Speech by Mr Gan Kim Yong, Minister for Health, at the Ministry of Health Committee of Supply Debate 2018

BUILDING A SUSTAINABLE HEALTHCARE SYSTEM FOR THE FUTURE

Introduction

1.      Mr Chairman, I would like to thank the Members for their comments and suggestions. With your permission, may I display a few slides during my speech?

2.    Today, Singaporeans are living longer, and our Health Adjusted Life Expectancy, which estimates the number of years a person is expected to live in good health, remains one of the highest in the world, at 72 years for males and 75 for females.

3.    But we cannot afford to be complacent. Our population is ageing rapidly, with growing chronic disease burden. About 3 in 4 Singapore residents aged 65 and above are affected by diabetes, high cholesterol or hypertension, or a combination of three. If nothing is done, diabetes is projected to affect more than one million Singaporeans by 2050.

4.    We want to not just live long, but also live well. To do that, each of us must also do our best to adopt a healthy lifestyle. We also need a good healthcare system that is both accessible and affordable. 

Update on Healthcare 2020

5.    Dr Chia Shi-Lu asked about our progress on Healthcare 2020, which outlined our strategy to improve accessibility, quality and affordability of healthcare. We have made good progress but much still needs to be done from now till 2020 and beyond.

6.    Over the next few years, we will continue to add healthcare facilities across Singapore. To the north, we are developing Woodlands Health Campus, which will be ready progressively from 2022. Down south, we are developing Outram Community Hospital and the new National Cancer Centre as part of the redevelopment of the Outram Campus. In the North-east, we are on track to open Sengkang Hospitals later this year. The new CGH Medical Centre in the east will also be ready this year. In the west, we look forward to the new Centre for Oral Health at NUH. Not forgetting the central region, where the Integrated Care Hub and National Centre for Infectious Diseases are being built at Novena.

7.    Since 2011, we have added 1,700 acute hospital beds, 1,200 community hospital beds, and 5,300 nursing home beds. To support ageing in the community, we have also added 4,200 home-based and 2,900 centre-based care places. We have also grown our healthcare workforce by about 25,000, or about 36%, since 2011.

8.    To ensure healthcare remains affordable to Singaporeans, we increased subsidies at outpatient clinics, and enhanced Community Health Assist Scheme (CHAS) for primary care, commonly known as the blue card and orange card. In 2015, we introduced MediShield Life for inpatient care.

9.    We are also investing in a future-ready workforce that will anchor the transformation of our healthcare system. SMS Amy Khor will elaborate on our plans to grow and upskill our healthcare manpower later. We need to innovate and find new ways to deliver quality care to patients in a more effective and efficient way and for better outcomes. For example, at Pioneer polyclinic, which opened in July 2017, patients are cared for by a team comprising doctors, nurses and allied health professionals. Having a regular primary care team will ensure better continuity of care for patients. This is one of many initiatives that has improved the quality of care.    

Healthcare Spending

10.    Sir, our continued investment in healthcare means higher National Health Expenditure (NHE).  NHE has increased by more than 60% in five years, from $10.9 billion in 2010 to $18.9 billion in 2015. At 4.6% of GDP, this is lower than most developed countries, but we expect this to rise over time as our population ages.

11.    Government expenditure grew twice as fast, by about 120% over the same period, to fund infrastructure investments and to keep healthcare affordable for Singaporeans, by reducing their share of out-of-pocket expenses from about 40% to 30%. With the introduction of the Pioneer Generation Package and MediShield Life, and the extended use of Medisave, the out-of-pocket for 8 in 10 bills for subsidised hospitalisation episodes was below $100.

12.    But we cannot simply keep increasing subsidy or insurance payouts. Higher insurance payouts will result in higher premiums, while higher subsidies will need to be funded. All these will be borne by Singaporeans eventually through higher premiums and higher taxes. Therefore, we need to take a long term view on this. 

Beyond Healthcare 2020

13.    Even as we implement Healthcare 2020, we need to look beyond 2020, and make three key shifts to ensure our healthcare system is future-ready. The Three Beyonds provide the roadmap to a sustainable system beyond Healthcare 2020.

Hospital to Community—Strengthening Social and Primary Care

14.    First, we are going Beyond Hospital to the Community. Over the last decade, we have increased our total spending in primary care and intermediate/long term care sectors by close to four times, from $1.3 billion in FY2007-11 to $5.1 billion in FY2012-16. These investments reflect our priority to anchor care firmly in the community. As we continue to invest in community care, we also need to bring social and healthcare services closer to better serve our people. This has led to the formation of the Silver Generation Office as well as expansion of Community Networks for Seniors, which I elaborated on in my speech earlier on SG Cares.

15.    SMS Lam Pin Min will share later how we are strengthening primary care for the future. 6 new polyclinics are being built under HC2020 — two are already open, with four more to come by 2020.

16.    And we will add another 6 to 8 new polyclinics by 2030. This is part of our commitment to ensure Singaporeans can access primary care closer to their homes. We are not just building polyclinics; we are also partnering private GPs through Primary Care Networks to offer subsidised team-based care in the community under CHAS.

Quality to Value—Sustainable Healthcare

17.    Our second shift, beyond Quality to Value, plays a pivotal role in ensuring sustainability. We adopt a multi-pronged approach to manage healthcare costs:

18.    We set up the Fee Benchmarks Committee earlier this year, to provide a reference to guide doctors in setting reasonable fees, and to help patients make informed choices on their care options. We established the Agency for Care Effectiveness (ACE) to provide guidance on cost effective drugs and treatment. We also introduced the Healthcare Productivity Fund, to spur productivity improvement efforts in our healthcare institutions. But we need to do more.

19.    Mr Chairman, co-payment has been an integral feature throughout all our healthcare schemes, including MediShield Life and Integrated Shield Plans. It plays an important role in ensuring our healthcare system is sustainable: by emphasising personal responsibility in healthcare, by encouraging service providers to focus on appropriate and cost-effective interventions, and nudging patients to make prudent decisions in healthcare services. This is important as it ensures that all stakeholders, including patients, have a stake in the decision. As Dr Chia pointed out, some private insurance policies offer zero co-payment coverage. They are called full riders. Such riders encourage a buffet syndrome as patients do not need to pay anything for their treatments. It undermines the co-payment principle and dilutes the personal responsibility to choose appropriate and necessary care. This will encourage unnecessary treatment, leading to rising healthcare costs not only for those with such riders, but for all of us.

20.    Therefore, MOH has been working with the insurance industry, and have issued a set of new requirements to Integrated Shield Plan insurers which will be applied to all new rider policies. We will require them to have co-payment features going forward. SMS Chee Hong Tat will elaborate more. This will encourage responsible behaviour by both patients and healthcare providers.

21.    We will continue to review our healthcare financing policies to ensure that co-payment remains affordable, through targeted subsidies, MediShield Life, Medisave use, and for those who still face difficulties, Medifund will be the safety net. No one will be denied appropriate healthcare because they cannot afford to pay.

Healthcare to Health—Taking Ownership of Health

22.    But ultimately, the best way to beat rising healthcare cost is to stay healthy. This is the focus of our final shift, Beyond Healthcare to Health.

23.    Parliamentary Secretary Mr Amrin Amin will give an update on the War on Diabetes, and detail how we are encouraging and supporting healthier lifestyles. We will create a supportive environment for Singaporeans to lead healthy lives, but each of us must do our part. 

Reorganising Our Public Healthcare System

24.    These three shifts will be a multi-year effort. To support these initiatives, we have taken the first steps to reorganise ourselves. Last year, I announced plans to reorganise the public healthcare system into three integrated clusters. I am pleased to report that the reclustering exercise has been successfully completed. I would like to take this opportunity to thank the unions and management for their support in this exercise and for all our staff who have worked very hard to ensure a smooth transition. But this is not the end. In fact, this is just the beginning of a journey to create synergy and deliver better care for Singaporeans.

25.    Let me share an example.  Mr H, 73 years old, was admitted to Singapore General Hospital (SGH) after a fall last year. Besides rehabilitation treatment for his fall, he also needed to manage his diabetes and hypertension. Ms Siti Hajar, a Patient Navigator and experienced nurse from SGH, coordinated both his health and social care even after he has been discharged. Ms Siti visited him fortnightly and ensured that his chronic conditions were well managed from home. As Mr H lives alone in his flat in Kaki Bukit, the Changi General Hospital Community Care team—now part of the Singhealth cluster—was activated to accompany him for follow ups at Bedok Polyclinic and arrange for home help services for him.

26.    I am pleased to know that Mr H’s condition has now stabilised, and the Singhealth team continues to provide him with strong support. This is what reclustering is about—bringing healthcare institutions and the community closer together to provide good, seamless care for patients such as Mr H, and many others.

National Healthcare Supply Chain Agency

27.    Another example of this synergy is the new national integrated supply chain we are setting up. This goes beyond the Group Procurement Office (GPO) currently run by SingHealth. It pools the whole supply chain’s functions, including procurement and resources of the three clusters to achieve economies of scale, create greater synergy, develop new capabilities and evolve innovative supply chain solutions. This will yield system-level gains for patients, providers and staff. This will also help to mitigate cost increases and bring greater convenience to patients.

28.    The transformation process must continue. Advances in medical science, increasing digitalisation and connectivity hold tremendous promise for re-thinking healthcare.

MOH Office of Healthcare Transformation

29.    In addition to progressive improvements, we also need to explore game-changing ideas. That is why we have set up the MOH Office of Healthcare Transformation (MOHT), to identify and experiment with bold innovations. MOHT will focus on longer-term ideas that can be scaled up for system-level transformation.

30.    Some of these ideas will be tested at the health empowering Alexandra Hospital campus which NUHS will take over from the second half of 2018. Similarly, we will be initiating the master planning of NUH’s Kent Ridge Campus in the West, to see how Kent Ridge can be best positioned to meet future healthcare needs. We have already started some development at the Kent Ridge campus. In 2013, we opened the NUH Medical Centre, and will be opening the National University Centre for Oral Health next year. The master planning study presents us with the opportunity to plan ahead, and reimagine how the future Kent Ridge campus, including the main NUH hospital building, which is more than 30 years old, can be rejuvenated to support current and future models of care. 

Conclusion: Everyone Can Play A Part

31.    At the end of the day, we must remember that the state of our health primarily depends on our choices. As far as we can, we must choose to live healthily. This is the key not just to a sustainable healthcare system, but a vibrant society and good quality of life. 

32.    Mr Mohamed Irfan is a good example. He is pursuing a sports diploma at Republic Polytechnic. Keeping fit is as much part of his work as it is his passion. Not only is he enjoying the benefits of better health, he is also going the extra mile to influence others. He persuaded his family to eat brown rice, more fruits and vegetables, and less fried food. Last year, he co-started a health programme, where he was the health coach. Every week the group gathers to exercise. Their last activity involved jogging in the park before enjoying a picnic. Mr Irfan believes an active community can motivate individuals to sustain a healthy lifestyle. He exemplifies how taking ownership of one’s health can have a ripple effect, to better the lives of many more.

33.    Mr Chairman, I believe by working together, each of us can bring about Better Health, Better Care, and Better Life for all Singaporeans.

34.    Thank you.