Thursday 17 November 2011

Singapore's Changing Healthcare Landscape

By Chee Jia Yi, YP member, 16 Nov 2011

Current State of Healthcare in Singapore

Singapore has a well-established healthcare system and prides itself on its focus of providing quality healthcare. In education, it seeks to empower and train the next generation of healthcare professionals, as well as conduct research for advancement in technology. It has in place the necessary infrastructure and expertise for a successful healthcare system. Singapore’s world-class building and infrastructure has put it at the forefront of the race. However there is no room for complacency as this is an ongoing process of revamping and renewing the infrastructure. The standards of healthcare professionals are also maintained and there is a move to increase their numbers by both beefing up the local intake as well as introducing more foreign-trained professionals.

The crux of the matter is whether the current healthcare system will be able to cope with the changes that will follow in coming years.

State of Flux- The Future and Beyond

Cynics paint a bleak picture of the impending silver tsunami, where the proportion of elderly is set to triple within the next 25 years. Singapore is the second most rapidly ageing population in the world today and needs to be well-equipped in order to face the economic and social demands that this phenomenon poses. With the changing demographic profile, an emphasis has to be made on management of chronic conditions, caregiver support and provision of aged care facilities.

Singapore faces a growing population, which has crossed the 5 million mark, a substantial number of which consists of foreigners. This would place a significant strain on healthcare resources to provide for the ever-burgeoning number of residents.

Although Singapore has made leaps and bounds in economic progress, there is still an apparent rich-poor divide. Those at the bottom half of the spectrum will worry about the ever-increasing healthcare costs. In view of this growing income inequality, much must be done to ensure that healthcare is made affordable, available and accessible to all. It is imperative to ensure that the needy do not get left behind and that they are able to receive adequate treatment, regardless of financial ability.

Of course, quality of healthcare cannot be compromised, and neither can cost-efficiency. This represents a quandary of sorts; after all, a fine balance between quality and cost-efficiency has to be sought.

The Next Wave- Impending Silver Tsunami

In view of this phenomenon, various schemes have been rolled out and measures put in place to combat the potential strain on healthcare resources. Some of the new initiatives that have been introduced are the expansion of the Primary Care Partnership Scheme (PCPS), improving the coverage and payouts for Eldershield, and a top-up of the Eldercare fund. There is a move towards integrating care for the elderly and those with chronic conditions. In order to avoid a potential bed-crunch, nursing homes such as Kwong Wai Shiu hospital are gearing up and increasing the bed capacity to house the elderly and debilitated. The VWO (Voluntary Welfare Organization) sector is also undergoing development for the long-term care of patients; examples include St Luke’s, Metta Welfare Association, and Home Nursing Foundation.

Graceful and healthy ageing is strongly advocated, and there is much support for active ageing. Resources are allocated to the development of homecare and family support services. Local communities are being engaged for the promotion of this cause.

Covering the Cracks:

The elderly is a particularly vulnerable group, especially so when their insurance cover expires and life expectancy continues to increase. Even Medishield covers the elderly up to a maximum age of 85, much less the external insurance providers. More often than not, these elderly are left to fend on their own. These elderly thus face a double whammy; they are more prone to be plagued with catastrophic illnesses, while not under insurance coverage.

Proposed Changes:

Additional subsidies for the elderly should be given, since they do not enjoy extra privileges as compared to the rest of the demographic for the 3Ms, namely Medisave, Medishield and Medifund. For instance, free treatment for certain admissions to the hospital (references to Japan, where all elderly covered by a government-sponsored insurance) could be considered by the government.

The Rise- Burgeoning Population of Singapore

Singapore’s population is growing at a rate of 2% a year, with a substantial proportion being Singapore Permanent Residents and foreigners. Inevitably, this will be a strain on the physical infrastructure and a challenge to recruit adequately trained professionals. There is thus a need to streamline work processes, enhance productivity and better manage existing space and infrastructure.

More hospitals, both acute and community, have been built to accommodate the increasing healthcare needs of the growing population. Khoo Teck Puat hospital was recently opened last year, and yet another restructured hospital, Ng Teng Fong General Hospital, is slated to start in 2014.

Training and upgrading of the healthcare workforce will ensure healthcare professionals remain relevant to the ever-changing medical field. The expansion of the Lee Kong Chian School of Medicine and the introduction of the Duke-NUS medical school are congruent with the need for more healthcare professionals to meet the needs of the nation.

Heart of the Matter- Affordability of Healthcare

It is the duty of the State to ensure that healthcare is made affordable, available and accessible to all. In Singapore, various social safety nets, such as Workfare, Medishield and Medifund, are in place to render aid to those who fall through the cracks. Recent changes include Medisave top-ups and raising the withdrawal limits for outpatient expenses under the new medisave400; Expanding healthcare financial assistance to needy Singaporeans through Medifund through an endowment increase to $3 billion; and a more inclusive Medishield with improved coverage and payouts, with a 1-to-1 matching for donations to VWOs. Part of the healthcare scheme includes inpatient subsidies and specialist outpatient clinic subsidies, as well as increasing subsidies for high cost drugs for chronic illnesses. Additionally, a marked improvement of financial counseling and education on healthcare treatment has been seen.


Two vulnerable groups that are often neglected in society are the disabled and the single parents. They often fall short of the criteria to be eligible for many subsidies, especially the single parents.

Proposed changes:

Medisave, Medishield and Medifund (lower eligibility criteria and barriers to entry; review of schemes in accordance with annual increases in the cost of living, and inflation rate)
More financial help for disadvantaged groups (eg. Financial aid for patients undergoing cancer treatment, as it is a lifelong disease and is very debilitating physically, emotionally and financially)

The Balance-Quality vs. Cost Efficiency

Much discussion has been about striking the right balance between quality and cost efficiency. We cannot have the best of both worlds; one has to be compromised in favour of the other. However, they are not always mutually exclusive; it is more of interplay between the two. The question thus: how do we quantify quality and what exactly is the benchmark we should use to quantify?

Introduction of new models for primary and rehabilitative care, and new capabilities in community care, mental health and home care
Enhancement of ILTC (Intermediate and Long-Term Care)
Encourage biomedical research and innovations, as Singapore prides herself for being a research hub

Other issues of contention:

Whether there has been a compromised quality of doctors/healthcare professionals, especially with the influx of foreign health professionals (in question: training quality, language barriers, cultural differences, experience, ability to adapt to Singapore’s health system)

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