Govt to shoulder larger burden of medical care

Elderly to be a major focus: Health Minister

By Salma Khalik, The Straits Times, 4 Nov 2011

Health-care spending will go up as Singapore ages, and the Government will shoulder a larger burden of this to ensure medical care remains affordable, said Health Minister Gan Kim Yong.

While some of the additional money will be spent on infrastructure, manpower and services, the rest will be on 'very targeted help', he said.

One key area is the fast-growing segment of older people.

'A significant portion of the money will be spent on managing the ageing population, whether it means more nursing homes, more day care sectors... a lot more support for home care,' he said.

Mr Gan, who heads the Ministerial Committee on Ageing, noted that Singapore had not really experienced the real pressures of an ageing population yet.

Babyboomers will hit 65 only around next year, and at that age, people are still healthy, he said.

But in 10 to 20 years' time, the change in the make-up of society will be really apparent.

'We have to prepare for that, so I think a significant portion of the additional money that we'll be spending will be on this ageing,' he said.

The extra money will have to be spent wisely as resources remain limited, and projects must be those that will 'really make a difference'.

One example is the Primary Care Partnership Scheme  (PCPS) where eligible patients can see a general practitioner for their chronic ailments, with the Government footing part of the bill.

The scheme will be expanded from next year to benefit half the population aged 40 years and older.

This will mean an injection of more than $25.5 million a year. This additional money, Mr Gan said, is 'targeted very specifically at chronic diseases'.

Another area where more money might be spent, he hinted, is to help patients discharge from hospitals early.

'Some patients are ready to return home, but they are not prepared to do so because the rest of the family members are not ready,' he said.

'If we are able to help them, then we will be able to cut down the cost and consumption of more expensive health-care services.'

Such targeted expenditure, he said, is one of three keys to keeping health-care costs down in the long run.

He cited personal responsibility - where every Singaporean takes some responsibility for his own health - and innovation as the other two.

'From time to time, we need to take a fresh look. Can we do it in a better way, in a more cost-effective way; delivering good quality health care efficiently while keeping the cost low?' he said in an interview with The Straits Times recently.

'We will need to continue to innovate and find ways of delivering our health-care services more cost-effectively.'

Changes in the health-care scene will have to be continual, as must the Government's targeted help. 'There's no end point.'

He acknowledged that there is currently a squeeze on facilities and more infrastructure will have to be built, especially step-down facilities like community hospitals and nursing homes.

The ministry is working on a masterplan for intermediate and long-term care facilities. These are far cheaper to build and run than general hospitals.

Part of this masterplan will look at building more day facilities so elderly people who require care can be left there during the day and picked up in the evening, much like working parents who leave their young children in day care.

One of the things the ministry is looking at is where these centres should be located, and what services they should offer. His expects to see different models, as there is no one correct answer for everyone.

Mr Gan said spending money helping the elderly stay home might be better, even if it does cost a bit more. Singapore has space constraints, so building more nursing homes might be difficult. Most of the elderly also prefer to continue living at home than in an institution.

'We have to acknowledge that there is a place for institutional care and there is a place for home care. The key is right siting; receive the appropriate level of care at the appropriate site. That will be most cost-effective overall,' he said.

Health Minister Gan on:

Dealing with an ageing population

'Ageing cannot be prevented. You can't even slow it down, although a lot of us want to.

But you can minimise the adverse effects of ageing. So, for example, if you manage chronic diseases well, even if you have a chronic disease, it may deteriorate slower.

So you slow down the progress of your disease, slow down the onset of your disease.

But other than this medical side of ageing, you've got to also think about how to keep these seniors active, so that they can have fulfilling lives, meaningful lives in their senior years.

So how can we encourage the community at large to accept these seniors in their midst, not look at them as a burden or a liability but as an asset that adds colour, adds vibrancy, adds value to society.'

Pilot projects on housing the elderly

'What kind of housing types would be useful, effective, in addressing their needs? Is it practical to relocate them en bloc to another purpose-designed facility for seniors, or is it better for us to do in-situ modification, let them stay where they are?

Are studio apartments for the older population a practical solution? Do we need to modify them?

What kind of refinement will make it more effective and meaningful for the seniors?

There are pros and cons. You put them all together, there's economy of scale, better focused services, voluntary welfare organisations (VWO) will be very effective in supporting them.

But is it better for them to integrate more into the community? Should we have a mix of these studio apartments with other developments?

There may be less economies of scale, but you may have a better outcome. So it's a trade-off, it's a balance.'

Importance of maintaining a healthy lifestyle

'We hope that we can be successful in promoting healthy living so that we have fewer severe cases. And we hope that we are successful in managing the chronic illness so that progress can be slowed down, and that fewer will be institutionalised.

There are only three key factors that affect the outcome.

One is ageing, which we can't stop. Secondly, it's extending lifespan, which is good to have. The third one is lifestyle.

That is the only one that we can influence. So the other two, either it's desirable or you can't change it. So the focus must be on changing the lifestyle for Singaporeans.

If you are able to screen earlier, encourage better chronic disease management in the community, ensure that patients continue to receive treatment and take their medicine regularly, consistently, then you will be able to manage progression of these chronic disease in the society.'

The role of the Ministerial Committee on Ageing

'Rather than setting ourselves a target, we will continue to improve, continue to find ways to engage the seniors, allowing them to have a better life, healthier life always, and fulfilling life. So we hope to be able to do better next year than this year and so on.

The ageing process does not stop and the whole team is very conscious about the urgency. That is why I think we are quite committed to press on, work hard on this.

The pressure doesn't come from me as a minister. The pressure comes from the ageing society. By 2020, 2030, you will find that society would have aged significantly; the landscape would be different from what we are seeing today. And the unfortunate thing is that we can't wait till then to do something. We got to do it now.

The members of the committee are very conscious of that, and that's why they are very motivated. While we have other portfolios, this is a key portfolio.

It is not extra-curricular activity. It's part of the core curriculum.'

Remaining in the pink of health care

Editorial, The Straits Times, 7 Nov 2011

HEALTH Minister Gan Kim Yong's assurance in an interview that the Government will shoulder the larger burden of health-care spending as Singapore ages is welcome news. Especially so for lower- and even middle-income Singaporeans who will feel the strain from what has been a gradual but inevitable rise in health-care costs.

Just last month in Parliament, Sengkang West MP Lam Pin Min made a pitch for more Medisave subsidies and an extension of the MediShield insurance coverage beyond its current age limit of 85. The tide of the oft-cited 'silver tsunami' lies behind such concerned calls by MPs like Dr Lam, given the reality that one-fifth of Singapore's population will be 65 and older in 20 years' time. And with longer life expectancies here, some have even begun to ask if the laudable and longstanding Medisave health-care savings scheme will be adequate to meet needs.

Cost concerns are clearly in play too, with Parliament having heard that in the last three years, medical costs rose 6 per cent to 8 per cent every year compared to wages, which were up 2 per cent to 4 per cent a year.

That Mr Gan and his ministry have been aware of the signs and are working on measures, both broad and targeted, will give hope and spell relief to those feeling the pinch.

Yet even as the Government moves to ensure that health-care costs remain affordable and seeks to balance resources on infrastructure and delivery of services, Singaporeans must themselves act responsibly in matters of health and costs. The importance of buying individual health cover while they are healthy and insurable cannot be overstated. Many assume that coverage they receive while employed will suffice.

Such thinking can lull many into a false sense of security. The nature of employment and economic cycles in this day and age suggests that changing jobs will be as commonplace as downturns and the industry-wide restructuring that takes place to keep economies, and companies, competitive. And in many instances, company-provided health schemes are not portable. So that particular umbrella of health protection can be upturned. Retirement also inevitably looms for all - even as steps are taken to encourage bosses to let employees stay on longer in the job. But hanging up work tools, logging off and turning in the company pass is an inescapable reality every worker faces.

The burden and responsibility for health care does not have to rest squarely and solely on families and the Government. But that can happen only if individuals take more deliberate steps today to work on remaining in the pink of health and plan for their future needs.