Few would dispute that healthcare is one of the biggest challenges facing Singapore as we look to the next 50 years. The twin challenges of ageing and chronic diseases are straining our healthcare system, further exacerbated by concerns around rising healthcare costs and delays in the opening of the Ng Teng Fong General Hospital.
I suspect though, in a decade, we will look back to 2014 much more kindly as the turning point in our healthcare system. Four policies in particular merit specific mention, especially for the fundamental changes they represent in the way we think about healthcare and society.
Better Protection. For All. For Life is the tagline for MediShield Life. To be implemented at the end of next year, the scheme will cover all Singaporeans from cradle to grave, unlike the current MediShield, which excludes those with pre-existing illnesses and Singaporeans above the age of 92. MediShield Life coverage will continue to evolve and conditions not sufficiently addressed in this iteration can be explored subsequently, but the most important enduring change is a philosophical one. As Health Minister Gan Kim Yong passionately articulated: “The idea of MediShield Life goes beyond healthcare and insurance. It is a reflection of the kind of society we want to build: A more inclusive society … and a more caring society.”
PIONEER GENERATION PACKAGE
Cynics may criticise the Pioneer Generation Package (PGP) for not going far enough in providing healthcare benefits for Singapore’s pioneers. However, what is far more significant is the recognition that Singapore today owes a tremendous debt to the generation that built modern Singapore. More so because this generation slogged in an era of low wages but modest inflation, and is now spending on healthcare in 2014 when medical inflation is 10 per cent year-on-year. Add to this the limited benefits that schemes such as Medisave and MediShield offer to this group of Singaporeans, and it is clear more can and should be done for them. While PGP is not perfect and will need review and modification regularly, its various healthcare benefits for the pioneers are definitely a good start.
HOME PALLIATIVE CARE FINANCING
Beyond the macro-financing reforms, a small but seminal change took place in the way the Ministry of Health (MOH) pays providers. In July, Mr Gan announced that MOH subsidies for home palliative care would be restructured on a per patient rather than a per visit basis. This means palliative care providers will get MOH subsidies for every patient under their care instead of the number of visits to the patients. The policy change allows, in Mr Gan’s words, a more predictable stream of financial resources, enabling providers to plan and deliver more holistic, patient-centric services.
More importantly, it would provide “greater flexibility to test out new models of care”. Behind this change, which is also applicable in other healthcare settings, is the trust MOH is placing on care providers to do the right thing. Instead of trying to fit care to financing, providers can design and develop the care patients need knowing that they will not be financially shortchanged for doing the right thing. For example, providing care via video or phone may be just as effective as an in-person visit, at a fraction of the cost. But before the change, providers would not have been able to recover any cost for the services rendered. This may be a modest policy shift in a niche sub-sector within the larger health eco-system, but the implications of such a funding shift applied more broadly will be profound.
EMERGENCY CARE IN PRIVATE HOSPITALS
Earlier this month, Mr Gan announced that Raffles Hospital will start receiving emergency patients from the middle of next year, and patients will have subsidised care and pay rates similar to those at public hospitals. If inpatient or specialist follow-up care is needed, Raffles Medical Group will provide it, at similar subsidised rates.
Healthcare insiders appreciate how momentous this announcement is. There is often acrimony between the public and private sectors, resulting in difficulties working together. This means the vast resources of the private sector are unavailable to the majority of Singaporeans, who seek care in the subsidised system.
The public sector has 60 per cent of specialists, but serves 80 to 90 per cent of Singaporean patients. Most specialists make the move to the private sector and do not return to the public sector. In fact, Deputy Prime Minister Tharman Shanmugaratnam has compared the transition to “crossing the Rubicon — there is no turning back; most stop serving public-sector roles such as teaching the next generation of doctors and treating subsidised patients”.
It is important that Singapore policymakers recognise the realities of our challenges and reach across the divide to do what is right for Singaporeans. The Community Health Assist Scheme, which allows lower-income Singaporeans to be treated inexpensively by private general practitioners (with the Government subsidising the differences) is opening the door wide to partnerships in primary care. It is hoped that the Raffles collaboration can be extended over time beyond emergency cases to also include routine specialist services and elective surgeries.
Mr Tharman forcefully argued three-and-a-half years ago on the occasion of Raffles Medical Group’s 35th anniversary dinner: “Improving healthcare for Singaporeans must involve both the public and private sectors … We need all hands on deck to manage the healthcare challenges of the future.” In six months’ time, Singapore public healthcare and Raffles Medical Group would have taken a small step towards this reality. Mr Gan and his team may have stumbled a little on hardware and infrastructure, but they have made substantial progress where it matters much more, in hearts and minds.
Much hard work remains to realise the ambitions of the 2014 announcements. However, the foundations in changed mindsets and partnering openness put Singapore and its healthcare system in good stead. Implemented well, we can face the future with optimism. My hope is that we as a country and community will recognise the improvements made to our healthcare system, set aside the ideological divides for now, roll up our sleeves and get our system to work the best it can.