Weaving the Healthcare Tapestry

25 Jun 2009

By Health Minister Khaw Boon Wan

Venue: The Ritz Carlton Millenia, Singapore

Distinguished Guests

Ladies and Gentlemen

Introduction and Welcome

1. Let me extend a very warm welcome to all the delegates, and especially our foreign visitors.  H1N1 is in pandemic mode.  I hope that none of you picks up, leaves behind or brings back the virus. 

2. Singaporeans have a modern healthcare system that delivers a high standard of care. We did not arrive at this by accident.  We started with humble beginnings and achieved what we have today through very deliberate planning and by taking a pragmatic approach.  In response to the organisers' request, let me share this journey with you.

From Third World to First

3. Post-war Singapore in the 1950s was a typical third world city. Those were my childhood days.  The challenges were rapid population growth, unemployment, poor physical infrastructure. There was high infant mortality. The main causes of death were infectious diseases such as tuberculosis and pneumonia. The few hospitals built by the British and Chinese philanthropists like Mr Tan Tock Seng, were functional but overflowing with patients.

4. With self governance in 1959 and independence in 1965, we faced significant challenges in the political, social , economic and health front. Against all odds, the many pieces needed for nation building and social economic development were systematically put in place.

5. By 1970s unemployment was largely solved and physical infrastructures such as housing, clean water supply and sewage treatment were in place. Infant mortality rate had decreased from about 80 per thousand live births to 20 in 1970.  Infectious diseases were no longer the top causes of death.  That was the period when I first started working in the Ministry of Health.

6. Today, Singapore is a First World city with First World health challenges.  Lifestyle, chronic diseases and care of the elderly are becoming the major health challenges.

A pragmatic approach to delivering health

7. Over the years, we have taken a pragmatic approach to delivering healthcare for Singaporeans.

(a) Build what we need when we can afford it

8. First, we did not over invest in high tech high cost hospitals in the early days. Instead the limited resources we had were largely invested in basic physical infrastructures such as housing, water supply and sewage treatment and for social economic development, including education, transportation, ports and industrial parks. 

9. To address the health issues of the 50s and 60s, we develop a basic but effective primary health care system, comprising GPs and a network of government-run Outpatient Dispensaries and Maternal & Child Health clinics.  Our first major investment in public healthcare facilities was only made in the 1970s when the economy was gradually coming on track. Opened in 1981, the 1500 bed Singapore General Hospital was planned as a tertiary referral centre for specialised medical services. The next tertiary hospital, the 900 bed National University Hospital was opened in 1985. Both have stood the test of time and today are at par with some of the best hospitals in the world.

10. In the 90s we built a number of specialists’ centres, including National Skin Centre, Singapore National Eye Centre, National Heart Centre, National Neuroscience Institute and National Cancer Centre to bring selected specialisation to the next plane. All of them have achieved their mission. Also during the 90s we re-built three major hospitals, the 1100 bed Tan Tock Seng hospital, the 800-bed Changi General Hospital and the 900 bed KK Women and Children Hospital.

(b) Ensure affordability

11. Second, we pay close attention to the issue of health care financing.  This is the major challenge throughout of the world. Whether financing is through taxation or insurance, the same problem of affordability exists.

12. In Singapore we have opted for a national health savings account model supplemented by insurance for catastrophic illnesses and tax supported subsidy. Our 3M model: Medisave, Medishield and Medifund together with heavy government subsidies have ensured that we can afford a high quality healthcare both at the individual and societal level for today and in the future.

13. By having significant co-payment by users at point of usage and targeted financial support for those in needs, Singapore has avoided some of the over consumption and moral hazard problems seen in other countries with significant third party payment.

(c) Learn from everyone but forge our own solution

14. Third, at each phase of our development we learn from everyone. We send study teams to visit the best centres around the world and pick the best ideas. We invited experts to visit and share their knowledge and ideas. Typically our hospital planning teams would visit dozens of award winning and outstanding equivalent projects overseas before they embark on their detail planning. Yet, we have not copied wholesale from any project. Instead we have planned and built facilities to address our needs in our own unique ways.

(d) Balance quality with affordability

15. Fourth, we put a premium on functionality and sustainable design.  Quite understandably, many planners and architects would prefer to build beautiful, elegant looking buildings. Most would rather build an award winning "Shangri-la" for a few rich patients instead of a plain looking functional building serving the masses. The reality is that in most parts of the world and Singapore included, we need to balance aesthetics, quality with functionality, efficiency and affordability.

16. I am proud to say that our healthcare facilities have all been planned and built to be highly functional and efficient allowing us to treat high throughout of patients. Yet the environment created has been aesthetically pleasing and comfortable for both patients and staff.

Future will not be the same

17. Today we have a respectable health care system in place. Our facilities are a match to the best around the world.  Yet, we spend less than 4% of our GDP on health. WHO has ranked our healthcare system 6th in global ranking. But we still have much to do.

18. Singapore, like the rest of the world is facing rising healthcare cost. While we have managed acute care adequately, the care of chronic diseases can be better organised. With a rapidly ageing population, we will soon face a silver tsunami. We need to prepare adequately.

19. Recently I had a good discussion with Harvard Prof Clayton Christensen who has been writing about disruptive innovation for years. I share his view that more of the same will not do. We need to find new, innovative, creative way to solve the huge challenges ahead of us.  Prof Christensen advocated the need to segment different parts of healthcare to address the different problems differently. A one-size-fits-all model where a hospital tries to do everything for every patient is not a viable model. Interestingly, many of my colleagues and I have arrived at the same conclusion as Prof Christensen.  In recent years, I have encouraged my colleagues to innovate and try different models of care to address the different needs of the chronic sick and the aged.  Applying the acute hospital care model for them will not be satisfactory for the patients.

20. For example, with the latest hospital that we are building, the Khoo Teck Puat Hospital (KTPH), I have asked the planning team to totally re-examine our assumptions and build a hospital unlike any. The team has planned for a smaller hospital (550 bed instead of 800 bed we have typically built) to focus on "fast medicine". The aim is to diagnose and treat patients with acute needs effectively, efficiently and quickly.

21. At the same time, we are planning a new breed of community hospital to specifically address the needs of the older patients. To be located next to KTPH, the new facilities will be designed to handle "slow medicine" from wellness programme for the elderly to geriatric assessment and treatment to end of life care.  

22. We are also re-looking at nursing homes, home care and other community services. We will leave no stone unturned to make health care better, faster, cheaper and safer for our people.

Conclusion

23. This is a brief historical perspective to health care development in Singapore. We have chosen a path that has largely met the past and present health care needs of our people. We are now planning ahead to be ready for the future.

24. I hope you will take time off to visit our healthcare facilities. We welcome your suggestions on how we can further improve.

***************

End