay for their dialysis treatment. I would like to emphasise again that the provision of government subsidies and MediShield payouts for renal patients will not displace the role of NKF and the other VWOs in providing subsidised haemodialysis or peritoneal dialysis. In particular, NKF and the other VWOs have a crucial role to support the older dialysis patients who are retired or who are not covered by MediShield. Many of our existing patients belong to this category because MediShield only started in 1990.

If we all work together, I am confident that we can provide good and affordable renal care to Singaporeans.

Conclusion

On this note, it is my pleasure to officially declare open the National Kidney Foundation Centre.

Thank you.