Speech by Minister for Health, Mr. Gan Kim Yong, at the World Health Summit Regional Meeting – Asia’s Asian Ministers Panel Discussion, 9 April 2013

Excellencies

Distinguished Guests

Ladies and Gentlemen

Sustainable Development in Asia: The Role of Health Policy

1.            Let me begin by extending a warm welcome to all. Singapore is honoured to host the first regional meeting of the World Health Submit in Asia.

Asian Development and Implications for Health Policy

2.            Why Asia? The Asian region will see rapid economic and social development over the next decade or more. With rising standards of living, demand for healthcare services will increase and people’s expectation will also grow. With more resources generated by economic growth, governments in the region are also able to do more to improve the health outcomes of their people.  Therefore, the healthcare sector will increasingly be a key area of interest among Asian nations for many years to come.  This Summit is a timely one that provides a platform for academics, professional practitioners, policy makers and government leaders to come together to share their views, identify challenges, exchange ideas, and create solutions to support sustainable development in Asia.  It also provides an opportunity for the healthcare community to meet and refresh their friendship, strengthen their ties and extend their professional network.  I do hope you have found the Summit useful.  

3.            While Asia’s economic development has enabled better health outcomes through improved nutrition, sanitation and healthcare, it has brought new challenges. For example, many countries in the region, including Singapore, are facing rapidly ageing populations as a result of longer life expectancies and falling fertility rates. Coupled with lifestyle factors associated with rising affluence, these countries face a growing burden of chronic, non-communicable diseases. This has come even as infectious diseases remain a significant concern, leaving healthcare systems having to battle on both fronts.

4.            As countries spend more on healthcare, sustainability will become a key concern.  We will need to constantly innovate to find new and more effective ways to keep our people healthy and deliver care appropriately and efficiently.  

Singapore’s Approach

5.            Singapore takes a systems-approach towards tackling our health challenges. We begin upstream with helping our population stay in good health. Downstream, we ensure good quality care that is accessible, affordable and sustainable through high performance and cost-effective healthcare delivery and financing systems. Let me elaborate.

Better Health for All

6.            I’ll start with preventive health. First, we ensure a healthy start for our children. Through our childhood vaccination programme, we reduce incidence of major communicable diseases. Through our school-based dental and health services, we lay the foundation for health for our future.

7.            At the next stage, for the population as a whole, we plan to embed healthy living into our environment and provide incentives to encourage healthy lifestyles. We have adopted a 3P framework – Place, People, and Price.  

a.    First, Place. We want to provide convenient and natural places for active and healthy living.  Most of us spend much of our time at work. The workplace is therefore a strategic location for health promotion. Last month, we started an initiative called Sunrise in the City that provides free fitness workouts at six central locations before the work day starts. More fundamentally, we work with employers to support the integration of healthy practices in the workplace.  

b.    Next, People. Peer influence is more effective than any brochure in changing behaviours. Since 2011, our Health Promotion Board has trained more than 5,000 Health Ambassadors. They are ordinary citizens who advocate healthy living and preventive care among their peers.  In doing so, we move beyond traditional awareness campaigns to creating social movements.

c.    Finally, Price. We want to create affordable options so that a healthy lifestyle is within the reach of everyone. Singaporeans love to eat and we eat out a lot. We have made healthier dining options affordable at hawker centres, coffee shops and food courts – where 60% of Singaporeans eat at least four times a week. Under the Healthier Hawker Programme launched in April 2011, food stalls provide healthier options like brown rice and wholegrain noodles. This programme is a win-win: consumers have convenient access to affordable healthier food, and participating hawkers have reported a 20% increase in business.

Better Healthcare for All

8.            Despite our best efforts, we cannot totally prevent diseases so we must provide quality healthcare that is accessible for all. We are doing this by building more capacity and greater capability in our healthcare system and adopting cost-effective solutions to ensure sustainability.  Let me elaborate.

9.            Singapore is ramping up capacity across the healthcare value chain to prepare for a growing and ageing population. With the building of at least two new acute and four sub-acute hospitals, we will be adding more than 4,000 beds by the end of this decade. We are also looking to add 10 new nursing homes in the next few years.

10.         However, building in-patient capacity alone is not a sustainable strategy to tackle chronic conditions which are best managed in the community. The private sector delivers the majority of primary care in Singapore. As such, we are working with them to develop new care models such as the Family Medicine Clinic, which provides comprehensive team-based care to better manage chronic diseases. Through the Community Health Assist Scheme (CHAS), we provide portable subsidies at participating private GP clinics for Singaporeans with low and middle incomes.  We are also developing more options for seniors to be cared for in the community through home care services and better caregiver support.

11.         More fundamentally, we are reorganising our healthcare system into Regional Health Systems (or RHS) to facilitate integration of care. The RHS will keep all providers who are involved in the care of the same patient on the same page through shared clinical pathways, care protocols, and a National Electronic Health Record system to centrally manage each patient’s health record. These allow patients to transit seamlessly to the right setting with the most appropriate level of support as they follow-through with their treatments. The right-siting of patients in turn improves overall system performance by distributing demand to the most appropriate and effective point across the healthcare system.

12.         As we develop new ways of delivering care, we are mindful that new is not necessarily better. Advances in medical technology, coupled with higher expectations from a more demanding population, can result in unsustainable cost escalation. Therefore, before we introduce any new technologies, treatments or drugs into mainstream use, we judiciously evaluate them using evidence-based approaches which take into account clinical effectiveness and need, as well as cost effectiveness.

13.         Our public healthcare institutions also play a crucial role in the development of a cost effective system:

a.    In Singapore, the public sector is the main provider of hospital care. Our public hospitals are managed as corporate entities with a public service mission. They are subsidised based on diagnosis-related groups and block budgets rather than on a fee-for-delivery model. This minimises over-servicing and promotes operational efficiencies.

b.    Our public sector polyclinics also set the benchmark for quality care and cost effectiveness in the primary care sector and ensure affordable access to all Singaporeans. In addition, polyclinics play an important role in gatekeeping to manage access to expensive but highly subsidised tertiary care.

Peace of Mind for All

14.         Besides a high performance healthcare system that is accessible to all, we must ensure affordability for now and in the future. Therefore, to complement the supply-side cost containment that I earlier described, on the demand-side, we preserve the principle of co-payment to prevent a buffet syndrome in healthcare consumption. Nevertheless, there is a need to provide peace of mind for all Singaporeans that co-payment will be affordable.  We need to strike a careful balance between individual responsibility and government support

15.         First, we provide generous subsidies of up to 80% in various care settings. This is followed by the 3Ms of Medisave, MediShield, and Medifund, to ensure that patients’ co-payments after subsidies are affordable. Let me elaborate on how this is achieved:

a.    Foremost, Medisave helps Singaporeans to put aside part of their monthly incomes as savings for their co-payment needs.

b.    Second, MediShield, our national health insurance system, helps patients with large bills. MediShield is designed with co-payments and deductibles to guard against over-consumption and keep overall premiums affordable. For 9 in 10 policyholders, the monthly premium is S$40 or less, or approximately 3% of median per-capita household income.  This can be paid for using Medisave.

c.    The result is affordable healthcare. After subsidies, and with Medisave and MediShield, patients need not pay more than S$100 in cash in 8 out of 10 subsidised hospitalisation bills in Singapore.

d.    Finally, the Government steps in with Medifund to help any Singaporeans who still have difficulties after subsidies, Medisave and MediShield. Medifund is set up as an endowment fund, again, with sustainability in mind. Only interest income is utilised, hence preserving the fund in perpetuity for future generations. The Government itself saves for rainy days and injects capital into the fund when budget surpluses are available.

Conclusion

16.         Singapore’s health policies and our funding model have led to good, cost-effective outcomes.  Nevertheless, our system is still very much a work in progress as our healthcare needs evolve over time with an ageing population.  Like many other countries, we constantly seek better health, better care, and better value for our people in a sustainable manner. We believe this is possible through a pragmatic approach focused on outcomes rather than ideology. Although our respective circumstances differ, I believe there is much we can learn from one another and I look forward to the exchange of views in this session and tomorrow.

17.         Thank you.