SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2026, ON 5 MARCH 2026

Mr Chairman

1.               Three years ago in April 2023, I informed the House that Singapore would become a super-aged society in 2026 – this year. This is when 21% or more of our population would be 65 and above.

2.               So you consider that in June 2025 last year, already 20.7% of our population was 65 and above, and that percentage has been going up by about one percentage point every year. So we would have crossed the 21% threshold by now.

3.               So as I speak, Singapore is a super-aged society. So welcome to super-aged Singapore.

4.               When was the exact point of transition? Actually I do not think anybody knows. We can do an estimation. What happened at that exact moment? Nothing dramatic - there was not a SCDF siren or anything. It came and go.

5.               Ageing does not arrive with a bang. Neither is it a whimper. It progresses quietly, with a real and profound impact – and at the Ministry of Health (MOH), we feel it very strongly in the hospitals, in the emergency departments, in nursing homes, and we are doing our best to manage the workload and care for all our patients.

6.               More importantly, we foresaw this demographic transition years ago and took as many early actions as we can. These include raising the GST to strengthen our fiscal position; increased the retirement and re-employment ages; built many more age-friendly streets, two-room flexi flats and senior apartments; bolstered financial security for seniors through Silver Support, CPF Life and MediShield Life.

7.               And these policies are long in the making. They have helped cushion the impact of this very profound demographic transition.

8.               But arguably, the most complex task to prepare for an older population is to sustain and to transform the healthcare system. These are the two topics I want to talk about today – sustain and transform. Let me first touch on sustaining the healthcare system.

Sustain Healthcare System

9.               Rising demand and care mean the healthcare system must expand. It will become bigger, which we are doing. At the opening of this term of Parliament, the MOH Addendum set out the target of adding 2,800 more public acute and community hospital beds between 2025 and 2030. We are on track.

10.           However, meeting rising demand and running a larger system will cost more. And if we do not manage this carefully, rising healthcare spending can strain public finances and household budgets alike. In fact, if we are really extravagant and not careful about it, it can even cripple our system.

11.           How do we ensure healthcare remains affordable? I think we need to start at the very top – to ensure that the national healthcare bill is under control. Otherwise, it is like the Titanic sinking and you are pouring water out of the deck. It must be floating.

12.           National healthcare expenditure – and that is the hospital bill of the nation. And that bill, remember this, is always and is ultimately paid by the people, whether through healthcare charges, through taxes, through insurance premiums, through medical security contributions. Ultimately, it is always paid by the people.

13.           So a government can claim we provide cheap, or even free healthcare. It is actually not very true. The truth is that healthcare is never really free – even if patients do not pay anything at the point of delivery. They will just pay in some other ways. A sick nation that consumes healthcare indiscriminately will incur a large and wasteful bill, and it will be very costly to the population, to the households, to the patient and to the people.

14.           So with your permission, Mr Chairman, may I display a couple of slides on the screens please? Thank you.

15.           The is a scatter chart of different countries. As you can see, Singapore is an outlier in the bottom right corner. Let me interpret this chart. The vertical axis measures how much the population spends on healthcare. Developed economies, shown by the different dots on (the) screen, typically spend around 9% to 12% of GDP on healthcare, with the US – the outlier in the other direction – spending 17%. Singapore spends below 5%.

16.           The horizontal axis is average lifespan – this is an internationally accepted and generic measure of health outcomes. And Singapore has one of the highest lifespans in the world. But of course beyond lifespan, there are many other measures of health outcomes. And across all these measures, Singapore is comparable to, or even better, than many developed economies.

17.           So how did we become an outlier like this? I think it has a lot to do with our S+3M healthcare financing system that members are familiar with. And MediSave is the linchpin of that system.

18.           Singaporeans and our employers set aside part of our monthly income into MediSave. The Government also provides top-ups from time to time for various segments of the population, as we did that again this Budget. And we then use MediSave to co-pay directly for a small part of the cost of healthcare.

19.           So even a modest co-payment goes a long way to instil discipline and reduce unnecessary consumption – on both the supply as well as demand sides.

20.           And we do not have to look very far to imagine what will happen if that discipline is eroded.

21.           We just look at private healthcare in Singapore. The discipline of co-payment was weakened because of overly generous insurance, including the IP riders. And as a result, private hospital bill sizes have been rising rapidly. Private insurance premiums are escalating very quickly. So once that genie is out of the bottle, it is difficult to put back. But we will try – it will not stop us from trying!

22.           In our S+3M system, multiple payers – they pull their weight to pay for this national healthcare bill. Apart from co-payment, we have insurance schemes like MediShield Life – it plays a sizable role. A big part of it is also paid by charity dollars. We thank all the donors and philanthropic organisations.

23.           But the biggest proportion – about half – of the national healthcare bill is paid through tax revenues, redistributed as Government healthcare subsidies. The Government health budget today is about 2.7% of GDP this year, and it is expected to rise to around 3.5% (of) GDP by 2030.

24.           This 0.8 percentage point increase is actually very significant – it means increasing the Government’s health budget from about $22.5 billion this year to about $30 billion in 2030.

25.           And beyond 2030, the Government’s health budget will likely continue to grow. We must ensure that the increase can be supported by economic growth and by rising tax revenues. And at the same time, we must continue to maintain discipline and avoid unsustainable levels of healthcare spending that we see elsewhere.

Transform Healthcare

26.            So the next topic I want to talk about is to transform the healthcare system. A healthcare system for a young population is very different from one for an older population for a super aged society.

27.           Because imagine for a young person, sickness tends to be episodic – you are admitted to hospital, you got treatment, you get discharged, and then you recover. Good health is the default.

28.           On the other hand, an older person’s care journey is complicated and continuous. When well, they need preventive care; when sick, they need coordinated care, because they tend to have multiple conditions; post-discharge, they need rehabilitative care and follow-up care in the community. Good health is not the default, it is a continuous quest for an old person.

29.           So from episodic hospital care, we now need continuous multi-disciplinary care across settings. 

30.           And this shift is reflected in how we have allocated healthcare funding over time. Let me show another chart on the screen. The height of the chart is our government health expenditure. (The left bar is) 2021, and the right bar is 2024. You can see that overall, the budget has increased by 1.5 times, but I want to point members (to and) draw members’ attention to the composition.

31.           At the start of this decade, in 2021, about three-quarters of our operational funding for the healthcare sector went towards acute hospital care – that is the white portion of the bar. The remaining one quarter was spent on aged care and population health, including preventive and primary care.

32.           Today, we move to the right (in) 2024, the budget is 1.5 times higher. But the share for acute hospital care has fallen, from three-quarters to almost two-thirds, and the remaining one-third goes to aged care and population health.

33.           Specifically, the share of funding for aged care rose from 11% to 13% - that is the green portion – between 2021 and 2024. Over the same period, the share for population health grew from 14% to 19%. And these shifts are driven largely by national programmes - Healthier SG and Age Well SG.

34.           And looking ahead, how would this chart go? I think, almost certainly, the share of spending on aged care will grow further because we need more nursing homes, Senior Care Centres, rehabilitation services and hospice care.

35.           As for population health, we do our best to maintain this share at around 19%. With total spending rising, maintaining the share alone requires a strong commitment to continue to invest in population health.

Making Further Improvements

36.           Mr Chairman, today, my MOH colleagues and I will be speaking on further steps to transform healthcare and get ready for the future.

37.           SMS Koh will speak about manpower. It is a key agenda, including how we will significantly shorten the time to train clinical psychologists. We are taking seven to eight years currently; we will reduce it to about five years.

38.           SMS Tan will speak about anchoring care in the community through technology. And you heard MOS Rahayu speaking about population health and preventive care, including what we are doing in the North where prevalence of chronic diseases is higher. There was a question by Ms Marian Jaafar – you missed a part of that speech

39.           I should emphasise, this is in case she asks many clarifications later, preventive care and population health remain the overarching strategic thrust of what we are doing, anchored by Healthier SG and Age Well SG. I thank Ms Mariam Jaafar and Dr Haresh for speaking about this. This is at the core of healthcare transformation, and MOH agrees with many of the points you have raised.

40.           I will now speak about three new initiatives to support healthcare transformation.

Predictive Preventive Care

41.           The first common topic this whole COS and Budget debate - AI once again. Ms Mariam Jaafar and Dr Choo Pei Ling spoke about how AI can strengthen healthcare delivery and we agree.

42.           So when it comes to AI in healthcare, we are guided by two principles. Number one, care should be AI-enhanced, not AI-decided. Clinicians remain in the loop and healthcare remains a profoundly human endeavour.

43.           Number two, we take a practical, use case approach. AI should not be a hammer looking for a nail, a solution looking for a problem. We deploy AI when we know it will improve patient outcomes or the delivery of care, and we can do so cost-effectively. 

44.           One such use case is in health screening.

45.           Around the world, many AI models have been trained to predict if a well person is likely to develop severe diseases in the near future. And if you use it appropriately and responsibly, such tools are very useful. They help the clinicians intervene early. It can delay or even prevent the onset of severe diseases.

46.           MOH has developed such a model for our local context using anonymised patient data. With this model, by reviewing an individual’s current health status, it can identify if he has a high risk (defined to be 75% chance or above) of developing chronic diseases such as diabetes and high cholesterol within the next three years.

47.           We chose diabetes and high cholesterol because they are the key drivers of strokes and heart attacks, which affect 60 Singaporeans every day. Every day 60 Singaporeans either have a heart attack or stroke. Many of these cases can be prevented if early actions were taken, such as through lifestyle adjustments and medication.

48.           This AI risk assessment tool will be rolled out to doctors for all Healthier SG enrolees from early 2027. If the tool flags a patient as high risk, the doctor may recommend more significant lifestyle adjustments and instead of three-yearly check-ups, maybe annual check-ups. And these additional screenings will continue to be subsidised under Healthier SG.

Managing Hereditary Breast and Ovarian Cancer

49.           The second initiative, I think is an exciting and significant one. It is also a breakthrough – which is to use genomics to strengthen preventive care. Dr Hamid Razak asked about this. 

50.           We are born with our genes. They shape our biological blueprint, and indeed many diseases are linked to our genetic characteristics. But we need not be fatalistic about it. Genes are not our destiny. How we live, how we manage risk matter a lot.

51.           So we do not go fumbling through our genetic blueprint, hunting for blemishes and possible mutations that we know little about. It would create a lot anxiety and all of us will become a nation of hypochondriacs!

52.           Instead of shooting in the dark, we should focus on the parts of the blueprint that are illuminated by science.

53.           This means taking a disease-specific approach: identifying genetic characteristics that we know drive certain diseases, and for which we know there are established preventive interventions and treatment pathways.

54.           And this is what we did for Familial Hypercholesterolemia (FH). And we did that last year. FH is a genetic condition that increases the risk of heart attacks even among young people.

55.           The FH genetic testing programme offers subsidised genetic testing for individuals with abnormally high cholesterol levels. And if they are tested positive, we will offer the same test to their immediate family members. This is what we call “cascade testing”. And by doing so, we try to identify as many individuals as we can in Singapore with the FH genetic mutation. And then we take steps to reduce their risk of future heart attacks and strokes.

56.           And we will now move on to the next genetic condition which is Hereditary Breast and Ovarian Cancer (HBOC).

57.           In Singapore, it is estimated that 1 in 150 individuals carry a mutation in genes such as the BRCA1 or BRCA2 that are associated with HBOC. Such a mutation substantially increases a woman’s lifetime risk of developing breast and ovarian cancer.

58.           From December this year, we will offer subsidised genetic testing to at-risk individuals for HBOC – such as individuals with a family history of HBOC, or breast or ovarian cancer.

59.           They will undergo genetic counselling before and after the test. And if they test positive, we will also offer the test to their immediate family members – cascade testing. We expect over 2,000 individuals to be eligible for the test annually.

60.           We will make the test affordable.  In addition to subsidies, the cost of tests can also be offset using MediSave.

61.           For those found to have the mutation, they will be offered suitable preventive interventions. Typically this means more frequent breast MRIs or mammograms, or oral medication.

62.           Patients will ultimately decide, in consultation with their doctors, which intervention is appropriate. A minority may opt for surgical interventions. Members may recall celebrity actress Angelina Jolie, after she discovered she had the BRCA1 gene mutation, she underwent a double preventive mastectomy.

63.           I came across women in Singapore who chose to undergo preventive mastectomy to reduce their risk of breast cancer, such as Ms Gwendolyn Toh, and these women have demonstrated great courage.

64.           Unfortunately, they lament that they cannot claim insurance for such surgeries, because MediShield Life generally does not cover prevention and it is designed to be so for good reason – it is to keep coverage focused and premiums affordable. Then private insurance takes dressing from MediShield Life.

65.           Dr Hamid Razak and Ms Sylvia Lim asked about this. In fact, Ms Stefanie Thio, she is the founder of the non-profit organisation, SHE (SG Her Empowerment), has raised this issue with me several times.

66.           I share your concerns. With advances in medical science, the boundary between preventive and curative care is increasingly blurred. If a high-risk individual is unable to undergo preventive mastectomy, she has a high chance of eventually needing cancer treatments, including a curative mastectomy to remove cancerous cells in her breast, or cancerous tissue in her breast.

67.           There is hence a case for MediShield Life to be judiciously extended, to cover certain selected preventive surgeries. We are prepared to do so when there is a clear clinical need, minimal risk of abuse, the procedure is suitable for risk-pooling through insurance, and it does not financially burden the MediShield Life scheme.  

68.           Risk-reducing mastectomies for breast cancer prevention, and the removal of both fallopian tubes and ovaries for ovarian cancer prevention, fall within these criteria.

69.           We will therefore extend MediShield Life and MediSave to cover preventive surgeries for HBOC later this year. I should add that breast reconstruction is also covered, no different from today. This will better support women to harness genomics to better take care of their health.

70.           I think this is a meaningful policy change ahead of International Women’s Day on 8 March.

Update Medisave

71.           The third initiative is to inject more flexibility in the use of MediSave, to encourage early intervention and reduce downstream complications.

72.           Assoc Prof Jamus Lim was right to describe medical expenses as lumpy. Indeed, it is very well-documented that hospital expenses escalate, almost like a vertical wall, towards the end of life. Even after accounting for inflation, the average Singaporean living up to their mid-eighties, spends almost four times as much on hospital expenses in the last ten years of their life, compared to the previous ten years.

73.           That explains the existing design of MediSave withdrawals and why the scheme is designed like that – it has higher limits for more complex treatments and longer hospital stays, and you can draw on it as and when you need it. This meets the original objective of MediSave, which is to co-pay for major inpatient episodes, whether they happen unexpectedly or in old age.

74.           With this design, after subsidies, MediShield Life and MediSave, nine in ten Singaporeans pay less than $500 out of pocket for their subsidised inpatient bills.

75.           However, it is human nature to worry about present medical expenses, rather than lumpy, potential, unexpected or future hospital bills.

76.           Hence, as a relief valve, we have schemes like Flexi-MediSave and MediSave500/700 to provide flexibility for chronic disease management, for scans, for dentist visits et cetera, without overly diluting MediSave’s original objective of catering for these big lumpy hospital bills in old age or during emergencies.

77.           But the situation has changed since MediSave was implemented in 1984. At that time, people in Singapore lived to about 73 on average. Today, we live to 85 and beyond.

78.           On one hand, it continues to be important to preserve MediSave for big hospital bills. On the other hand, as people live longer, the need to spend on preventive care and chronic disease management also goes up.

79.           Hence, I can appreciate the repeated and various calls by members to allow MediSave to be used more flexibly, to cover more chronic diseases, or as Mr Pritam Singh suggested, to pay for higher private insurance premiums.

80.           But I also hold the realistic view that no matter how frequently MOH reviews the MediSave scheme, how much we liberalise and expand its usage, the public and Members of this House will continue to press me and MOH to liberalise the scheme every year during the COS and probably outside of the COS.

81.           It is the karma of this scheme because it is designed to be the linchpin of the healthcare financing system. It must always navigate between present and future healthcare needs, between recurring disease management and the major hospitalisation episodes.

82.           Trade-offs are inherent in the MediSave scheme. It is zero-sum. Using more balances for recurrent medical expenses means having less in the future when we are hospitalised, and vice versa. And when the tension becomes too severe, we will have to consider raising contribution rates so that we have a bigger pot to spend.

83.           The tension is therefore deliberate and a design feature. It is a balance we must constantly and carefully manage, to ensure the system of co-payment is held together while ensuring affordability and keeping CPF contribution rates reasonable for everybody.

84.           Hence, we continue to have ongoing, regular reviews to study where we can expand the use of MediSave and provide more flexible withdrawals. For example, we recently increased the Flexi-MediSave limit for seniors and we doubled the annual limit for diagnostic scans.

85.           This time, we will make further changes to the MediSave500/700 scheme, this scheme helps patients pay for the recurring costs of managing conditions on the Chronic Disease Management Programme, or CDMP. Mr Cai Yinzhou and Mr Gerald Giam asked about this.

86.           So today, individuals with a simple chronic condition can use up to $500 a year, while those with complex chronic conditions can withdraw up to $700 per year.  

87.           To provide more support for preventive and chronic care in the community, we will raise the MediSave limits from $500/$700 to $700/$1,000. This will benefit over 910,000 patients who currently tap on the scheme, roughly 20% of whom have annual bills exceeding the withdrawal limits.

88.           We will also expand the list of conditions covered under the CDMP to include hyperthyroidism and hypothyroidism. In addition, we are studying whether we can include other chronic conditions such as eczema in the CDMP.

89.           With the above enhancements, we will rename “MediSave500/700”. t is actually a cumbersome name, every time you change the limit, you change the name. We will rename it to the “MediSave Chronic and Preventive Care Scheme”, to reflect the scope of coverage. The changes will be effective January 2027.

90.           Before I end this section, let me address the question posed by Ms Sylvia Lim.

91.           Ms Lim – I thank her for watching my TikTok videos – she mentioned the role of riders in providing additional coverage for cancer treatments not on the Cancer Drug List (CDL). The objective of the recent changes to the IP riders is to prevent the over-erosion of co-payment, because that sets off a ‘buffet syndrome’ and then that leads to rapid escalation of private hospital bills. IP riders covering non-CDL drugs for out-patient treatment do not contribute to this erosion, and therefore this feature will not be affected by the changes. I should also point out that the changes to IP riders affect only new policy holders, but not existing policy holders. We will always watch out for the cancer patients when we make changes to the IP riders.

Mandarin Speech

92.           Mr Chairman, in Mandarin please.

93.           今年是2026年，新加坡社会已经迈入超级老龄化。我们要以平常心来看待这件事，就像过生日一样，虽然大了一岁，但是日子照过，没有什么突如其来的变化。

94.           新加坡一直都有未雨绸缪的精神，因此，早已为社会老龄化做好了准备。过去10年，政府陆续调整各领域的政策，目标就是要每一个新加坡人都能够老有所养、病有所医、住有所居。

95.           最重要的一点就是要国人保持这个人老，心不老的心态。因此，预防性保健已成为卫生部的政策核心。

96.           所以说到卫生部，我对这个名称有一点看法。严格来说，卫生部不是管卫生的。卫生英文是 “hygiene” – the Ministry of Health does not look after hygiene。卫生是由环境及可持续发展部 - 傅海燕部长所管 – 她今天不在。但从医疗角度来说，大家也明白所谓的卫生，指的是预防、抵抗和治疗各种传染病。这依然是我们的重要宗旨。

97.           但现代社会的医疗挑战跟以往已经不一样了。非传染病，比如癌症、心脏病、糖尿病，所造成的伤害，远胜于传染病。

98.           为了更好反映卫生部的核心政策，我们将把部门的名称改为“保健卫生部”。英文名，Ministry of Health没有改。我们的名正了，言举就自然顺了。

99.           有人也许会问我，卫生部改中文名是否会花很多钱？请大家放心。我们的标志、法令、文件、网站等等，几乎全部都是用英文名称。这是另外一个问题 –我们用的都是 Ministry of Health。所以这次改名主要是影响今后的媒体报道，所以开支非常少，甚至没有，但是所传达的意义是重大的。

100.           我也刚宣布了几项新政策。

·      第一，为了让国人继续负担得起慢性疾病所需的医疗开支，我们将从明年起把保健储蓄的年度限额从500元调高到700 元，而病情较复杂的慢性病患年度限额也会从700元调高到1000元。

·      第二，我们将从今年开始为风险较高的女性提供遗传性乳腺癌和卵巢癌的基因检测的政府补贴。

·      第三，我们会运用AI，协助医生预测国人患上高胆固醇、糖尿病等慢性疾病的风险。对于高风险的国人，我们会通过健康SG，鼓励他们采取反防措施。

101.           说到AI，我在过去一年里，和保健卫生部的团队分别到美国和中国考察，学习他们在科技应用方面的经验和做法。

102.       在美国，我参观了几家很好的医院。我问他们：在所有的AI应用场景中，哪一个最管用？他们都不约而同地说，使用AI记录病人的病历最好，即省时，又省力。

103.       我非常赞同这种做法。虽然用例看起来很简单，但能让所有人从中受益，鼓励大家接受新科技，明白这个新科技能够帮助我们，而不是威胁我们。

104.       在新加坡的公共医院，我们已经开始使用AI记录病历。我们的AI听得懂英语、华语、马来语、淡米尔语，和广东话。但我不知道为什么它只听得懂广东话，我们的AI正在努力学习其他方言。

105.       有人曾经开玩笑说：最有经验的医生看人，有经验的医生看病，没有经验的医生看电脑。我相信不久的将来，大多数的医生有了AI自动打入笔记，都会看人，而不是看电脑。

106.       今年，我也到访了中国，参观了一些医院和科技公司。我发现中国医院也正在大胆地尝试新科技。

107.       这种敢于尝试的精神值得我们学习。但我们也必须认识到中国和新加坡国情不同。例如，在我参观的中国医院中，一些传统手术已经被机器人所取代。但是机器人手术成本高昂，这些费用往往由病人自行承担。或者医保的报废也会增加。因此在新加坡，我们推广机器人手术或任何科技的时侯，我们非常谨慎，考虑到成本效益和患者的负担能力。

108.       从希波克拉底 -就是Hippocrates- 和华佗，到AI和机器人手术，医疗领域的发展日新月异，我们会多管齐下，用长远的政策、高素质的医疗团队，以及具有成本效益的科技，为国人带来更好的医疗服务。

Hallmark of Governance

109.        Mr Chairman, when I informed the House three years ago that we would be a super-aged society this year, it was not to instil fear, but to prepare ourselves.

110.       Our transition to a super-aged society has been steady rather than dramatic. It reflects deliberate, long-term planning, including transforming the healthcare system.

111.       Indeed, healthcare transformation is fundamentally a long-term endeavour, not one sweeping reform. It is the accumulation of numerous small steps – each taken with judgement and purpose, each carefully planned and executed. Today, we announced further deliberate steps.

112.       Mr Chairman, it is my hope that this House continues to support our approach of long-term planning, long-term governance, to anticipate future challenges early and act before they overwhelm us. If we do so, we need not fear being a super-aged society. We can embrace it and we can make the best of it.

113.       Ultimately, it is not the percentage of Singaporeans above 65 that defines us. We can exercise our wiser minds, to mourn less for what age takes away from us than what it leaves behind.

114.       What matters is that Singaporeans are not just living for longer; we are living heathier for longer. We are not just a super-aged society; but we are striving to be a super-healthy one as well.

115.       Thank you, Mr Chairman.