Speech by Dr Lam Pin Min, Minister of State for Health, at the opening ceremony of the 10th Asia Pacific Congress in Maternal Fetal Medicine on Friday, 22 Aug 2014

Dr Tony Tan, President of OGSS and co-chairman of the 10^th Asia Pacific Congress in Maternal Fetal Medicine

Professor Leung Tak Yeung, co-chairman of 10^th Asia Pacific Congress in Maternal Fetal Medicine

Prof Sabaratnam Arulkumaran, President of the International Federation of Obstetrics and Gynaecology (FIGO)

Distinguished Speakers and Chairpersons, 

Members of the O&G profession

Introduction

1.            Good afternoon to all of you. It gives me great pleasure to join you today for the official opening ceremony of the 10th Asia Pacific Congress in Maternal Fetal Medicine (APCMFM).

2.            This important Congress has gathered doctors and healthcare professionals from many countries to share and learn about improving fetal and maternal medical care for the patients. For the overseas participants with us today, a warm welcome to Singapore.  I do hope that you will find some time amidst your busy conference schedule to explore and visit our beautiful island country.

Advances in Maternal Fetal Medicine

3.            Singapore’s good obstetric and perinatal care has contributed to the decline in our neonatal and perinatal mortality rates. The maternal mortality rate (MMR) in Singapore, at 2.5 per 100,000 live and still births last year, and our infant mortality rate of 2.0 per 1000 resident live births, are amongst the lowest in the world.  This makes Singapore one of the safest places in the world in which to be a mother. These achievements are a testament to our dedicated and well-trained professionals and good medical facilities.

4.            The practice of obstetrics has evolved from the focus on safe delivery for the mother and child, and the management of labour-related complications to more advanced medical care for both the mother and the foetus during the pregnancy itself, through the continuously advancing fields of fetal and maternal medicine.

5.            In the public hospitals, our obstetricians work closely with the various medical specialists in the management of high-risk pregnancies such as gestational diabetes, pre-eclampsia and underlying cardiac diseases. Advancement in research has also enabled us to manage them better. In January this year, the National Medical Research Council (NMRC) awarded a $25 million grant to further understand the impact of maternal health on the offspring's growth and development. One of the components of the project, ‘Growing Up in Singapore Towards Health Outcomes’, more commonly known as GUSTO, has established one of the most intensively studied birth cohorts in the world. The analysis has shown that what goes on during pregnancy can affect the subsequent growth and development of the child. This can potentially impact future clinical guidelines on maternal care.

6.            In the field of fetal medicine, with improved ultrasound resolution, some structural abnormalities can be detected earlier in the First rather than Second Trimester. Furthermore, advancement in ultrasound expertise has expanded the use of these scans to also screen for other pregnancy-related problems. For example, there is research ongoing to use ultrasound in the Third Trimester to identify late-onset intrauterine growth restriction in foetuses, where an earlier delivery might reduce the risks of stillbirth.

7.            Another advancement is in the area of non-invasive prenatal testing. It is a new option in prenatal screening for common genetic disorders. This involves a simple blood sample taken from the mother, which is sent to the laboratory for analysis to determine any genetic disorders in the fetus.  It is done after 10 weeks into the pregnancy, which is earlier than most prenatal screening or diagnostic tests. Studies have shown that it is more accurate with a low false positive rate, compared to the current routine blood tests and ultrasound scan.

Ensuring sustainable healthcare spending

8.            Therefore, advances in science and medical technology will open up new possibilities for patient care.  Some of the new inventions may become the standard of care in future, as say, ultrasound scans for checking on fetal abnormalities have.  Yet others may be found to be less effective or not cost-effective to be used on a large scale. The value of health technology is maximised when it is used for the right patient in the right way in clinical practice.

9.            In public sector hospitals, we encourage the use of drugs which have proven clinical efficacy and cost effectiveness, and we subsidise them. Given the large number of medical devices being introduced into Singapore each year, the Ministry of Health (MOH) has also introduced a similar Health Technology Assessment process for medical devices and implants to ensure they are both clinically- and cost-effective.  MOH is also working with the public hospitals to set up Medical Device Committees to ensure rational selection and utilisation of new medical devices, similar to the existing Pharmaceutical & Therapeutics Committees for drugs.

10.         Rising healthcare costs, due to medical inflation and other reasons, will always be a concern to the public. Several letters in the forum pages of our main newspapers from medical professionals as well as patients have also raised concerns on the impact on healthcare costs due to the way some doctors practise and charge for their services. All of them meant well as most, if not all doctors, are concerened about the nobility and reputation of the profession.

11.         The recent public feedback has reminded us that, as members of a respected profession, doctors are expected to adhere to the highest standard of professionalism and always act in the best interest of the patient.  The Singapore Medical Council’s Ethical Code and Ethical Guidelines state that the doctor cannot abuse the doctor-patient relationship for personal gain. This means that a doctor shall not let financial considerations imposed by his own practice, investments or financial arrangements influence the objectivity of his clinical judgement in the treatment of his patients. A doctor shall refrain from improperly obtaining fees from patients, improperly prescribing drugs or appliances in which he has a financial interest and fee sharing or obtaining commissions from referral of patients.  I am confident that the vast majority of our doctors do observe these codes and guidelines closely. The Review Committee set up by the Singapore Medical Council raised the issue of determining ethical and reasonable medical fees. To reflect changes in technology, practice patterns, societal norms and expectations, a consultation paper to review the ethical and professional conduct framework is being prepared and will be sent to all SMC registered medical practitioners for their inputs.

12.         The Ministry of Health is also reviewing how best to provide more useful information for patients and the medical fraternity.  We are enhancing information transparency, to help Singaporeans make more informed choices.  Since 2003, MOH has been publishing total hospital bill sizes for common conditions in both public and private hospitals.  We intend to go further.  From next month, MOH will publish on its website the ‘Total Operation Fees’, which is a component of the total hospital bill comprising the ‘Surgeon Fee’, ‘Anaesthetist Fee’ and ‘Facility Fee’ in our public hospitals.  In public hospitals, as most doctors are paid a salary by the hospitals, there is no direct link between the Total Operation Fee and doctors’ salaries.  Therefore, the data will not be further broken down into the various components, including what would have been called “doctors’ fees” in the private sector. Nevertheless, publishing such data for both unsubsidised and subsidised patients in our public hospitals will serve as a useful point of reference on procedure-related professional fees which are applicable to both public and private sector healthcare providers.  MOH will continue to work to extend transparency of healthcare charges to facilitate informed decision-making by patients.

Conclusion

13.         In closing, I am glad that the good work done by societies such as the Obstetrical and Gynaecological Society of Singapore (OGSS) in continuing medical education and organising international and regional O&G conferences such as this, which enable O&G professionals to keep up-to-date with the latest developments in the sector. I wish you all a very successful conference.  Thank you.