Speech by Mr Tharman Shanmugaratnam, Deputy Prime Minister and Minister For Finance and Manpower at Raffles Medical Group’s 35th Anniversary Dinner

10 Jul 2011

By Mr Tharman Shanmugaratnam
Venue: Raffles Medical Group’s 35th Anniversary Dinner, The Ritz Carlton Hotel

1. It is my pleasure to join you in celebrating Raffles Medical Group’s (RMG) 35th Anniversary this evening. RMG has come a long way.  From a two-clinic operation when it first started, it has now a large network of healthcare facilities and services in Singapore, Hong Kong and Shanghai.

SINGAPORE  HEALTHCARE

2. In many ways, the growth of RMG through the years has mirrored the development of healthcare in modern Singapore. Our healthcare system and public expectations of it have evolved dramatically, within the short span of over four decades since our independence. From a system comprising basic healthcare services provided in simple settings, today’s system brings together extensive specialist expertise and technology in both primary and tertiary care.  Like many other developed countries, the focus of treatment has also shifted from infectious diseases to chronic diseases.

3. Most nations share the same objectives in healthcare  -  a high quality but efficient healthcare system; one that provides access to all in the population and equitably; and ultimately, healthcare that allows for long, healthy and productive lives.

4. No nation, including us in Singapore, imagines that it has got this just right.

5. The US provides rapid access to high quality, specialised healthcare services but with high costs, and the exclusion of many citizens who are not insured and lack affordable access to even primary care. Some others like the UK and Canada provide services at little cost to the patient, but with long wait times for specialist services. 

6. Singapore’s healthcare system is generally well-regarded on most broad indicators, which reflect both quality and equity. For example, the International Institute for Management Development’s (IMD) World Competitiveness Yearbook rated our healthcare infrastructure as the 4th best in the world in 2009 ; while the World Health Statistics 2010  ranked Singapore as the 2nd lowest in infant mortality and the 9th highest in life expectancy.

7. However, there is still much to be done to improve and refine our system - from prevention and detection of illnesses by promoting healthy lifestyles and screening, through to treatment, rehabilitation  and long term care. We face the same challenges as most developed countries, of a population that is getting older. The overall burden of disease will rise, with more people suffering from chronic conditions such as diabetes and hypertension.

8. We want to provide quality care as our people get older, but at an affordable cost to both the patient and the tax-payer. No healthcare system is sustainable otherwise. This includes meeting the needs of those who are not poor, but not rich either -  those in the middle-income groups. We are focused on meeting these needs as we go forward.

AVOIDING A ZERO SUM GAME BETWEEN THE PUBLIC AND PRIVATE SECTORS IN THE  HEALTHCARE SYSTEM

9. Improving healthcare for Singaporeans must involve both the public and private sectors. They both comprise our national healthcare system. This means a shared responsibility to meet the  needs of our people and ensure the sustainability of the healthcare system as a whole.  We need all hands on deck to manage the healthcare challenges of the future.  

10.  All our doctors start out in the public sector, where they are trained and acquire the skills that will serve them for the rest of their careers. Some spend most or all of their careers in the public sector.  But a growing number have moved into private practice, with some not even serving out their bonds in the public sector.

11. However, when doctors cross over to the private sector, for the vast majority it is like crossing the Rubicon – there is no turning back; most stop serving public sector roles like teaching the next generation of doctors, and treating subsidised patients. About 40%  of our specialists are now in the private sector whereas much of Singaporeans’ needs are still catered for by the public sector. 

12. We have to find systemic solutions to avoid this being a zero-sum game.

13. As our population ages, and more Singaporeans need care, the public sector itself cannot meet all their needs if it does not retain enough doctors.  In this regard, the government is thinking through what might be a sustainable new framework.

14. We don’t have the answers yet.  But the direction of our thinking includes the private sector carrying some of the responsibility for training and education, and taking on a share of the load to treat subsidised Singaporean patients, even as the public sector remains the anchor of the healthcare system.  When a doctor crosses over from the public to the private sector, we want to have a bridge that makes it easier for them to step back, so that more doctors in private practice can still be tapped upon to serve a public mission.

15. The Ministry of Health will look at how we can facilitate the better integration of private and public healthcare services through review of our financing, incentives, regulation and clinical programmes  -  all aimed at ensuring a national healthcare system that serves the public well  and at affordable cost. 

16. One aspect of this is information sharing through electronic clinical records. For chronic diseases especially, effective care has to be team-based, and effectively coordinated and integrated across providers. The National Electronic Health Record (NEHR) system that we have embarked on will be an integrated healthcare record centered on the individual.

17. We have made good progress. The new NEHR is ready for launch soon.  We will be rolling out this out to community hospitals, GPs and eventually the Nursing Homes.  We should together explore how the private sector hospitals can be part of this integrated national medical records system.

18. We will engage widely, as we think through the improvements needed for the future. We look forward to leadership from players like RMG with presence in both acute specialist and primary care, to work with us in building a stronger sustainable healthcare system.

SUSTAINING THE VALUES OF THE MEDICAL PROFESSION

19. The private sector also plays a key role in shaping the right behaviour among practitioners and professionals.  When patients go to doctors, they do so with hope and trust. Hope that the doctor can save their lives, or help them live more satisfying lives. Trust that whatever course of action that the doctor chooses for the patient, it would be with the noblest of intentions and for the good of the patient. Nobody wants to be subjected to more tests than necessary or overcharged, let alone offered sub-standard care.

20. Medical practice is very much self-regulated by the profession rather than by an external regulator.  This means that the profession has a responsibility to come together to ensure that it sustains a consensus about ethics and ethos of practice that is centred on the interests and safety of the patient. It is therefore critical, even with business playing a legitimate role in medical practice, that we guard against any drift from the time-honored values and ethics of the profession.

21. Singapore’s reputation for medical excellence is a collective honour and responsibility, and I hope to see the medical leadership across the country coming together to sustain this.

CONCLUSION

22. In closing, let me once again congratulate the board, management and staff of Raffles Medical Group on your remarkable story to date. I am sure you will continue to build on this, enjoy more fruitful years ahead, and add resilience to our national healthcare system.