Providing good health care a challenge: Prime Minister Lee Hsien Loong at Universal Health Coverage Ministerial Meeting, 10 February 2015

Governments must be trustworthy stewards and present trade-offs of health spending to their citizens, says PM Lee
By Salma Khalik, Senior Health Correspondent, The Straits Times, 11 Feb 2015

HEALTH care has always been both an emotional and political issue, said Prime Minister Lee Hsien Loong, and "it is always tempting to say we will do more, we will do better and it will cost less... maybe even free".

But governments have to be trustworthy stewards and present the trade-offs as they are to citizens and not sacrifice tomorrow for today's political gain, he said.

Every dollar the Government spends on health care is a dollar taken from taxpayers.

It is "a dollar we cannot spend on education, housing, defence, or on personal needs of our people", Mr Lee noted.

Opening the Ministerial Meeting on Universal Health Coverage yesterday, he said providing good health care is one of the most important responsibilities of any government - but is very challenging to achieve.

"It requires an honest conversation among ourselves, and hard choices made."

He gave a 30-minute summary of Singapore's health-care evolution, from the days of night soil collectors just 40 years ago to the setting up of MediShield Life, the compulsory all-inclusive health insurance scheme to be introduced later this year.

The two-day meeting at the Grand Copthorne Waterfront Hotel is organised by the Health Ministry.

When it comes to health care, the usual economic models do not work, Mr Lee told the 300-strong audience, including the health ministers from Bangladesh, Brunei, Finland, Indonesia, Myanmar, Thailand and Vietnam.

Expanding capacity for future needs may stimulate a supply-induced demand. As doctors know far more than patients, a "willing buyer, willing seller" model does not work. And protecting patients from financial consequences could lead to overtreatment.

So, a variety of tools are needed, Mr Lee said, from pricing and regulation to incentives, exhortation and, sometimes, even compulsion, "to shape behaviour by doctors, patients, administrators, drug suppliers, in order to produce a good collective outcome".

Giving the keynote address, Dr Margaret Chan, director-general of the World Health Organisation (WHO), praised Singapore for achieving a good health-care system at a relatively low cost. "In terms of return on investment, you are No. 1 in the world," she said, pointing to the 4.2 per cent of gross domestic product spent on health care here, compared with the 18 per cent in the United States.

Dr Chan told delegates that each country has to develop its own model of universal health care, based on its culture, existing system and people's expectations.

She outlined Bangladesh's success. Through a few high-impact interventions, such as getting community health workers to cover the shortage of doctors and nurses and building and running 12,000 community clinics, the country now has the longest life expectancy and lowest child mortality in South Asia.

She said: "Any country that really wants to move towards universal health coverage can do so. Even barriers like a dense and very poor population and frequent natural disasters will not stand in the way."

MediShield Life a strategy for building more inclusive society: WHO Director-General
The WHO also commends Singapore's foresight in achieving first-rate healthcare with outstanding outcomes at a cost lower than in any other high-income country in the world.
By Vimita Mohandas,Channel NewsAsia, 10 Feb 2015

The World Health Organization (WHO) is confident that the various healthcare schemes and programmes available in Singapore will put the country in good stead to deal with more complex healthcare challenges in the future.

WHO Director-General Margaret Chan - who is in Singapore for the two-day Ministerial Meeting on Universal Health Coverage - singled out MediShield Life, which provides universal health coverage for Singaporeans facing large hospital bills. She said that besides giving citizens more assurance, the scheme also works as a strategy for building a more inclusive and progressive society.

By 2030, one in five Singaporeans will be aged 65 and above. Studies have shown that the elderly are four times more likely to be hospitalised than younger Singaporeans. So designing MediShield Life - a healthcare financing system that is fiscally sustainable - is key to ensuring that Singaporeans are taken care of even in their silver years.

The WHO commended Singapore's foresight in achieving first-rate healthcare with outstanding outcomes at a cost lower than in any other high-income country in the world. However, Dr Chan also stressed the importance of individual responsibility.

She said: “In terms of health, there is no free lunch. Where is the money coming from? People will think ‘the money comes from the Government’. But Government is basically poor. Its wealth comes from tax from the population.

“You can ask for many things like the sun, the moon and the sky and do not want to pay for it. There is no such thing. Money has to come from somewhere. So it is in your own interest that you use the health services and system judiciously."

With universal health coverage, the problem of overconsumption of services may arise. And it is critical that healthcare institutions work closely to share data on the right level of care to be provided for a patient.

Dr Chan also suggested incentivising both patients and healthcare providers. She said: "If you reward volume of services, providers of care like your doctor - whatever system you have - will gravitate towards that in order to generate more income. But if you provide incentives to discourage over servicing and gradually the behaviour change of both physicians, the patients will move towards the right balance."

She added: “If you reward visits, every visit a doctor gets paid, then the doctor will encourage. Patients will keep coming back. For example, in Monaco, they use an all-inclusive charge for (appendicitis). If you have no complications, you get this payment but if the patient has complications and has to be readmitted to sort out the complications, there is no additional fees for that.

"So you are rewarding quality of care. So in this way, you will encourage physicians to provide good care and reduce complications.”

Dr Chan also warned about growing healthcare concerns such as childhood obesity - a common problem that countries which enjoy economic success are likely to face.

Holistic approach to healthcare needed to empower consumers: Gan Kim Yong
By Sara Grosse, Channel NewsAsia, 11 Feb 2015

A holistic approach to healthcare needs to be taken to empower consumers to make the right choice, said Health Minister Gan Kim Yong at the ministerial roundtable of the Ministerial Meeting on Universal Health Coverage on Wednesday (Feb 11).

Speaking during the Ministerial Roundtable discussion, Mr Gan said there is a lot of scope for Singapore to “move upstream” in health promotion.

“In fact, going upstream in health promotion does not require a lot of money and investment, because money and investment is not the key determining factor in health promotion,” said Mr Gan. “It's got to do with our programming, our environment, many factors. We want to find a way to encourage healthy living to become natural.”

Mr Gan said such a strategy is easier and more sustainable in encouraging healthy habits than implementing regulations.

The World Health Organization's director-general Dr Margaret Chan also called on the medical community to pay closer attention to their patients when it comes to consumer behaviour.

"The sugary drink industry - they invest so much money in terms of R&D, understanding consumer behaviour, taste preferences and what takes them to buy their products,” said Dr Chan. “So this is another lesson we have to learn. We always talk about being patient-centred but we ignore our patients. How many doctors look at the patient and do a proper physical check? They just look at the screen of their computer. Please look at your patients and not the screen."

Closing the discussion, Mr Gan outlined how universal health coverage must be affordable, accessible and sustainable. To achieve this, he said the economy must remain robust.

"All our countries, all our governments will have the resources to implement universal healthcare and all our people will have income, will have employment, will help them afford the healthcare,” said Mr Gan. “And in fact, employment and economic growth is a key driver for our universal healthcare.”

During the ministerial roundtable discussion, health ministers from several countries such as Philippines, Vietnam, Malaysia and Thailand shared the lessons they had learned about universal health coverage. This included the importance of having a good database for administrative work, encouraging health promotion and having food and beverage industry players take a larger role in promoting healthy choices.

Mr Gan also shared his thoughts on the lessons learned from the ministerial meeting.

"The ministerial conference was a very useful platform for ministers and delegates from 16 countries and Hong Kong to exchange notes on how we each tackle the challenges of bringing universal health coverage to our people. We learned that it is not how many dollars we spend, but how we focus our investment that makes the most difference,” he said.

“Countries as diverse as Bangladesh, a large country like China, emerging economies like Thailand and Indonesia, higher-income economies like Korea and Finland, and cities like Hong Kong and Singapore, can achieve universal health coverage.”

“For it to be sustainable, we must involve all stakeholders: individuals, family, society, healthcare providers, and the government, each playing its part,” he added. “For example, individuals should choose to live a healthy lifestyle, healthcare providers should offer appropriate and cost effective care, and governments should help the needy.”

In his closing speech, Mr Gan said universal health coverage is fundamentally about balancing between four objectives: Affordability, accessibility, quality and sustainability.