MOH Budget Speech (Part 3) - The elderly chronic sick

07 Mar 2006

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health

Venue: Parliament

"The elderly chronic sick"

1 I thank Dr Chong Weng Chiew, Mr Ang Mong Seng, Dr Tan Cheng Bok and Dr Tan Sze Wee for their questions and comments.

Ageing and the Community

2 We are an ageing population. There are about 300,000 senior citizens in Singapore. They form 9% of our citizens. Singaporeans are living longer and healthier lives than ever before. These improvements in life expectancy and freedom from disease for most of an average person's life are an achievement that our healthcare system can be proud of.

3 But this has created new challenges. A good proportion of the elderly will develop a chronic illness in the last phase of their lives. 85% of the elderly will have one or more chronic illnesses that requires life-long treatment. Some will develop disabilities that require daily assistance. At any one time, 5 to 10% of the elderly population will need help with their personal care and the activities of daily living.

4 The historical focus of healthcare systems - which is to manage episodes of acute illness with intensive treatment - is not well-suited to manage the medical problems of the elderly. The elderly usually need continuous low intensity medical or nursing care to manage their chronic illness and to enable them to live good quality lives even if they have an age-related disability. If this can be provided in an efficient manner away from hospitals and nursing homes, they can enjoy a higher quality of life. We must focus our health services to bring care as close to the home setting as possible. This needs a mindset change on the part of everyone - healthcare providers, patients and their families.

5 The Committee on Ageing Issues in its report has recommended that the government adopt a holistic family practitioner approach towards managing the healthcare needs of senior citizens. Over the next decade, our healthcare system will evolve in this direction.

6 Dr Chong Weng Chiew has pointed out the benefits of bringing medical care closer to the elderly and asked about subsidies for mobile healthcare and home therapy. We should consider this. Subsidies that today channel the elderly to hospitals should be re-chanelled to keep the elderly chronic sick at home. Providing for subsidised home therapy for the needy elderly is one way, as was also suggested by Dr Lily Neo.

7 The Ministry of Health launched the Primary Care Partnership Scheme (PCPS) in 2000, to help bring affordable healthcare as close to the doorstep of the needy elderly as possible. Instead of having needy elderly patients travel to polyclinics, this scheme engages neighbourhood GPs to provide common outpatient medical services conveniently for acute medical conditions, and at polyclinic prices.

8 This is a start. We will study our experience with the PCPS scheme and expand the program to manage chronic illness in the elderly in line with the recommendations of the Committee on Ageing Issues.

9 To bring therapy and care closer to home, MOH together with MCYS intends to partner the private and people sectors to develop a range of community-based nursing services and personal care services. In addition, we will enhance case management services in the community through tighter integration between the acute and step-down care facilities.

Application for Financial Assistance

10 Mr Ang Mong Seng asked about automating the application of financial assistance for the elderly and the needy. I too have seen such cases in my constituency. Very often, they have not spoken to the Medical Social Workers. This is because they get the final bill upon discharge, which means that our hospitals treat all patients regardless of their ability to pay.

11 Today, all public sector hospitals, national centres and polyclinics have Medical Social Workers (MSWs) on staff. An estimated total of 140 MSWs help look after the social and financial needs of patients. They help administer Medifund, the Government's safety net to help those Singaporeans who, despite Government subsidies, MediShield and Medisave coverage, are still unable to pay the balance of their bills.

Gerontological Education

12 Dr Tan Cheng Bock and Dr Tan Sze Wee asked about the promotion of gerontological education in Singapore. This is in support of the proposal in the recent open letter from SAGE (Singapore Action Group of Elders).

13 I would go one step further. With an ageing population, it may not be appropriate to consider gerontology as a specialised area for a select group of healthcare and welfare workers. The elderly population are the major consumers of medical and welfare services. In some developed countries, more than 50% of government healthcare expenditure is directed towards the elderly. With care for the elderly becoming such a major part of medical and welfare services, gerontology, or the holistic study of the elderly has to be part of the core education of a doctor, nurse, social worker or anyone else in the medical and social services field of study.

14 Three university professors in their private capacity supported the SAGE initiative. I encourage these professors to don their university caps and in their professional capacity as professors in the University responsible for the education of our future doctors and social workers, promote gerontology as part of the mainstream university core curriculum in their respective faculties.

15 MOH, for its part, will be doing more to promote gerontological education. Most geriatricians currently work in acute care hospitals. But if the elderly are to be looked after in the community, then geriatric skills must reside in the doctors looking after patients in the community. That means family practitioners must practise community geriatrics. MOH will facilitate Continuing Medical Education (CME) courses that will equip GPs with the knowledge skills needed to function as community geriatricians.

16 Ageing issues are complex and must be tackled through an integrated and holistic approach involving Government, community agencies and the private sector. Much progress has been made in the last several years, though more remains to be done. Going forth, the collective will and effort of all sectors - the public, private and people sectors, will contribute towards achieving "Successful Ageing for Singapore".