The Opening Ceremony of The 3rd National Disease Management Conference

19 May 2006

By Mr Khaw Boon Wan, Minister for Health

Venue: Grand Copthorne Waterfront Hotel

Three years ago, I rejoined the Ministry of Health after an absence of nearly 15 years. Some old issues remain important on our agenda, such as healthcare cost, ageing of the population, low birth rates.  Being familiar with these evergreen issues, I was able to start work immediately. 

As I resumed my reading of health journals and discussions with the industry experts, I was glad to note that there were new issues too. In particular, some healthcare policy innovations have entered mainstream thinking. The medical world has thankfully not remained stagnant.

One such innovation is in the management of chronic diseases. That chronic diseases are major causes of death and human suffering remains a fact as in the past.  But experts have by now a better understanding of the progression of these chronic diseases and in some cases, have reached consensus on how best to manage them so that the patients can delay or even avoid serious complications. Also, new medications have become standard provisions in the doctors' toolbox. 

Diabetes is a good example of what proper disease management can do to help diabetic patients live a longer and healthier life, while saving them money in unnecessary medical treatment.  

Impact of Chronic Diseases

Last month, at SGH I met a Malay woman who had diabetes for many years, but not well-controlled. Now she suffers from heart and kidney complications and for the first time popped up in our hospital. She has to see multiple specialists, take many medications and chalk up large medical bills. 

Many countries are grappling with similar problems. Patients who have chronic diseases tend to be diagnosed late, only when complications have developed. And when they commence treatment, they are treated by multiple specialists, given all sorts of medication, with poor coordination of care. Surely, there is a better way to manage these problems?  

Making a Difference

I hope we can transform the way chronic diseases are managed in Singapore. Being small we have some advantages. We are compact and I believe, better organised. The SARS experience gave me optimism that Singaporeans can rally together to fight a common problem, when the problem and the solution are well explained.

The tools for managing chronic diseases are already here: healthy living, early detection, prompt treatment and patient compliance. These are not rocket science.  Their effectiveness has been proven in local pilot studies.  

For example for diabetes, the key is to control the blood sugar level. In our polyclinics, patients under the diabetes disease management programme showed twice as much improvement in blood sugar level control when compared to those not on the programme. This will mean fewer complications for such patients in the future. The challenge is to scale up these local disease management programmes nation-wide.  We need to get more patients routinely on such structured disease management programmes and in control of their blood sugar level. 

We are allowing the use of Medisave to help co-pay these chronic disease management programmes, even when they involve outpatient treatment. This is a major change in Medisave policy.  There are four reasons.

First, we want to lower the barrier to treatment by patients who may otherwise forego treatment until complications emerge.

Second, we want the patients to comply with the structured programmes and take ownership of their own health. They must change their lifestyle and take regular medications. Medisave withdrawals will be subject to patients' compliance with the prescribed programmes.

Third, we want to ensure a good standard of disease management by the participating doctors. Medisave withdrawals by their patients will be subject to regular audit by MOH.  

Fourth, we want to disseminate information to the patients so that they can make better-informed decisions when they shop around for suitable disease management programmes for themselves. Through the Medisave claims, we will collect health outcome data of the patients, like blood sugar level or blood cholesterol level, track them over time, compare with results in similar patients in other clinics and publish them. 

In this way, we can over time, learn from one another on what protocols work better and cost less. The aim is to transform the way we manage chronic illnesses using evidence-based preventive strategy through patient compliance and empowerment. Treatment protocols must conform to international best practices with proven effectiveness. Patients must be managed based on their needs and not based on how much can be withdrawn from their Medisave.       

The Task Ahead

To succeed, we must work together. We will consult widely. Dr Lee Suan Yew chairs a Disease Management Advisory Committee of Experts. They will help us develop and monitor our chronic disease management strategy.    

We must innovate and try out new ideas. When necessary, we should break through existing mindsets, identify new initiatives and chart bold directions.

As an example, we will use the upcoming Jurong Medical Centre (JMC) to actively engage patients in their care and develop best practices in chronic care. It will be a one stop centre, with the necessary nursing, paramedical and support services (e.g. podiatry, eye screening and dietary counselling) needed for good chronic care. The facilities will serve the GPs in the vicinity. I hope they make full use of these facilities. 

Dr Tan Cheng Bock is actively helping us in this project. He chairs the JMC Advisory Committee. They are engaging the patients, the GPs and the VWOs to help evolve a patient-friendly and seamless health network for the residents of Jurong. The lessons learnt from JMC would seed further innovation in other parts of Singapore. 

Enabling Providers and Empowering Patients

We will enable and support the GPs so that they can consistently provide the many aspects of care required for the management of chronic diseases. The College of Family Physicians and our hospitals will run updates on chronic disease management as part of the continuing medical education. 

We must particularly engage the patients in their own care. They cannot improve if they do not comply with the treatment prescribed or adjust their lifestyle.

Thus empowering the patients with the necessary knowledge and helping them make the necessary lifestyle changes is a critical success factor. Our diabetes centres have many such wonderful stories of success. 

One lady in her 60s has been on insulin for years. But she was able to get off the daily insulin injections, after she reduced her weight by controlling her food intake and exercising diligently.

There are many others who were able to slow down the deterioration of their kidney functions, after they controlled their blood sugar level, blood pressure and generally eating wisely and exercising regularly. They were able to delay having to go on dialysis.

There are many successes like these and we want many more patients to improve like them.

Healthy Lifestyle

The keys to good health are well known. Eat wisely, exercise regularly, practice good hygiene, do not smoke and learn to cope with stress. Five simple steps.  Let's all make it our way of life.

Let me end by urging all Singaporeans to be four million shining examples of healthy lifestyle. This will have lasting impact on your health and your well-being. It is the most effective way to help us live long and healthy lives and lower medical cost.   

Thank You.