Our Minister of Health, Mr Khaw Boon Wan, spoke on 14 Nov 2006 at Parliament. He opened with a reflection of his trip to Japan with his wife. However, being a dedicated minister, couldn’t help but think about work even while on holiday. Apart from his philosophical inputs in the speech and what our current 3M system is and will do, he did not spare from criticising our own health system, and suggesting improvement.
Focusing on the Unglamorous
These enhancements are largely for the acute care sector, where patients receive treatment in hospitals and specialist clinics. The enhancements will ensure that Singaporeans continue to have access to high-quality care, without causing severe financial strain to themselves or to society.
But with the continuing ageing of the population, I will now focus greater attention on primary healthcare and step-down care. Unlike tertiary care, this is an unglamorous cousin. But for the elderly, this is an important sector. The better a sick elderly patient is cared for by his Family Physician or in the step-down care sector, the better off the patient will be. We will study how best to strengthen and grow this sector. This sector ranges from care at home, to care at day centres, to GPs, to nursing homes, hospices and community hospitals.
We do not yet have all the solutions, but some of the problems are known. First, the care is not well-integrated. When patients move from one care provider to another, they often encounter obstacles. Patient flow across facilities and institutions is certainly not seamless. To make proper chronic disease management happen, our doctors, nurses and other professionals need to work together, in a different, improved manner across inpatient, outpatient and step-down care. We need to have public sector specialists collaborate with private sector GPs. We need VWOs running community hospitals and nursing homes to work with acute care institutions and Family Physicians, to deliver better patient care. Ideally, all care providers should regularly share information and consult each other, but the reality is not quite there yet.
Second, the care quality varies over the range of providers. While some providers do provide good care and service within their facilities, there are places which do not do as well.
Third, information on this sector is incomplete and hazy. Patients do not know the full range of step-down care choices that are available to them. Some feel that they are stuck with no option other than their current provider. Last month, we published the key data on nursing homes and community hospitals. It is a first step and we will refine the publication further.
Fourth, we do not know if our range of step-down care services is comprehensive enough. Are there gaps? Are there niche services which are absent today but can usefully meet a real need? Some of these services go beyond my Ministry’s portfolio, and we will work with other Ministries to ensure that genuine needs are adequately met.
Mr Speaker, Sir.
Our population will continue to age. We will try to slow it down by raising births and stepping up immigration, but we cannot avoid it. The better prepared we are for this inevitable demographic change, the better we can ensure that elderly Singaporeans face old age with confidence, calm and peace of mind. My Ministry will do its part to anticipate rising demand for healthcare services, both at the acute and step-down sectors, and marshal resources to ensure that there will be sufficient beds, manpower and expertise.
Today, we spend about 4% of our GDP on healthcare services. Considering the high standard of our care and Singaporeans’ health status, this is quite an achievement. But to meet the future needs of our population, it is not possible to keep healthcare expenditure in this region of 4% indefinitely. It is bound to increase. This increase will have to come from all stakeholders: Government, employers, insurers, patients and their families. This is part of the reason why GST has to go up. But I will recommend to the MOF to fully offset any GST increase on medical costs incurred by subsidised patients, as we did in the previous GST offset package.
On my site visit this second semester to Kingston Centre, a sub-acute hospital in Melbourne, the geriatric medicine registrar was explaining to us the concept of acute & sub-acute hospitals, nursing homes and rehab centres. It was intriguing. I couldn’t help but to wonder if we had such comprehensive care in Singapore, given our aging society. I knew we have top-notch acute hospitals, like Tan Tock Seng Hospital, Singapore General Hospital, Changi General Hospital, etc, belonging to the 2 big public healthcare groups, National Healthcare Group and
SingHealth, and a lot of nursing homes.
But sub-acute hospitals? The place where we dedicate geriatric medicine specialists to these elderly patients, aid their route to recovery, throwing in physiotherapists, occupational therapists and other allied health professional services on a CONSISTENT rehab program that ensures they can be discharged with full independence SAFELY? OR is it just my lack of understanding of our public healthcare system, perhaps, that we already are doing that in Singapore, somehow? Are our acute hospitals not really acute in that sense? Or do we really lack that aspect of wholistic healthcare?
On the topic of wholistic healthcare, Josh was mentioning its marketability in Singapore. Consumers love it. They will embrace it like a new branch of medicine, a new technology that is complementary, alternative or even wholistic. If the Chinese like Traditional Chinese Medicine, we should embrace it. We western doctors should take a step to understand what the TCM practitioners are doing, and keep them in check, or even integrate them in our practice. I know of a clinic in Camden Medical Centre that does just that. The TCM community has their specialties as well – this clinic is an excellent example. And hey, there are more and more private practices all over – Paragon, Camden, Shaw Centre, etc, that offers a variety of specialties to patients, making themselves each a one-stop clinic for all health issues. Examples are Excellence Health Care and Asia Medic.
This probably seems a little off topic. But wait for me, my point is coming, what about the middle and lower class people in Singapore? Are we going to tell them “Get out of my elitist face” or “Let the government worry about this societal problem”. Is there a solution? Will the public healthcare system suffice with the 3M framework? How else can we improve it? Will the Minister of Health’s recommendations above suffice? Or are they just sweet talk with no action? Time will tell.
Brings me back to my personal blog’s entry on “Singapore – Are you a stayer or quitter?”
Will we want to be the people, who, being grateful for the safe and conducive physical and non-physical environment we have been brought up in, want to give something back to the nation? Or will we just immigrate to some other country, for conveniences, for career opportunities, for lifestyle choices?
I can’t profess to be any group for now. How about you all? (‘click comments below and say your piece/peace’)
But i do know, someday, somehow, i’ll be back. For there is a longing in my heart.
Cheesy line alert: “This is home, truly, where i know i must be, where my dreams wait for me.”
