SPEECH BY MINISTER GAN KIM YONG AT THE ECONOMIST “HEALTHCARE IN ASIA 2014” CONFERENCE 20 MARCH 2014

Excellencies,

Distinguished Guests,

Ladies and Gentlemen,

Good morning to all. It is indeed my great pleasure to join you this morning at the Economist “Healthcare in Asia 2014” conference. First let me extend a warm welcome to our overseas delegates and speakers.

The Diversity of the Asian Healthcare Landscape

2.            Asia is a populous and diverse continent.  It has close to 50 countries and an abundance of ethnic groups. It is home to 60% of the world’s population.  Asian societies are in various stages of development.  While each has made strides in improving their healthcare systems over the last decade, all of us face challenges at home.

3.            Take Japan as an example.  Its life expectancy is the highest in the world, and its population is also amongst the healthiest, with the lowest mortality rate due to non-communicable diseases in the world.  Despite its more aged population, it has achieved admirable healthcare outcomes with just 8.5% of its GDP, slightly below the OECD average.  While it has done well so far, the continued greying of its population poses continued challenges for the country. There is one in four Japanese over the age of 65 now, but 40% of the population will be over the age of 65 in 2050. A study by McKinsey warned that Japan’s healthcare’s share of GDP could double by 2035, and without reform, the healthcare system would struggle to cope with the burden of its ageing population and may not be sustainable.

4.            India, on the other hand, has a young population, with a median age of 28.  With a large, 450 million strong workforce accounting for almost two-thirds of its population, and growing, it can expect to reap significant demographic dividends for many more years to come.  Its key healthcare challenges today relate largely to expanding capacity to support its rapidly growing population, and making further investments in public health programmes, to enhance access to safe drinking water, sanitation, nutrition, and vaccination.

5.            This is the diversity in Asia, which, in my view, is also our strength.  The diversity means that we can learn from one another within Asia.  Forums like this conference help to facilitate rich and active exchange amongst academics, professionals, policy makers, and government leaders from across Asia.  Asia’s diversity also forces policy makers and government leaders to always be conscious of the differences between societies, learn from these differences, and contextualise the learnings to our own healthcare systems.

Singapore’s Challenges

6.            Over here in Singapore, our population is ageing rapidly. Today, 1 in 12 Singaporean residents are aged 65 and above. By 2030, just 15 years from now, the figure would be 1 in 5, very much like what Japan is today.  This is four times faster than the global rate of ageing in developed countries. Healthcare demand will rise, as our elderly are about four times more likely to be hospitalised.  The chronic disease burden will also rise rapidly, as the elderly are likely to suffer from such chronic, age-related conditions, such as cancer, osteoarthritis, diabetes, cardiovascular diseases, and dementia.  We also see the cost of healthcare delivery rising rapidly, because of the rising demand driven by an ageing population, and advancements in medical technologies.

7.            These developments – an ageing population, rising chronic disease burden and medical advances – have led us to transform our healthcare system, which was built for a much younger population.  We will need to build on the existing healthcare system, and optimise it to meet our needs, going forward.

Lessons from Asia

8.            Fortunately, Singapore is not alone in attempting to transform our model of healthcare to better support an ageing population and ensure good and effective patient outcomes.  Japan started to tackle these challenges nearly two decades ago, with Hong Kong, Taiwan, and South Korea following suit in recent years.  Allow me to share a few lessons we have learnt from our Asian neighbours.

Strengthening Care for the Elderly

9.            First is Japan. Japan has many well-developed residential care facilities, which cater to the diverse needs and means of the elderly.  Some facilities are more upmarket and privately operated, while others are sited within, and are run by local communities.  In addition to existing residential care facilities, Japan is also developing other residential care models for seniors with lower care needs such as “housing plus care” or “retirement villages”, which cater to the elderly who desire independent living while being cared for holistically.

10.         Hong Kong has a wide spectrum of subsidised healthcare services to support the elderly with varying degrees of need, provided by both the Government and voluntary welfare organisations.  These include residential care facilities, which help to care for the elderly who suffer from poor health and severe to moderate impairment.  More recently, Hong Kong has started to enhance home care and community support services, from home care services, to day care centres and social centres for the elderly.  This has helped to ease the demand for residential care.

11.         Japan and Hong Kong have taught Singapore that seniors will require different levels and amounts of care as they age and their circumstances change.  To prepare for the growing number of elderly, we have been building more nursing homes, senior care centres, and senior activity centres within residential estates.  We are also similarly making significant investments in home care.  Collectively, these facilities and services will help support and care for the elderly more effectively, and allow them to age gracefully within their homes and communities.

Encouraging Informal Care & Family Support

12.         In many Asian societies, there is great value placed on caring for our own aged parents, and many children have a strong sense of responsibility and desire in supporting and caring for their parents in their old age.  Some societies have even enshrined this in their constitutions and laws.  For example, the Chinese Constitution states that “children who have come of age have the duty to support and assist their parents”. Filial support laws also exist in India and Singapore.

13.         No matter how much the government and policymakers work to improve services for the elderly, nothing can replace the care and concern of one’s own family.  Many Asian societies, including Singapore, emphasize the role of the family, alongside the government and community, in caring for the elderly.  But as families become smaller, more elderly being single, and life expectancy rises, children in their 60s and even 70s may still have to care for their very aged parents in their 80s and 90s.  Hence, society and community may have no choice but to shoulder a greater burden in caring for our elderly. 

14.         We need to encourage, recognise, and support children in caring for their parents.  This includes providing better training for caregivers, providing caregiver-support through home and community-based care services, extending emotional support through counselling, and providing respite care services.

Affordable Care & Peace of Mind Amid Rising Costs

15.         Singapore has achieved good access and quality of care for all Singaporeans, at 4% of our GDP.  Services at the public sector institutions are heavily subsidised, and available to all Singaporeans.  There is also Medisave, MediShield and Medifund – our 3Ms – to help with the remaining co-payment, according to the ability of the patient to pay. 

16.         But we can do more to give Singaporeans, especially older and lower-income Singaporeans, a better peace-of-mind over rising healthcare costs through greater collective responsibility. By expanding Singapore’s national health insurance scheme, MediShield, to cover all Singaporeans, regardless of their age, health, or financial circumstances, all Singaporeans will be assured that they and their loved ones will always enjoy protection against large healthcare bills, in addition to existing safety nets. We are going to introduce MediShield Life to provide coverage for all Singaporeans for life.

17.         As we expand the coverage of MediShield, we will extend greater support to help middle- and lower-income Singaporeans pay for their premiums through means-tested subsidies and transfers.

18.         As we enhance our healthcare financing system, sustainability must also be considered.  We must guard against overconsumption as we and our children will eventually bear the cost.  I am glad that many experts and policymakers agree with us that co-payments are integral in any healthcare financing system to avoid overconsumption.  The challenge is calibrating it right, enough to curb overconsumption, while not too much, to ensure it remains affordable.  

What’s Next for Asia?

19.         Even as we learn from one another, we need to keep our eyes on the horizon for emerging challenges and opportunities.  Developing Asian societies will need to invest further in their healthcare systems, to build a strong health system staffed by well-trained healthcare workers, and supported by a sustainable healthcare financing system which ensures that their people can afford healthcare while also driving efficiency in the use of healthcare resources.

20.         Developed Asian societies which are ageing will need to find new ways to meet the rising healthcare and social needs of their elderly which guard against healthcare inflation.  These societies will need to adopt healthcare technologies in a big way, and fundamentally re-think the role of technology and human contact in the delivery of health and social care. 

21.         Healthcare systems may also need to re-think the roles of healthcare workers and patients, to support patients to administer care themselves, where it is safe to do so.  An example of this is a self-dialysis programme in a county hospital in southern Sweden, where nurses have transitioned 60% of its peritoneal and haemodialysis patients to a self-management programme. Under the programme, patients operate the dialysis machine, interpret lab values, and document their own care on a report form themselves.  The initiative has allowed patients to play an active role in their treatment, which resulted in increased compliance, lower costs, and better outcomes

22.         An affluent and ageing Asia presents numerous opportunities for businesses to invest in and capitalise on the silver industry.  These include healthcare services, the insurance industry, elderly-friendly travel, and elderly-friendly technology products and services, such as senior-friendly cell phones and online shopping.

Conclusion

23.         Singapore’s healthcare system is fundamentally sound.  We are not perfect. There is room for improvement. It has delivered good care outcomes, and has kept Singaporeans healthy at a relatively low cost. We will continue to improve. We have learnt many useful lessons from our Asian neighbours on how we can strengthen the foundations of our healthcare system to help our seniors live healthy and fulfilling lives.

24.         For this reason, I am glad that discussions at Healthcare in Asia 2014 will focus on the question “What can Asian countries teach each other?”.  Asia is a diverse continent with many lessons to offer, and Asians need only to look in our own backyards for novel healthcare solutions so we can help improve our own health systems back home.

25.         I wish you all a fruitful conference.