Speech by Mr Chee Hong Tat, Minister of State for Health, at The Good Life Co-operative Conference, 10 June

Long-term Affordable Healthcare for All

Ladies and gentlemen, members of the Organising Committee

Good Morning

1             I would first like to thank Dr Carol Tan and her team for organising today’s Good Life Co-operative conference, and bringing together the different partners in our healthcare system to discuss this important topic of building a more sustainable healthcare ecosystem.

Improving Accessibility, Affordability and Quality in Healthcare

2             Why is healthy eating an important part of what we want to achieve? It’s because as we all know, prevention is better than cure. I fully agree with Carol that we are going to have higher demand for healthcare services as our population ages. It is to be expected. But how we age will make a difference. We can’t stop ageing but we can age healthily, and actively, age well, lead a good life, a carefree life, or we can age without a good quality of life. Part of it is also dependent on what lifestyle we choose for ourselves, and the system we have to support our seniors so that they can age gracefully.

3             One of the priorities we will be focusing on going forward will be moving beyond healthcare to health promotion. We are the Ministry of Health, not Ministry of Illness. We should not be focusing mainly on treating people when they are ill, but how to help people to stay healthy as much as possible. At the same time, we accept that even if we stay healthy, lead a healthy lifestyle, we do still fall sick and require hospital services. As we grow old, we require primary care, hospital care, long term care, so we should also pay attention to the ecosystem beyond promoting good health. 

4             How do we move beyond hospitals and send healthcare services into the community? The partners we can work with will be the primary care providers, our GPs, polyclinics.  As for hospitals, we are trying to build more community hospitals beyond acute hospitals, some are run by the public sector.  I have visited various hospitals and I am impressed by some of our VWO-run hospitals. Very often, because of the mission and the values that they hold, the ability to be able to bring together support from volunteers, donors, it brings together a very good value proposition, that will serve the needs of our patients well. Among the things that have impressed me, when I visited these hospitals, is the ethos and values. They are very dedicated and focused on doing what is right for the patients. And one of the key is also to keep healthcare cost affordable. This is part and parcel of what gives patients greater peace of mind and assurance.

5             At the systems level, we have been increasing healthcare capacity, building more hospitals, Ng Teng Fong Hospital just came up, Seng Kang is the next one, after that Woodlands, community hospitals as well, Jurong Community Hospital, Yishun Community Hospital. We are also hiring more healthcare workers to meet higher demand with an ageing population, we need to have enough people to look after our patients.

6             If we continue business as usual, this trajectory is unsustainable. We cannot afford to keep building more hospitals and hiring more healthcare workers in the same manner, operating the current business model, the current care models, we are going to run out of people. Our population is ageing, our Singapore workforce by 2020 will hit a plateau and the total number of Singaporean workers will start to go down after that.

7             So if we don’t change our care models, if we don’t focus on improving productivity, if we don’t look at how we can transform our healthcare beyond hospitals and into the community, and improving the sustainability of our system, I think we will be in trouble. Not just the Ministry of Health that will be in trouble, but all of us, as Singaporeans, will be in trouble.  Because at the end of the day, all of us will have to pay for the cost increases, through medical fees, insurance premiums, or taxation, one way or another, the cost of an expensive healthcare system will be borne by everyone in the system. So, it is in our collective interest to work together to make sure that we are able to succeed in transforming our healthcare sector, in promoting better health for the population, in thinking about how to improve sustainability and productivity, so that we are able to collectively keep our healthcare system affordable and sustainable for all Singaporeans and for our future generations.

8             Please allow me to comment on a few points that Carol shared in her presentation. First, she did a comparison among countries and if you look at the numbers, I think one of the things that stood out in the slides, was that US has a very high percentage of overall GDP spent on healthcare. We also see how other countries have done better, perhaps even with older populations. So, I think it’s important for us to learn from what other countries have gone through, don’t have to repeat the mistakes that other people have made, pick up good practices and good policies, and see how we can bring some of these to Singapore. One critical area is data because without data you are not only feeling different parts of the elephant, you may not even know there is an elephant in the room.  And the danger is that you want to shoot ducks, you need to know where the ducks are, but without data, you are shooting blind. I don’t think today we are starting from zero, we have some data, on fees and statistics, but these are not enough. This is an area where we should work closely with our industry partners, our insurance companies, work closely with our community partners, and try to see how we can share more data to help people to make comparisons, make decisions and to identify where are the areas for improvement and where are the gaps.

9             We may be constrained by certain existing system difficulties. Our healthcare system is actually quite fragmented even among the public hospitals. Not all of them use the same IT systems. When I came to MOH that was something which hit me quite quickly. Different hospitals, different practices, sometimes I think some of these local customisations may be going overboard. It is not about being autocratic, but about having a comparable and standard set of system specifications, so that the systems can talk to one another, data is comparable and we could make sense of all the data sources that we collect from different parts of the ecosystem.

10         These are different players that we can bring together to share data and where data sharing is of mutual benefit. We need to think this through, both in terms of safeguards to protect confidentiality but anonymizing data will help improve decision making and planning. I think that is something worthwhile for us to focus on together. That will help the objective of achieving a more sustainable healthcare system. 

11         The second area which Carol mentioned was cutting waste, whether it is inefficiencies, redundant procedures, excessive form filling - I hear from the nurses that they often need to fill in multiple forms. I don’t know why that is the case. Maybe over time, we are very good at adding new requirements but not so good at removing outdated and obsolete requirements. In Singapore, sometimes people say this is called “kiasu”, because adding will not invite audit queries but if we remove and something happens, there may be an audit query. I think we need to break free from this kind of “kiasu” mentality. It’s about at the end of the day, not increasing the administrative burden that will take away time and resources from our healthcare professionals, to focus on the core mission which is to look after patients, to care for patients.

12         There is also scope for us to look at procedure or administrative burden, how to remove unnecessary and redundant steps. Let me share an example, recently I was visiting one of the institutions and patients would do a blood test and the armrest which the patient would put their arms on – in the past, they will clean the armrest in between patients, that means after a patient has left, before the next patient comes, they will clean the armrest so that it is ready by the time the second patient arrives. However, they changed the procedure one day to clean the armrest in front of the second patient to prove that they have cleaned the armrest. So, they will wait for the second patient to come and to clean the armrest in front of the patient. After they are done cleaning, the patient must wait for it to dry. All that waiting time, who benefits? Nobody benefits. Now, if it adds to the safety outcomes, I don’t mind. But how does cleaning in front of people, compared to cleaning it before the patient arrives improve safety? We should be prepared to question the value and the purpose of existing rules and requirements. If we need to change, we change. As a system, we should be prepared to revisit and question some of our existing practices with the objective of providing good quality care, which is affordable and sustainable.

13         Another area is that we must also be aware of the developments in other sectors. Healthcare is not static, there will be new technologies that will come in, and there will be new business models. She mentioned about third party agents. I don’t know enough to comment on that specifically.  But if it doesn’t add value and it’s just a parasitic activity, it just adds on to cost, and it doesn’t add any value, we should not allow it. Who will pay in the end? The doctors will charge the patients in the end. The patients will pay.  It goes back to what I mentioned earlier.  Ultimately, if the system has inefficiencies, if the system has wastage, if the system is more expensive than necessary, the cost will eventually be borne by all of us.

14         We need to look at when a new technology comes in, a new drug comes in, to strike a balance. The most expensive technology or drug is not necessarily the best way to treat our patients. There is a need to have a professional assessment on this in a rigorous way, to look at what is appropriate care. This is best done professionally based on rigorous scientific and medical assessment. It is important for us not to end up in a situation where we just chase after the latest, most expensive technology, most expensive procedures, most expensive drug. We have to assess the outcomes. In the end, it is also about providing the care in a manner which is affordable and sustainable for patients.  That is in the best interest of our patients.

15         I visited St Luke’s Hospital recently, and they showed me this glove that they developed to help stroke patients.  They explained to me that stroke patients very often cannot open their hands, and their fists and fingers will be clenched up. The original product from the US would cost more than $2,000 to help the patients exercise their fingers. The team at St Luke’s came up with an equivalent device which cost about $200. Later, the therapists and nurses came up with a second version using Velcro, which achieved more or less the same purpose, but at a cost of $12. Because it is much more affordable, more patients are able to use it. This is an example of achieving the objective without necessarily going for expensive products or expensive technology. Technology is a tool to help us, it is not the end in mind. We should not be pursuing productivity improvements by buying new high-tech toys because we think that high-tech toys are sexy and fun. This is about improving productivity, affordability and patient well-being. We are happy to support ideas from our colleagues, whether it is from hospitals or from our community partners, on ways we can improve productivity.  Whether it is high-tech or not, it does not matter. It can be administrative or procedural in nature, it can also involve some equipment or technology. Our focus is on the outcomes. 

16         I would like to conclude my speech by saying that the journey ahead will be a tough one, because we are in many instances also going into new areas, with a doubling of our ageing population within the next 15 to 20 years, coupled with a shrinking local workforce and a slowing economy. These are going to be challenging times, but I am not pessimistic because I think we are also at a stage of development where we do have resources and the capabilities to think of new ways of doing things that will help us overcome these challenges. We have a better educated and more highly skilled population. We have more resources now compared to 50 years ago. We are better linked up with the rest of the world and can get new ideas, new technologies, new ways of doing things. In the end, it depends on us. First, are we open to new ideas from overseas, new ideas from other sectors beyond healthcare to help our innovation and transformation journey? Are we willing to learn from one another, not just public hospitals learning from public hospitals, but also learning from our colleagues from the private and people sectors?  There are many good practices outside the healthcare system which are worthwhile for us to learn from and see how we can help one another to raise our collective standards for the benefit of patients. We should see this as an ecosystem and not as a public-private divide.  We should learn from one another, learn what the best practices are, and we should be open to ideas which are from outside our industry and organization.

17         These require a collective effort, everybody needs to work together and see how we can all play a part. Individuals need to look after their own health, our family’s well-being, take responsibility to look after ourselves well. The providers, of course, play a critical role in treating and looking after our patients.  For the Government, there are some areas that we will need to come in, setting standards, making sure our policies and regulations are effective, and overall how well we manage the country and economy as a whole, which will then determine how much resources we have to provide subsidies and support for Singaporeans in important areas like healthcare.           

Conclusion

18         Let me end by thanking the organisers once again for inviting me to speak at this morning’s conference and very importantly to organize such an event to raise collective awareness and get good ideas from everyone on how we can work together to achieve a more affordable and sustainable healthcare system for all Singaporeans. Thank you very much.