Speech by Minister for Health, Mr Gan Kim Yong, at the MOH Committee of Supply Debate 2017

BUILDING A SUSTAINABLE HEALTHCARE SYSTEM FOR OUR FUTURE

Introduction

1.    Madam Speaker, we announced the Healthcare 2020 Master Plan in 2012 which outlined our plans to add capacity, improve affordability as well as enhance care quality.  Last year, we declared War here in this Chamber, War on Diabetes. I also highlighted 3 key shifts we need to make to prepare ourselves for the future beyond 2020. Today, I will give an update on our progress of Healthcare 2020 as requested by Dr Chia Shi-Lu.  I will also give Members an update on the state of the War on Diabetes and outline our broad strategies to achieve the 3 key shifts beyond 2020. My colleagues will then elaborate on the specific efforts and the measures we intend to include.

2.    Madam, a report published in the Lancet medical journal last year placed Singapore in the top ranks for global health, alongside Iceland and Sweden. We have also made progress in managing and treating diseases which are leading causes of premature death in Singapore, such as Ischaemic Heart Disease, and Stroke. Between 2000 and 2015, we have reduced the premature mortality rates for both diseases by half. 

3.    However, there are some worrying trends. Our obesity prevalence rate has risen to 1.7 times – a 70% increase – from 1992 to 2013. Not 1.7%, but 1.7 times. What is even more worrying, is that the obesity rate amongst younger Singaporeans aged 18 to 39 has grown at an even faster rate, doubling from 4.2% to 8.4% over the same period. This is worrying because obesity is a key driver contributing to the diabetes burden in Singapore. Based on our projections, 1 in 3 Singaporeans will develop diabetes in their lifetime. Obesity and diabetes are risk factors for heart diseases and stroke. If we do not address these risk factors early, the progress on these two diseases that we have achieved over the years will be eroded.

4.     We therefore have a strong impetus to keep our Singaporeans healthy.

Update on HC2020

5.     Allow me now to give an update on Healthcare 2020.

Accessibility

6.    Since 2012, we have opened Ng Teng Fong General Hospital (NTFGH), Changi General Hospital Integrated Building (CGH IB), Jurong Community Hospital (JCH) and Yishun Community Hospital (YCH). Together with the expansion of existing facilities, we have added a total of 2,500 hospital beds.

7.    Next year, Changi General Hospital will open its Medical Centre, which will allow it to expand its specialist outpatient services. We also expect to open the Sengkang General and Community Hospitals by end-2018. The new National Centre for Infectious Diseases is also due to open progressively from end-2018. The construction of Outram Community Hospital is underway and it is scheduled to open by 2020. This is part of our overall plan to redevelop the Outram Campus including the Singapore General Hospital, in a multi-phase process that will take us up to 20 years or more.  Woodlands General Hospital and its co-located Community Hospital will break ground next month and they will be opened progressively from 2022.

8.    The National University Health System (NUHS) will take over the operations of the Alexandra Hospital after the Sengkang team, who is currently now in Alexandra Hospital, moves to the new Sengkang hospital in 2018. The 79-year-old Alexandra Campus is a unique site. The campus offers a unique opportunity as it has tremendous potential for redevelopment. I have therefore tasked NUHS to re-imagine healthcare for the future, taking this opportunity to design new and innovative care models that can better promote health and integrate care, and test them at the Alexandra Campus.

9.    In addition to hospital developments, we have also added 7 new Family Medicine Clinics (FMCs) and 7 Community Health Centres (CHCs) to support the primary care GPs in the community. We have also added 3,400 nursing home beds and 5,600 centre-based care and home care places since 2012. We will add a further 4,200 beds and 4,700 places by 2020.

10.    But adding capacity alone is not a sustainable solution in the long term if we do nothing else. Our capacity growth must be coupled with efforts to transform our care model to leverage on strong primary and community care, and keep our people healthy with better disease prevention and healthier lifestyle choices. 

Quality

11.       To deliver quality services to our people, we need to grow and develop our healthcare manpower. The healthcare workforce has expanded by some 23,000, or 33% over the past five years. We need 9,000 more healthcare workers over the next 3 years and there are many good career opportunities for Singaporean PMETs in the healthcare sector. Given Singapore’s limited labour pool, however, we cannot just grow the number but ensure that our healthcare workers are meaningfully and effectively deployed. SMS Amy Khor will share more about MOH’s efforts to build a strong, future ready healthcare workforce.

Affordability

12.      Several MPs have asked about the affordability of healthcare. We have a multi-layer system of support to ensure that Singaporeans can afford the appropriate care that they need.

13.    Treatment and drugs that are clinically-effective and cost-effective are subsidised. Means-tested Government subsidies at hospitals, Specialist Outpatient Clinics, CHAS clinics and nursing homes serve as the baseline support.

14.    Larger bills, such as inpatient hospital bills, and selected costly outpatient bills like chemotherapy and kidney dialysis, are covered by MediShield Life.  Since its launch in late-2015, MediShield Life has provided Singaporeans, and especially seniors, with better support and assurance. Over 500,000 claims were approved under MediShield Life in 2016, an increase of 47% compared to 2015. Claims by older Singaporeans aged above 65 increased even more at 73%, from 124,000 to 215,000 claims. This resulted in a 90% jump in the total amount of claims for seniors, from $181 million to $343 million.

15.    Mr Murali Pillai asked about MediShield Life coverage for direct admissions to community hospitals. MediShield Life was designed primarily to provide coverage for large acute hospital bills. As an extension of this coverage, MediShield Life covers community hospital stays for patients transferred from acute hospital to community hospitals. Nonetheless, we note that there could be some groups of patients who are suitable for direct admission to community hospitals without going through acute hospitals and might benefit from MediShield Life coverage. We will study this proposal carefully because this has impact on premiums as well.

16.    After subsidies and MediShield Life, the patient can use his Medisave savings to help cover his share of the healthcare bills. Dr Lim Wee Kiak asked if the Flexi-Medisave limits could be raised. The Flexi-Medisave scheme was recently introduced in 2015 to allow older Singaporeans to use up to $200 a year to pay for outpatient medical treatment. So far, the majority of eligible patients have not fully utilised their Flexi-Medisave withdrawal limits. It is still early days, but it suggests that the claim limit is generally sufficient. We will review from time to time.

17.    Finally, for needy Singaporeans who still have difficulty with healthcare costs after Government subsidies, MediShield Life coverage and Medisave, we have Medifund to help them.

18.    Mr Low Thia Khiang asked about profit margins for our drugs in our hospitals and public healthcare institutions. I should take this opportunity to clarify that our public healthcare institutions are not-for-profit organisations. While the drug prices include a margin, this is to offset overheads and operation costs. Therefore they are not profit margins, they are just margins to cover part of the operation costs. In fact, last year we provided a total of $4.3 billion of funding to our public healthcare institutions to support their operations to keep our healthcare cost low.

19.    To help patients with their medication costs, our public healthcare institutions such as our Specialist Outpatient Clinics (SOCs) and polyclinics, provide subsidies of up to 75% for standard drugs, with Pioneers receiving a further 50% subsidy. In addition, the Medication Assistance Fund (MAF) is also available to help patients with selected high cost non-standard drugs, if it is deemed necessary. Patients who still face difficulties despite all these subsidies can also apply for Medifund.

20.    With government subsidies, and the 3Ms, MediShield Life, Medifund and Medisave, Singaporeans have multiple layers of support for their healthcare needs. The system is constantly evolving, and we will regularly review the adequacy of drug subsidies and the different schemes, to ensure that medication remains affordable.

Three Beyonds

21.       While we have made steady progress on Healthcare 2020, we need to plan for the long term. Last year, I outlined our plans to go beyond Healthcare 2020, encapsulated in the “3 Beyonds”. We need to: (i) move beyond hospital to the community; (ii) move beyond quality to value; and (iii) move beyond healthcare to health. These 3 moves are critical in preparing us to meet our long term healthcare needs in a sustainable manner.

Reorganisation of clusters

22.       The first step is to better organise ourselves so that we can implement these three shifts more decisively and more effectively.  In January, we announced that we will be reorganising the healthcare system into 3 integrated clusters.

23.    With the reorganisation, the 3 integrated clusters will each have a broader range of healthcare services and facilities that will provide our patients with more seamless care. They can also tap on a larger pool of resources, including manpower and talent, both professional and managerial talent. The integrated clusters can also offer our healthcare workers greater development and training opportunities, thereby raising the competency of our workers that will translate into better quality of care and eventually benefit our patients.

24.    Primary care will play an increasingly important role in our care transformation. This is why we are strengthening the primary care capabilities of each cluster. The National University Polyclinics (NUP) will be created under the National University Health System (NUHS). With this move, each cluster will now have its own polyclinic group.  This will enable the clusters to work in close collaboration with the General Practitioners (GPs) to augment our primary care sector, and partner a wider range of community-based service providers including Voluntary Welfare Organisations (VWOs) to anchor care firmly in the community, as pointed out by Ms Tin Pei Ling. 

Beyond Hospital to Community

25.       MOS Lam Pin Min will share more about our plans in the primary care sector, including partnerships with the private GPs through the Primary Care Networks scheme. SMS Amy Khor will speak on our plans to strengthen our community mental health capabilities. MOS Chee Hong Tat will share about our collaboration with our community partners. 

Beyond Quality to Value

Agency for Care Effectiveness

26.       Another area of emphasis for us is to go beyond quality, and offer patients value in healthcare provision. Advancements in medicine and healthcare technology offer new opportunities and potential for health and healthcare in Singapore. We want to keep abreast with such developments, so that we can introduce new solutions that are clinically effective and cost-efficient and improve healthcare outcomes and quality of life.

27.    As pointed out by Dr Chia, we must be mindful that newer does not always mean better. Some new drugs or treatments may not offer significant clinical advantage, and yet come at a significantly higher cost. Generic drugs often offer similar outcomes as branded drugs, but it is a fraction of the cost. A good example would be the generic drugs for statins, used to manage high blood cholesterol, which usually cost less than half the price of the branded versions. Opting for generic drug options helps to reduce medication cost. We are working with our doctors to promote the use of generic drugs.

28.    The Agency for Care Effectiveness, or ACE, was set up to evaluate the clinical and cost-effectiveness of new treatments. Through the work of ACE, we aim to identify treatments with good outcomes at affordable costs to guide our doctors and patients. ACE will be publishing their first set of Guidances in May this year, and MOS Lam will share how ACE’s work on Appropriate Care Guides will play an important role in our War on Diabetes.

Beyond Healthcare to Health

29.       Moving beyond hospital to community, and beyond quality to value, are about how we change and improve the way we deliver healthcare to our patients who are already ill. But what is perhaps even more important and critical is to nurture a healthy nation and a healthy people. This is why our third thrust is on moving beyond healthcare to health, focusing on early interventions and healthy lifestyle choices, which will keep people in good health. This is easy to say, but hard to do. We have several initiatives on this, which my colleagues will elaborate later.

War on Diabetes

30.       Mr Christopher de Souza and Mr Chen Show Mao have asked about the progress of our War on Diabetes. The National Diabetes Prevention and Care Taskforce was set up to drive efforts on this war, with three strategic focus areas – namely, (i) healthy living and prevention; (ii) screening and follow-up; and (iii) disease management. These are underpinned by public education, data analytics and research as well as the mobilisation of stakeholders. The taskforce has engaged widely over the last six months and made useful recommendations even as their work continues. My colleagues will elaborate on these recommendations later on.  I will focus on how we can win the war, by working together – communities, businesses, employers, workers, and individuals - you and me.

Healthy living and prevention

31.       First we need to mobilise the community.  We are doing so, through initiatives such as the Community Networks for Seniors (CNS) which we launched last year. We set up Community Health Posts under the CNS, to make services such as health screening and monitoring more accessible to residents living in our heartlands.  We have already established some 30 active ageing nodes in the three pilot CNS sites, and engaged over 5000 seniors, including those with diabetes, or at risk of diabetes, in preventive health activities such as health screening and monitoring, health talks and exercise sessions. We plan to expand the CNS to the remaining precincts in the three participating GRCs - Tampines, Marine Parade and Chua Chu Kang by end 2017.  Our aim is to bring CNS to more mature communities progressively so that we can make every community a place where our seniors can be care for and supported by the community to age well in place. 

32.    Advisors and MPs too can play an active part in helping to spread the message and keep their residents healthy. Minister Lim Swee Say, for example, has set up a diabetes taskforce in Bedok to raise awareness on diabetes. I visited one of his many Chit Chat sessions last week, where he personally shared about the war on diabetes with about 50 residents.  It is a lot of hard work, but there is no short cut.  All of us have to play our part, in our own way, to reach out to our residents to help them stay healthy.

33.    Not just in the community, at the workplaces too. Seagate Technology International’s Woodlands office is one such example. They regularly organise activities for their staff, and participated in the National Steps Challenge^TM Season 2 Corporate Challenge. The office even organised an “intra-organisation challenge” to motivate their employees to clock more steps. Their efforts have paid off as I was told that all their participants have an average daily step count of more than 10,000 steps. Seagate Woodlands is also one of the top scorers for the Corporate Challenge! I hope and look forward to more employers coming on board this war on diabetes.  After all, a healthy workforce is a prerequisite to a productive workforce.

34.    To fight this war, and to fight any war, we need soldiers. So who are the soldiers? We are the soldiers. As individuals, we can play a part by being responsible for the choices that we make everyday. Apart from staying active, it is also important that we watch our diet. A healthy diet is half the battle won. Many of us eat out regularly, and that is why MOH and HPB have also been actively engaging our hawker centres, coffee shops, and restaurants to offer healthier meals with lower calories, and beverages with lower sugar. Like Minister Lim, I too, share with my residents on tips to combat diabetes. I encourage them to follow the three ‘R’s – Refrain, Reduce, and Replace. When we decide what to eat, Refrain from unhealthy food if you can. I know it is difficult, if you cannot but have to eat, try to Reduce the amount of unhealthy food you eat.  If you cannot Refrain and cannot Reduce the amount, then please Replace with healthier alternatives. So, Refrain, Reduce, and Replace – these are secrets to healthy living.

35.       Madam Speaker, let me say a few words in Mandarin.

36.       除了鼓励国人预防糖尿病，我们必须帮助那些有可能或已经患上糖尿病的国人，控制病情，预防并发症。为此，卫生部去年通过一系列在邻里举行的糖尿病路演、讲座及体检，把关于糖尿病的讯息传达给超过12万名国人。保健促进局也推出了“预防糖尿病计划”, 帮助血糖偏高的国人扭转他们将患糖尿病的风险和命运。其中受惠的就有吴素音女士，吴女士曾经因为血糖偏高而可能患上糖尿病。吴女士因为缺乏运动，加上高糖份的饮食习惯，常常感到疲惫。在她的医生的建议下，吴女士参加了保健促进局的“预防糖尿病计划”， 并且养成了做运动和选择健康饮食的习惯。吴女士的努力，让她不必用药，便成功地把血糖控制在健康的水平。她现在还积极地推广健康的生活习惯和预防糖尿病的重要性。吴女士经常鼓励朋友选择糖份较少或无糖的饮料，以及较健康的饮食。她也经常参加博爱村(Agape Village) 所举办的运动。吴女士可以说是糖尿病之战的勇士。

37.       Mdm Speaker, in my Mandarin speech, I shared the story of Mdm Goh, who benefited from HPB’s Diabetes Prevention Programme, which helped her manage her blood sugar levels and prevent diabetes. Programmes like these are useful in helping pre-diabetics better manage their conditions through healthy eating and exercise habits. We hope to see many more take a step towards proactive disease management and prevent diabetes. Therefore, HPB will launch the “HealthHub Track” in April this year – this is a personal health management app in HealthHub which will provide users with digital tools to monitor and manage their health conditions more conveniently.

38.    The War on Diabetes will not be a quick battle and we must be prepared to keep up the momentum and go the distance.  We need to fight the war on the ground one day at a time, one battle at a time, and even one person at a time. Winning the War is not about building more hospitals and clinics to take care of those already ill. We need to do so but not only building them, but motivating Singaporeans to take charge of their health, to live their lives free of diabetes, and for those who have diabetes, to provide them with support to help them to manage their condition well.  

Conclusion

39.       The three shifts – beyond hospital to community, beyond quality to value and beyond healthcare to health – will define the future direction of health and healthcare in Singapore. They will lead us towards good, affordable and sustainable healthcare in the long term. All Singaporeans - you and me - want to have good health for ourselves and their families. Therefore, let us work together as one healthcare system to bring Better Health, Better Care, Better Life for all Singaporeans.

40.       Thank you.