MOH Budget Speech 2005 (Part 4)

09 Mar 2005

By Mohamad Maliki Bin Osman, Parliamentary Secretary For Health

Venue: Parliament

Speech By Dr Mohamad Maliki Osman, Parliamentary Secretary For Health

Sir, I thank Dr Lily Neo and Dr Chong Weng Chiew for sharing their views and concerns. I agree there are immense challenges in transforming our health care sector and in ensuring more efficient use of resources and more effective delivery of services. The MPs have highlighted the importance of a multi-pronged and seamless approach for public health policies and programmes, from prevention to health services for the needy.

CONNECTING THE COMMUNITY - A CHALLENGE FOR HEALTH CARE DELIVERY

Today, the health care service delivery in both private and public sectors remains fragmented. This lack of integration gives rise to disconnects in service delivery and sub-optimal health care outcomes. Except within small groupings of providers, there is little sharing of critical information when a patient moves from one provider to another. To compound the issue, as discussed yesterday in this House, we continue to be concerned with chronic diseases such as diabetes, hypertension and heart disease, each of which can cause significant health and financial burden.

Tremendous effort lies ahead of us, and to date the progress has been slow. The technology needed to link up different health care providers has existed for many years, yet very few if any providers have taken the initiative to come together. Why is this so? Many chronic diseases can be detected early and actions taken to prevent their deterioration. Prevention or delayed onset of such diseases will help individuals achieve a higher quality of life, as well as lower health care costs.

We need to address this more systematically. To have better disease management and proper care for the chronically-ill, it is crucial that we continue to transform our health care delivery system innovatively on various fronts. More of the same is certainly not sustainable. With the advice and wisdom from our MPs who understand the issues on the ground, we are confident that these problems can be overcome.

To facilitate this journey of change, the Health.connect concept that was mentioned in this House last year has now been fleshed out in more detail and piloted in Jurong since July 2004. Jurong Health.connect is an initiative that MPs like Mdm Halimah, Dr Tan Cheng Bock, Dr Lily Neo and Mr Ahmad Khalis are actively involved in, with strong backing by Mr Lim Boon Heng. This is not an easy pioneering effort. Jurong Health.connect requires active support to integrate health care services across both public and private health care sectors, across hospital and step-down care, across carers and patients. When completed, it will deliver holistic care from all providers working as a team, with Electronic Medical Records as the backbone.

PREVENTIVE HEALTH CARE

Health Screening

Let me start with the first transformation needed, in preventive healthcare. One key to a successful health care system is the early detection of diseases. Thus a primary component of Health.connect is health screening. Today, we have many players who reach out to different subsets of the community for health screening, under programmes like Check Your Health, NKF screenings and ad-hoc outreach projects conducted by NGOs and religious groups. The GPs and polyclinics also conduct opportunistic screenings for their patients.

Unfortunately, there is no consistent health screening standard that these providers adopt - resulting in disparate datasets that are not effectively merged for useful analysis. Follow-up for those who require further attention is not systematically monitored. Jurong Health.connect is moving forward in this regard with various providers agreeing on a standard screening approach. The call centre under the Health.connect framework will reach out to those identified as needing further attention, allowing early intervention to manage the disease. Since the launch of the call centre hotline and website in mid-Oct 2004, it has fielded 101 calls, with 36 referrals generated. Cases helped by JHC include: (i) a woman who obtained a referral for a home nursing service for her 100-year-old mother recently discharged from hospital; (ii) another woman who obtained information on services for her mentally-disadvantaged uncle. JHC is gradually building up a network, one step at a time, to link up health care providers in the area.

While we applaud the move towards better co-ordination of early screening, it remains a great challenge. Although the government keeps the cost of screening affordable, we need more Singaporeans to be forthcoming.

For example, a few years ago when a Community Health Screening Programme was launched to detect diabetes, hypertension and high cholesterol at minimal charge, only a quarter of the target group turned up. The situation has now improved for ad-hoc screening programmes with larger numbers turning up, but not regular periodic screening.

The feedback from our health care providers and partners is that people still do not realize the importance of regular check-ups or of follow-up after an initial diagnosed medical condition. Singaporeans must do their part in preventive health care.

Healthy Lifestyle

On a broader level, preventive healthcare is about healthy living. MOH and the Health Promotion Board actively encourage Singaporeans to lead healthy lifestyles, so that they remain healthy and disease-free for as long as possible.

Promoting healthy lifestyle requires a multi-pronged approach to reach out to different segments of our population, such as school children, working adults and the elderly.

With a significant proportion of our population being working adults, employers have an important role to play. In 2003, the National Workplace Health Promotion Survey showed that 86% of the Singapore workforce had access to a comprehensive Workplace Health Promotion (WHP) programme. We hope they capitalize on the opportunities presented.

International studies show that adopting a healthy lifestyle can significantly reduce the risk of chronic diseases. It will also significantly reduce the individual's health care spending. Research in the US found that health care spending for obese Americans accounted for 27% of the growth of overall health spending, and health cost incurred by the obese was 37% higher than that for people of normal weight.

Preliminary results from our latest National Health Survey in 2004 show that Singaporeans are exercising more and smoking less. 24% of adult Singaporeans now exercise regularly, up from 17% during the previous survey. The proportion of smokers has fallen from 15% in 1998 to 13%, although there is a worrying prevalence of young female smokers. Singaporeans with diabetes declined from 9% to 8%, with high blood pressure from 22% to 20%, and with high blood cholesterol from 25% to 19%. These figures are indeed encouraging, but whether this improvement is sustainable remains to be seen. We will however, continue our efforts at encouraging Singaporeans to remain healthy.

HEALTH CARE FOR THE ELDERLY

Sir, Dr Lily Neo has raised some pertinent concerns with regard to the elderly population. I thank her for being a constant voice for our senior citizens and constantly reminding us of the plight of this group of Singaporeans. We acknowledge that as our society ages, more effort will have to be put in place to meet the health care needs of the population.

We have put in place an active programme of primary prevention and early detection and management of chronic diseases like hypertension and diabetes for Singaporeans at large, and in particular for the elderly.

I mentioned the HPB's "Check Your Health" and other community health screening programmes, which is being enhanced to encourage more participation by the elderly. The cost is kept affordable, and the screenings are conducted on Sundays in HDB town centres to increase accessibility to the public and the elderly. Where possible, the elderly are personally invited to undergo screening.

For those elderly who have acute medical conditions, our polyclinics and hospitals are able to treat them at affordable cost. We have set up the Integrated Care Services (ICS) since 2001, to ensure the proper discharge and post-hospitalisation handling of elderly patients and that they are able to access long-term care if required. To date, there have been 7,000 referrals, 70% of which were placed in nursing homes. The remaining cases either had families which found alternative arrangements, were not suitable for nursing homes, or subsequently passed away.

The elderly who require step-down care can access a comprehensive range of institutional and community step-down facilities [community hospitals, nursing homes, day rehabilitation services and home medical/nursing services] which are subsidised by the Ministry. The ICS has been effective in reducing the waiting time for nursing homes, from 3 months to 2 weeks . MOH is working to improve referrals to day rehabilitation centres and other community facilities through further publicity with public hospitals as well as community referral mechanism like the JHC. We will continuously review our processes to ensure that the movement of patients from acute hospitals to step down facilities is quick and smooth for patients and their families.

The provision of health care services in an ageing population will continue to be a challenge for us. MOH is working with its partners, including agencies like MCYS, People's Association, the Singapore Sports Council, VWOs, CDCs and other community organisations, to look after the health of elderly Singaporeans. We will continue to monitor the adequacy and effectiveness of elderly care facilities.

Ageing Issues - A Collaborative Effort by Multiple Agencies

The above and other inter-agency ageing issues are discussed through the key platform of the Committee on Aging Issues, co-chaired by SMS Balaji and myself. Recognizing the multifaceted nature of aging issues, this committee comprises relevant agencies such as MCYS, MOH, MND, MOT and MOF, as well as the people sector. To date, a sizeable number of ideas are being discussed for testing. The committee is also currently deliberating on the Eldercare Master Plan for the next 5 years. Health care is one main issue affecting the elderly which the Committee will monitor closely and provide further recommendations to ensure the health care concerns of the elderly population are addressed.

Home Care / Home Therapy

Dr Chong Weng Chiew raised the issue of home rehabilitation services for homebound patients. Indeed, we are keen to ensure that the elderly are placed with their family and within the community as far as possible. This ensures that the primary responsibility of the family is not compromised.

Today, MOH is already subsidizing a range of home care and day rehabilitation services for the elderly who live in their own homes. The subsidies cover: (a) home medical and home nursing services by 14 VWOs; and (b) 27 day rehabilitation centres and therapy services, many located in HDB void decks. In addition, the current capacity of existing services for the elderly can be stretched. For example, the day rehab centres can be further utilized, as current usage is about 63%.

Our low-income elderly patients today already have access to subsidized rehabilitation, therapy and home care services in the community. We are assessing the availability and cost effectiveness of alternative services in the community; as well as the level of need in the community. A service like home therapy requires one-to-one despatch of a therapist to a patient's home to provide rehabilitation services and comes at significant cost, and because of high subsidies required is not sustainable.

The Ministry is aware of Dr Chong's point that there are some elderly patients in need of rehabilitation who have problems travelling to day rehab centres. Today, there are a small number of private and non-government organisations, with some private foundation support, which offer home therapy. Some home nurses and therapists help develop home exercise programmes or train family members and caregivers to give simple physiotherapy for these elderly disabled until they can be brought to day rehab centres for therapy. We will monitor the current situation.

MOVING FORWARD WITH HEALTH.CONNECT - SEAMLESS HEALTH CARE FOR OUR COMMUNITY

Sir, the health care system is indeed a complex issue with many dimensions - quality of service, efficiency, cost to name just a few. The solution is not simply to build more hospitals and clinics or to keep on expanding existing services.

We believe that making the system work, requires the co-operation of all the stakeholders - the government, health care providers, and the people. The government has put in preventive programmes including screening, and is investing in more public education which promotes a healthy lifestyle. Singaporeans must take ownership for their well-being and go for regular screening and any necessary follow-ups.

Health.connect is an innovative experiment towards achieving seamless health care for our community - the issue that Dr Lily Neo raised. Health screening is an important step under Health.connect, but it is just a 1st step. Those patients who need acute treatment will enjoy seamless access to an appropriate treatment centre or hospital, accessed within the community as far as possible. Once discharged, Health.connect will facilitate the return and re-integration of these patients into the community through step-down facilities, including home medical and nursing care.

The small steps we take with Jurong today will one day lead us to a new model of health care delivery for Singapore. It will not be an easy journey. If successful, we may eventually have one nation-wide Health.connect which integrates and delivers health care to all Singaporeans who require it. Certainly for this to materialize, every stakeholder must play his part.