Speech by Mr Ong Ye Kung, Minister for Health, At Public Free Clinic Society’s 50th Anniversary Charity Dinner, 27 October 2024

大众医院院长 萧士发医师

院务顾问 黄马家兰女士

中医管理委员会前主席 符喜泉女士

各位嘉宾、女士们、先生们

大家晚上好。跟80桌嘉宾讲话不容易. 我的演讲今晚也长了一点，非常对不起，所以大家要原谅我。但是今晚，我是觉得是比较重要的演讲，所以希望大家耐心一点。所以抱歉。我很高兴出席今晚的慈善晚宴，庆祝大众医院成立50周年。 

2.     在中医的活动中，主宾通常是用华语演讲。但今晚，我将以中英双语发言。在结尾的时候，我会解释其中的原因。 

PFCS 50th Anniversary

3.     首先，祝贺大众医院成立50周年。过去这50年里，大众医院始终不分种族或宗教，致力于为有需要的病人提供优质而价格廉宜的中医服务。

4.     如今，大众医院也不断探讨如何通过流动医疗服务，扩大服务的覆盖范围，并与社区支援组织合作，增加中医服务的可及性。 

5.     尽管中医在新加坡不像西医一样有卫生部提供的津贴，并且受到管制，但仍然是许多新加坡人广泛使用的疗法。根据我国2022年的全国人口健康调查，每五名成年的新加坡居民中，就有一人在过去一年内曾到中医诊所寻求治疗，包括了我自己。 

6.     我相信中医药之所以受欢迎，主要是因为它强调整体观念、注重使用天然草药，以及重视通过调整和调理生活习惯来改善健康。这些特点，吸引了许多人。

7.     此外，中医界通过自我管制，以及不断提升行业标准，维持其良好的声誉。为此，今晚我要感谢大众医院，作为本地重要的中医机构，推动了本地中医药的发展。谢谢大众医院。 

State of TCM and Next Steps

8.     中医管理委员会这些年来在自我规管和提升中医师的专业水平方面，作出了很多努力，也值得表扬。只可惜，管委会主席张俰宾博士今晚人在国外，无法出席，可是他听了应该很高兴。

9.     目前为止，我国已有超过3,400名注册中医师，其中约百分之65的中医师还在行医。 

10.     中医的自我规管模式，我觉得是正确的。它确保中医界能够在主流西医监管体系之外蓬勃发展，以应对国人的需求。话虽如此，在这个模式中，我们也应该思考如何进一步发展中医药，与主流西医体系发挥协同的作用。 

11.     其中包括三个发展的领域：教育与培训、预防性保健，以及与主流医疗体系的协同效应。接下来，让我用英语来谈谈这三个方面。 

Education and Training 

12.     First, education and training. We made a significant breakthrough this year when Nanyang Technological University (NTU) launched Singapore’s own Traditional Chinese Medicine (TCM) degree – the Bachelor of Chinese Medicine – for the first time. NTU saw very encouraging responses, with 160 applicants for 30 places for its first year.

13.     By delivering our own degree, we concluded a decade-long collaboration with the Beijing University of Chinese Medicine (BUCM) for the training of our NTU undergraduate students. It is a pity, because BUCM had been a great partner and we learnt a lot from them, but Singapore will need to graduate at some point and start our own degree programme. 

14.     That said, NTU will continue to collaborate with BUCM and other overseas institutions, in education and research. 

15.     From my conversations with current and prospective students of the TCM degree course, they told me one important consideration was that they get to study overseas, especially in China, to learn TCM. Therefore, I have requested NTU to ensure that overseas attachment remains a key component of the new degree programme. I am happy to learn that NTU will ensure that students have the opportunity to participate in an overseas clinical internship for up to six months. 

16.     During this clinical internship, students will benefit from the guidance of international clinical mentors, make friends overseas, be exposed to diverse healthcare practices, and gain valuable insights on how culture shapes healthcare delivery. 

17.     With a new degree, and a renewed push to raise education and training standards, there is now an opportunity to streamline how we assess and qualify TCM graduates for registration and independent practice.

18.     I have asked Dr Teo Ho Pin, Chairman of the TCM Practitioners Board (TCMPB), to undertake this review. He said yes, and has been working hard with his Board members and engaged his stakeholders, and the TCMPB has decided to make the following changes: 

19.     First, the TCMPB is revamping the format of the clinical component of the Singapore TCM Physicians Registration Examination, or STRE, to focus on assessing the clinical, communication and analytical skills of our graduates, in a simulated clinical environment. The approach is very similar to what is being done for western doctors, but now TCM is doing the same. This will ensure that aspiring TCM practitioners will be more practice ready, and can operate independently as early as possible. 

20.     Second, streamline the requirements to attain a TCM practising license. Today, a graduate from the NTU Bachelor in TCM Degree programme, after graduation , still has to take the STRE, administered by the TCMPB. They must clear two exam hurdles and the second one is when many graduates tripped, and are unable to attain their licence to practise, even though they have graduated. 

21.     The TCMPB has therefore decided to grant full exemption for the STRE for graduates of the NTU Bachelor of Chinese Medicine Degree. 

22.     There is good basis to do so. This is in view of NTU strengthening its assessment of graduates, including the theory examination as well as the Clinical Competency Assessment, to meet the requirements of the TCMPB. That way, graduates of the NTU Bachelor of Chinese Medicine Degree will be issued their practising certifications once they graduate. 

23.     Graduates from the other two TCM schools can be exempted from the theory part of STRE, but all graduates will still need to be assessed on their clinical competencies to obtain their practising certificates. To be exempted from the clinical path route, I think the two schools need to work a lot harder. 

24.     Not only will this streamlined approach reduce students’ burden in having to take multiple theory tests, it allows our TCM practitioner candidates to focus their efforts in honing their clinical skills and better prepare for the clinical competency assessment. 

25.     Third, bearing in mind that many past graduates could not clear the STRE hurdle, from 2025, the Singapore College of Traditional Chinese Medicine will offer a refresher course, recognised by TCMPB, for those who wish to retake the exams. 

26.     Fourth, instead of waiting for a full year, graduates can now re-attempt the clinical assessment in six months. These changes allow for more timely revision and effective learning experience, ensuring that our graduates can put in their best efforts in passing the competency assessment as required by the TCMPB. More details will be announced by TCMPB in due course. 

27.     NTU will be starting its enrolment for the second batch of students for its TCM degree soon. With all these changes, I hope more students will consider this programme and enter the TCM sector. 

Playing a Part in Preventive Care

28.     Second, preventive care. As I have explained before, and many of you already know, TCM takes a holistic approach to health, focuses strongly on preventive care, and therefore, should play a role in Healthier SG, which is our major national programme. 

29.     In fact, this is a decision not for the government or western doctors to take. It is already decided by many Singaporeans, who are choosing TCM. Our job is to synergise the efforts between Healthier SG and TCM, and ensure that high quality and appropriate preventive care is delivered to as many Singaporeans as possible. 

30.     We have made good progress in Healthier SG, with over one million Singaporeans and Permanent Residents enrolled in Healthier SG. While encouraging, this is less than 50% of our targeted population. Amongst those aged between 40 and 59, the enrolment rate is one-third. It is not bad, but certainly can improve. 

31. Given that a fifth of Singaporeans see TCM practitioners, TCM offers a useful touchpoint to engage more to join Healthier SG. For example, PFCS alone sees up to 15,000 patients per month. You can persuade them to join Healthier SG.

32.     Conceptually, the patient can be referred by TCM practitioners to a GP for fully subsidised vaccinations and screenings, and chronic disease management, while continuing with TCM care, including receiving support on adjusting their lifestyles. Both can happen at the same time – TCM and GPs can work together, to make sure patients are healthy.

33.     I believe that together, we can work out the right models for TCM practitioners and GPs to work together, and develop an expansion scheme for Healthier SG. 

34.     But what will become sensitive is how the fees that the government is paying under Healthier SG will be shared. If we involve TCM practitioners in an expansion scheme for Healthier SG, it is only right that part of the Healthier SG fees would go to them as well. 

35.     As the Chinese saying goes ‘talking about money hurt feelings’ (谈钱伤感情). But I hope everyone keeps an open mind about this. After all, MOH is spending an additional $400 million a year on Healthier SG, and about $110 million spent through GPs, which include their service fees and subsidies for preventive care, such as screening and vaccinations. 

36.     We expect the amount to rise significantly over the years as Healthier SG gathers momentum and enrolment rate increases. Hence this is an expanding pie, which enables us to be more inclusive, including TCM practitioners, to deliver better results. 

37.     We will have to forge this partnership between GPs and TCM practitioners in a step-by-step, practical way. There are three things we can do now to develop this expansion scheme. 

38.     First, MOH will consult GPs and TCM practitioners on possible collaboration models, to appropriately allocate the roles and workflows between GPs and TCM practitioners. There is no question that health screening, vaccinations and chronic disease management, being western medicine interventions, will need to be performed by western GPs. What TCM practitioners can play a very useful role in is lifestyle changes, 帮忙调理，整体地调, given the holistic approach to health in TCM.

39.     Second, as I have announced before, the TCMPB is working with MOH on an accreditation framework for TCM practitioners. 

40.     An accreditation framework will recognise TCM practitioners who can meet higher professional and competency standards, and deliver better quality care. This should be a voluntary scheme, which can be used to determine eligibility to participate in helping to expand Healthier SG.

41.     The framework should also cover governance of the services and practitioners, proper care and safety protocols, aligning with the controls for proper dispensing and administration of Chinese Proprietary Medicines and specific services, such as acupuncture. 

42.     In the coming months, MOH will be inviting TCM service providers of various profiles, ranging from solo practitioners to group practices, to participate in site visits, mock audits, and dialogue sessions, to better define what these accreditation standards should be. Through these engagements, we hope to better understand the service and operational considerations in TCM services. 

43.     We aim to launch the framework by 2026. I hope to have your full cooperation and commitment.

44.     Third, which I think we can do now, it will be extremely useful if TCM clinics and institutions such as PFCS can start engaging like-minded western medical practitioners and clinics, to explore partnerships. As I mentioned above, the business model under a GP-TCM partnership can be a sensitive matter. But I believe there are willing partners in both the GP and TCM sectors who want to work this out and make this work. Ground up proposals on a joint participation model to expand Healthier SG, with suggestions on both patient management and fee apportionment, will be a significant step forward. It will really help MOH, so 拜托拜托.

Synergies with Mainstream Healthcare System

45.     Let me conclude by talking about the third and most challenging area of development, which is to draw synergies with the mainstream healthcare system, including in our hospitals. 

46.     By that I mean carefully incorporate certain TCM treatments into our public clinics and hospitals, where they become eligible for support under our healthcare financing framework, such as subsidies and MediSave withdrawals. 

47.     In Singapore, this is only done for acupuncture for lower back pain and neck pain. In jurisdictions such as China, Hong Kong and Taiwan, there is a broader integration. Many doctors are trained in both western medicine and TCM, and hospitals have both western and TCM departments side by side, covering many areas of treatment. 

48.     This outcome and situation are not surprising, given that TCM originated from these jurisdictions. Even so, whenever MOH visits hospitals in these jurisdictions, we meet TCM practitioners and researchers who speak the language of western medicine. They talked about clinical trials, measuring outcomes, collecting evidence and publications in international health journals, before treatments can be delivered in acute hospitals. 

49.     They appreciate and recognise that globally, even in China, healthcare regulation is largely based on western medicine. It is just the way the world is today. Hence TCM, despite centuries of practice and empirical experience, must meet the terms of that mainstream system to be incorporated in it. 

50.     It is like China deciding to join the World Trade Organization in 2001. If it wants to be part of the international trading system, it must sign on to the international rules. In healthcare, the international rules are western medicine which you have to sign on, and they understand.

51.     That said, much research has gone into TCM, producing a lot of clinical evidence on the efficacies of various treatments. Based on those evidence, we can design sandboxes and experiments within our public healthcare institutions (PHIs) to draw synergies between western medicine and TCM. A few of our PHIs are already exploring that. 

52.     The approach therefore must be selective inclusion, based on evidence. We should avoid a mindset or mentality of wholesale inclusion or wholesale rejection of TCM. That would be most unwise. This is a delicate process of trying to integrate and synergise between two fundamentally different systems, in origins and historical developments. 

53.     It is like two peoples from different cultures trying to communicate with each other and build a friendship. They speak entirely different languages, so how do you start? You probably start by 比手画脚gesticulating, then read body language, then you learn the key words and phrases of each other’s language, then you start to be able to communicate.

54.     They build up your means of communication over time, before they start to understand and appreciate each other. At some point, they will master each other’s languages, and begin to visit each other, trade, and even inter-marry. In history, many cultures have done that, to make our world better and safer. 

55.     That is why tonight I have to speak in both Mandarin and English. I noticed that whenever I come to a TCM event, and deliver a speech totally in Chinese, the coverage will tend to be only in the Chinese newspapers. Today I speak in both languages, and I have cameras from CNA in front of me. 

56.     Likewise, beyond events like this, I would encourage that the community organise a TCM conference at some point, maybe next year, in English. Invite our western doctors and healthcare leaders to attend. Invite top TCM practitioners from the region. Go beyond explaining the history and holistic approach of TCM, to presenting latest research results of TCM treatments, and how western medicine and TCM successfully complement each other in other parts of the world. 

57.     Do this to enhance understanding between the two sectors that speak different languages, to develop the TCM sector, and most importantly, deliver better care for our people. 

58.     Let me summarise in Chinese. 我和我的同僚到中国、台湾、香港考察的时候，看到那里的医院其实是中西药结合，它有照顾小孩子的西医部门，也有中医肿瘤部门，两个放在一起，同一个屋檐下， 但新加坡是不可能有的。那么，为什么会这样？我们也明白。因为中医药的出生地还是来自那些地方， 所以我们明白他们的情况。我们这边的情况就不一样。新加坡曾经是英国殖民地，而世界各地的主流医疗系统，还是以西医为主。在中国，和那边的医师谈话的时候，他们谈的其实也是西方管制的系统。即使在中国医院里的中医师，他们也说，他们要做科研、要有临床试验、要拿到资料和数据、有证据，也要刊登在国际期刊里。那么西医的体系才能够接受。所以，他们谈的也是西医的讲法。所以，我们是需要这样做的。整个世界的医疗体系都是以西医为主的。就如中国在2010年要加入世界贸易组织，也是要加入一个西方成立的一个体系。

59.     虽然这么说，但是很多中医药其实已经经过科研，有了数据和证据，也已经刊登在国际期刊里。有了这些证据，我们应该好好研究，如何把有证据的中医医疗方法，纳入我们的西医医疗体系、我们的医院里。很重要的是，我们不能够下意识地完全接受，或完全排挤中医。我们是用选择性的方法，哪里有证据，我们就要想方法，以实验性的方式，一步一步纳入西医管理的体系里面。

60.     这就像是两个文化的人想办法沟通，有时候鸡同鸭讲，怎么讲也讲不通。所以，我今晚需要用英语和华语一起演讲，因为我们用语文可以建起桥梁。我也鼓励我们的中医界在明年或后年，在短期内组织一个以英语为主的座谈会，把西医请来，也请一些外国高级的中医师前来讲解，不需要谈历史，或者谁治人、谁治病，这些不必要，而是谈数据、临床试验、证据，以及新的发展，大家一起切磋，然后就能建起桥梁。

61.     最后，今晚是大众医院50周年纪念，非常恭喜你们50年的贡献。祝你们接下来百尺竿头、更进一步。谢谢大家。