The Singapore International Cardiovascular Therapeutics Conference

05 Aug 2004

By Dr Balaji Sadasivan , Minister Of State For Health

Venue: Suntec City Convention Centre

Opening Address By Dr Balaji Sadasivan, Minister Of State (Health & Transport), At The Singapore International Cardiovascular Therapeutics Conference On Thursday, 5 Aug 2004 At The Suntec City Convention Centre At 8.30 A.M.

A/Prof Lim Yean Teng and Dr Tan Huay Cheem, Course Directors for the Singapore International Cardiovascular Therapeutics (SICT);

Distinguished guests,

Ladies and Gentlemen,

Thank you for inviting me to this inaugural SICT conference. This is an innovative conference, where delegates will get to witness live demonstrations of percutaneous coronary intervention (PCI) procedures from our own National University Hospital and no less than five overseas hospitals in China, India and the United States. The organisers are to be commended for bringing together an international faculty and coordinating the broadcasting of so many live demonstrations from around the world. I am sure that you, the delegates, appreciate this opportunity to learn about the latest advancements in the field of PCI.

Conferences, such as this one, are important for the opportunity they afford for doctors to share advances, learn from and network with others in the same field. Besides that, the topic of this conference is of particular importance because of the prevalence of coronary heart disease. In Singapore, coronary heart disease is the second leading cause of death. The two most common procedures to manage coronary heart disease are coronary artery bypass surgery and PCI. In Singapore, the number of patients who underwent PCI procedures has increased from 2450 in 1999, to 3225 last year.

In order to allow Singaporeans to benefit from and afford effective health technologies, my Ministry has introduced a Medical Service Package or MSP. The MSP is a system to ensure that Singaporeans receive the appropriate subsidies when there is a medical need for the healthcare services they use.  In practice, the patient's doctor will assess what basic and extended medical services the patient requires, and under the MSP, the patient will receive the target subsidies of 65% for B2 class patients and 80% for C class patients for their overall bill.

I mention the MSP as it has particular relevance to this conference because we have piloted the MSP in cardiac specialties since 5th July this year.

The greatest impact of the MSP will be a significant drop in the hospital bills of patients who requires items like pace-makers, stents and other cardiac implants. This is because they will now receive the target subsidy for these items when they are considered to be medically necessary.

I asked The Heart Institute at the National University Hospital for a report on how the MSP is helping patients at NUH. They have reported that between 5th July and 26th July, at NUH, 91 patients benefited from subsidies for devises.  Sixty cardiology patients enjoyed additional subsidies of about $1,850 per patient and 31 cardiothoracic patients enjoyed additional subsidies of about $1,174 per patient. In total, this amounted to additional subsidies of about $147,000 for 91 patients.

The MSP for cardiology services was developed with the help of a team of cardiologists. So, recently, when there were several letters in the newspapers about Lipitor, I checked the web-site www.Lipitor.com. to see if it could tell me how many additional months a patient would live if he took Lipitor.  I did not find the answer to what I was looking for but under the heading "important information", I found the following: Lipitor is used with a low fat diet to lower cholesterol, but it has not been shown to prevent heart disease or heart attacks. It is not for everyone. Under the heading "warnings", I found that it can give rise to serious liver and muscle damage.  Further internet research disclosed that if the level of cholesterol is decreased to a very low level, there was an increase in the risk of bleeding in the brain. This as we all know is a serious problem especially among Asians who are known to have a higher risk of bleeding in the brain than Caucasians. After reading about these risks, I think it is prudent to leave it to the experts, ie the cardiologists, who have the expert knowledge to determine the medical details of the MSP. The MSP will be reviewed when necessary.

What part can you, who are attending this conference, play in the proper management of patients? It is important that you continue to learn about new technologies and find out which ones are effective and bring the most benefit to your patients. You must also learn about the limitations and risks of new advances. By developing and furthering the evidence-base for the innovative procedures you will be discussing in the next few days, you will ensure that your patients get the correct treatment they need.

It now only remains for me to wish you all a fruitful and instructive conference, and to those of you who are visiting, I hope you will enjoy your stay in our country and come back again.