SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES, AT THE BUSINESS TIMES LONGEVITY FORUM

Mr Chan Yeng Kit, CEO, SPH Media

Mr Harpreet Bindra, CEO, HSBC Life

Friends

Ladies and gentlemen

1.             Just listening to all the thoughtful comments, I have a few remarks – a response. One is that actually I am very sure that we are already a super-aged society. Because the definition is 21% of your population aged 65 and above. We were already in touching distance in 2025, and given that National Day is coming, I think we have crossed it. And we are merely waiting for the official numbers to come out.

2.             Second, it is that we spoke a lot about longevity and leading a good life at the same time. And indeed, in the olden days, the main key performance indicators (KPIs) of a healthcare system are two – one is infant mortality rate, the other is lifespan. Infant mortality is important. On lifespan, we should really ditch it, given that people are really living to 70, 80, 90, or even becoming centenarians. The real KPI today is the gap between healthspan and lifespan. Today it is about 11 to 12 years for developed economies. If you can squeeze it down to below 10 years, life will be so much better. The burden on the healthcare system and our quality of life will be so much better.

3.             And lastly, I have to say something about the “blue zone”. Singapore has the honour of being listed as a blue zone economy, only by Netflix. The original author, Michel Poulain, I met him. He is a demographer, a French demographer. I asked him, “What do you think about Singapore being a blue zone?” He said, “I don’t agree.” It was never in his academic study. He studied, I think, California and the Greek islands. Then Buettner, who then made the documentary series, took his artistic licence further and included Singapore as a blue zone. But I think it is a useful addition, in the sense that he made it quite clear that Singapore is not culturally a blue zone. We are a manufactured blue zone because we have policies, we have nudges, people responded to incentives, and suddenly we become a blue zone. But I think we should really take this with a big pinch of salt. We are recognised for some of our policies and lifestyles, but really we need to culturally become healthier. And that is the quest that the Ministry of Health has now, to engender this whole social movement of Healthier SG.

4.             That is my preamble. Pleased to join you today at this inaugural forum. Because it is a Business Times (BT) forum, I want to talk about not just longevity, but the longevity economy. Because I think that is important.

The Longevity Economy

5.             As we all know, the world population, not just Singapore, is becoming older and lifespans are getting longer. And we have generations of baby boomers and Generation X, mainly people like me, who benefited from economic growth, accumulated savings, and are ready to spend during their retirement and their old age.

6.             To illustrate, Singaporeans born in the 1970s, they had around twice the median real income of those born in the 1950s by the time they reached about 40 years old. Average retiree household expenditure has been growing steadily. CPF balances, we noticed, have been growing across successive cohorts as well.

7.             So the seniors of today and tomorrow are very different from the seniors of the past. They will have different needs, different expectations, more resources and more savings to spend. This is what we call the decumulation of lifetime savings and at the same time it coincides with the desire to have a good quality of life in your retirement years. And this will drive what we call the longevity economy. We expect to observe more spending in many areas – retirement living, investment products, insurance, tourism including medical tourism, wellness and healthcare.

8.             We are already seeing growth in these sectors. One McKinsey study found that globally, Baby Boomers on average spend approximately three times more as compared to Gen Z travellers. Of course they have more savings and this reflects the spending power of the older cohorts. Similarly, the global wellness market grew from about US$4 trillion 10 years ago to US$7 trillion in 2024, and by the end of this decade it is expected to grow to about US$10 trillion. That is the wellness market.

9.             For today’s speech, I cannot focus on all these aspects of longevity economy. I will focus on the area I feel is the most important, which is healthcare. And I will make three points.

Healthcare is Unique

10.          The first point, healthcare is very unique compared to the other longevity economy sectors.

11.          We know that economic growth is important. Every economic sector, we wish for growth, because it creates jobs, it generates opportunities, eradicates poverty and improves lives. Yet, Singapore has never pursued economic growth at all costs. Because economic growth pushed to its limits will stress society, such as widening income inequality, or other social issues – crowdedness, pollution, a larger influx of foreign workers which inevitably will happen with more economic growth. And there always needs to be a balance between growth and social resilience, and the acceptance of that growth and its consequences.

12.          And these considerations are especially salient in healthcare, where growth is not necessarily always better. This is because healthcare is fundamentally an essential public service, with a strong social imperative to ensure quality, accessibility and affordability, for our patients and families, and especially when the population ages. The wrong kind of growth can seriously undermine the public and social objectives of healthcare.

13.          There is a part of healthcare, I would say, it does build health and improves quality of life, and that is very welcome. But a major part of healthcare spending is about restoring health, or managing sickness, often in an atmosphere of worry and anxiety. We never treat car repair as a big economic growth sector. When your car spoils, it is just bad news. You just want to repair it. When our body spoils, our organ spoils, it is the same thing. We are just trying to restore it. We are trying to manage it. It is an essential public service, but it is not wealth-creating in the traditional economic sector. So this makes healthcare highly susceptible to over-servicing and unnecessary treatments – the kind of growth that we need to be wary of.         

14.          Distortions in the healthcare industry exacerbate the risk. For example, over-generous insurance can create a buffet syndrome and over-consumption of diagnostics, medication and procedures. Anxious patients who are worried about small discomforts may undergo numerous expensive diagnostic scans, which can be unnecessary and can do more harm than good.

15.          If over-servicing and unnecessary treatments proliferate, we have not created health nor wealth. We simply generated cost for everybody. And this is happening everywhere in the world and makes healthcare increasingly expensive and unaffordable, especially at a time when the population is ageing.

16.          Healthcare is therefore more like medicine. The right dose is very good – it heals; too little is ineffective; and too much can be harmful and even dangerous.

There are Ample Opportunities

17.          This brings me to my second point, which is that notwithstanding what I just said, there are actually many opportunities to build the longevity economy. And these are areas that are not wasteful, avoid unnecessary treatment and over-servicing, nor do they prey on anxieties and fears. So let me cite a few things that are going on.

18.          Biomedical R&D and manufacturing – that is a key priority of our national Research, Innovation and Enterprise programme. Singapore is currently home to over 80 leading biomedical companies’ regional headquarters. We have 60 manufacturing plants and 30 R&D centres. And this sector generated over S$30 billion in output last year, and many good jobs.

19.          We are building deeper public-private partnerships that anchor global biomedical R&D in Singapore, including major pharmaceutical companies such as GSK and Roche.

20.          We want to further strengthen this R&D ecosystem, and one of the important aspects is to encourage clinical trials to be conducted in Singapore. There is one friction faced by pharmaceutical companies always give feedback to us on – is that we have three healthcare clusters.  So when they want to conduct clinical trials, they must work with many public institutions, and the bureaucracy can be overwhelming to them. So we have streamlined the contract review process across multiple medical institutions. We implemented a harmonised budget template. SingHealth has also introduced a new fast track lane for ethics review.

21.          Health products regulation offers opportunities as well. Done well, it positions Singapore as an important and trusted platform for safety and quality, which helps good innovations reach patients faster, not just in Singapore but around the region and the world.

22.          Our Health Sciences Authority (HSA) is highly regarded internationally. It is not one of those agencies, like the Housing & Development Board (HDB), that everybody knows about. But it is quietly in the background, flying the Singapore flag very high. It is a World Health Organization (WHO) Maturity Level 4 regulator, that means it is the highest-level regulator. It is a WHO Listed Authority for medicines. Listed Authority means you are right at the top, and it is also the first national regulatory authority in the world to achieve the highest maturity level of technical competency for medical devices. HSA is ranked right up there, amongst the top in the world rankings.

23.          Hence, HSA’s approvals for medicines or medical devices are now referenced by more than 10 international regulatory authorities. Being referenced means if we approve (medicines or medical devices), they will look at it seriously, and they might also approve on the basis that we approved. This means that securing approvals here in Singapore opens doors to markets across the region and beyond. Singapore can become a gateway to many other markets for medicines and medical devices.

24.          HSA is working with various agencies to fully realise this potential. If we succeed, together with clinical trials and regulatory approvals that are recognised around the world, whenever there is a new and effective drug or medical device, we hope our patients can benefit ahead of other markets, provided the price is right for us.

25.          Food and nutrition will also grow in importance. As we age, what we eat matters a lot more. Singapore can be a R&D hub and manufacturing base for innovative food products.

26.          One example is how Nestlé has partnered with the Nanyang Technological University (NTU) to understand how nutrition, dietary patterns and lifestyle factors influence ageing. Similarly, Danone set up a lab studying gut microbiomes in Singapore a few years ago, with a particular focus on healthy nutrition for an ageing population.

27.          Artificial Intelligence (AI) in healthcare offers very exciting opportunities too, and a lot is going on. In Singapore, we do not treat AI as a solution looking for a problem, which can be the case. We identify what are our problems, and ask ourselves, “How can AI and technology help solve them?” So AI is now deployed to very good use in Singapore, such as improving hospital operations, supporting clinical decisions by doctors, and identifying high-risk individuals for further preventive care interventions. In every use case, we ensure that AI enhances healthcare, improves efficiency, is integrated into existing clinical operational flows, and does not replace the care and the judgement of the doctor or the nurse.

A Stronger Partnership

28.          But the most challenging aspect of growing the longevity economy is to do so without undermining the public health imperative that I talked about, or cause the health system to become less sustainable.

29.          Hence, my final point is this: to achieve this, we need a stronger partnership between Government and the commercial sector in healthcare.

30.          This must be a conscious effort – we cannot just leave it to the market. In healthcare, it just does not work. It has to be a conscious effort from both the commercial sector and Government to forge a meeting of minds, then we can grow the longevity economy in a way that directly reinforces the public objective of healthcare. And in some ways, it is happening in Singapore.

31.          Because when distortions arise, such as over-generous health insurance riders that encourage over-consumption, we need the insurance sector to heed the Government’s call to rein in such products, and that is already happening.

32.          Private clinics and healthcare groups are playing a major role in the Healthier SG movement. I hope all of you have joined and enrolled. They enrol residents, develop health plans with you, and encourage you to adopt healthier life habits. Fitness studios and activity coaches are a thriving sector I think. They are working actively with communities to promote active ageing, help people eat better, and exercise more.

33.          We are planning to launch a not-for-profit private hospital. We hope to have strong private sector participation in this project. Because if it succeeds, we widen choices for patients through a more affordable private hospital option. This will strengthen our healthcare ecosystem.

34.          We have launched a national Grand Challenge on Maximising Healthy and Successful Longevity. Under this Grand Challenge, we will develop AI use cases in healthcare, to nudge healthier behaviour and support seniors to live safely and independently. We encourage the big tech companies all around the world to participate in this, leverage our very high-quality and anonymised data that we have in Singapore, and work with our public healthcare institutions to bring these solutions to life.

35.          The Government too must lean forward. We should not just regulate from a distance but work with industry to shape markets in the right direction. This means setting clear public health objectives and policy frameworks such as Healthier SG, Age Well SG or Nutri-Grade labelling which industry can work within and contribute towards. So it is not laissez-faire, there is a framework for them to contribute towards. The Government also needs to share problem statements, support and enable responsible innovation, and be willing to invite enterprises to help us meet the challenges of an ageing population and achieve better health outcomes.

Build on Our Strength

36.          In conclusion, healthcare is a very complex sector. In my whole public service career, this is the most complex thing I have ever had to deal with. It is a sector probably everybody cares about. We always say, in life we have thousand and one problems, but once we have a health problem, we only have one problem. But yet in many countries, it is heading towards unsustainability – patients queues are long, waiting time is long, cost is high – and private sector participation can inadvertently make things worse.

37.          Many developed countries today spend about 9% to 12% of their GDP on healthcare. Singapore is in a relatively good position. We spend less than 5% of our GDP on national healthcare, modest by international standards, while delivering good health outcomes also by international standards. And this did not happen by chance, it is achieved through very deliberate policy interventions and discipline in healthcare spending and investments.

38.          We must not squander this position as our population ages. That is why we are driving value-based care, shifting care to the community, investing more in population health and preventive care, and maintaining discipline in public healthcare spending through judicious infrastructure investment, co-payment, and means-tested subsidies. Co-payment is a very hard thing to explain for a Health Minister. How do you explain to the population, “you co-pay a bit, it’s cheaper”? Who will believe you? They will say, “No, in the United Kingdom (UK), you do not have to pay at all, it is cheaper.” But no, the healthcare bill, ultimately, is paid by the whole nation. Through co-payment, you reduce unnecessary payments, and then you build up your MediSave over time, you can use your MediSave to co-pay without paying from your own pocket. That system keeps the whole healthcare system lean and disciplined, and this minimises wastage. And all these are good health policies as well as sound economic policies.

39.          Now, faced with the unprecedented circumstances of a rapidly ageing population and a fast-growing longevity economy, the Government needs to partner the commercial sector, leverage its energy, creativity, innovation and investment, while keeping the longevity economy anchored on dignity, on affordability and on its public purpose, and better lives for our people.

40.          I wish you a successful and a fruitful discussion ahead. Thank you.