I do not want Singapore's medical system turning into an American one. Look here, here and here to see what other Singaporeans have to say about how our healthcare system is being Americanized.
SINGAPORE : Prime Minister Lee Hsien Loong has suggested that hospitals implement means testing to help the lower income group.
This is to determine how much patients should be subsidised, based on their means.
Mr Lee said this is a sensitive issue and the Health Ministry (MOH) will be consulting unions on this.
He was addressing over 1,000 unionists at the NTUC Delegates conference on Monday.
Good and affordable healthcare has been one important issue facing Singaporeans.
While many initiatives are being rolled out to address this, PM Lee told unionists that subsidies will still be needed to help the lower income.
To ensure that subsidies are given only to those who need them most, hospitals may need to implement means testing.
PM Lee said: "It's not easy to do; it's a very sensitive (issue) and the Ministry of Health is studying this carefully. The idea is there, but how do we implement it fairly and simply without making hospital care unaffordable for the middle income group.
"Once MOH has some firmer ideas, (Health Minister) Khaw Boon Wan and his team will consult the unions on what to do and how to go about doing this."
Mr Lee assured the labour movement that the government will always keep in close touch with the unions on all major issues.
Going forward, he said the government must now make sure that workers benefit from the growth and vitality of the economy. But the government cannot assume this would come about automatically. And in some cases, some special attention or action would be required.
Special attention to the economy has helped it grow 7.6 percent in the first half of the year, according to Mr Lee.
For the whole year, growth could possibly hit the top end of the government's forecast of 7-8 percent. But the current turbulence in global financial markets remains a risk factor.
Turning to the booming property market in Singapore, both in the prime office space and residential segments, Mr Lee noted that the Urban Redevelopment Authority has withdrawn the Deferred Payment Scheme for property purchases last Friday.
"This step will help to dampen excessive speculation and to inject some reality into the market. But more fundamental than the ups and downs of the property cycle, the government is committed to keeping housing affordable for Singaporeans," said the Prime Minister.
Mr Lee assured them that the government will continue to monitor trends closely and take further action if necessary. The aim is to make sure that the property market stays in balance over the long term.
Mr Lee also stressed that Singapore is successful only after difficult adjustments over the years.
He said: "Because we have taken these steps, each one difficult but each one necessary, we have moved forward together. We have stayed competitive, stayed ahead of other countries, our neighbours and we have prospered.
"Why have we been able to make these changes? It's not that other countries don't know they are necessary, but we have moved one step faster than others. And one major reason we have been able to do this is because of the strong support of the labour movement."
With the government, workers and employers working together as a winning formula, Mr Lee stressed that Singapore must keep on adjusting and adapting in order to stay ahead. - CNA /ls
Not treating Burmese murderous Junta is against Hippocratic Oath, but making sick S'poreans accept earlier death due to cost issues is not!
Wow! Our PM Lee had came up with a ingenious argument to defend the govt on why they should let the Burmese Junta to come to Singapore for medical treatment.
According to PM Lee, it is against the Hippocratic Oath to bar the murderous generals from seeking medical treatment in Singapore!
Mr Lee also responded to a question on whether Singapore should prevent members of the Myanmar government from coming to Singapore for medical treatment.
He said: "I think we have to decide whether we're trying to influence the policy of a government or whether you want to do petty indignities to individuals, which is really against human nature.
"Somebody who is sick, he wants to come to Singapore, he needs treatment and you're telling me that I shouldn't treat him because he is not a good man? It goes against the Hippocratic oath of doctors."
How noble PM Lee is!
If that is the case Osama Bin Laden should come to Singapore for medical treatment if he is sick, after all our govt already said that it is against the Hippocratic Oath if we don't treat him!
But wait... What should I make of this statement by PM Lee?
The practice of medicine has its limits. It takes wisdom to know these limits and the true needs of the dying. Heedless pursuit of “pure” medicine to prolong life, without regard to cost or the wishes of the patients, cannot be sustained in the long term, not even in the wealthiest countries. This is a serious problem plaguing the US healthcare system today. Alas fixing it is politically difficult. We must not get into such a situation.
PM Lee is telling the doctors that S'pore doctors that they should NOT heedlessly prolong life of Singaporeans "without regard to cost"!
Is PM Lee saying that Singaporean patients should NOT be treated when it is too costly to keep them alive?
Well, at least one of his minister had made his position clear.
I regret making the decision because, in the end, the baby continued to be in intensive care, and KKH now runs up a total bill of more than $300,000
SINGAPORE: Prime Minister Lee Hsien Loong has said that sanctions against Myanmar will be counter-productive.
He also stressed that ASEAN alone cannot solve the problem in Myanmar, and called on the international community to weigh in as well.
Mr Lee said this in an interview with the CNN, which was aired on Friday evening.
He was responding to the presenter who asked if ASEAN could do more besides issuing strong statements against the unrest in Myanmar.
ASEAN has to take a clear stand on Myanmar because what happens there affects the group's reputation, said PM Lee.
What ASEAN wishes to see is developments that will lead progressively to a Myanmar government that has more legitimacy at home and greater acceptance internationally, added Mr Lee.
But ASEAN, he stressed, does not have the leverage to solve the problems in Myanmar.
Mr Lee also explained why economic sanctions against the military-ruled country may not be productive.
He said: "First of all, this is a country which wants to isolate itself from the world, so they are not afraid of you cutting them off.
"Secondly, if you want to have sanctions, it cannot just be Singapore or even ASEAN, but all of the countries in the world have to do that, and that includes the Western countries, investors in Myanmar and its neighbours like China with big stake in Myanmar.
"And thirdly, if you do have sanction and it worked, I think the people who will be hurt by the sanctions will not be the regime or the SPDC (State Peace and Development Council), the government, but the people of Myanmar, so it will be counter productive."
Mr Lee added that the United Nations will play an important role, and the recent visit to Myanmar by UN special envoy Ibrahim Gambari is the first step to improving the situation there.
Mr Lee also responded to a question on whether Singapore should prevent members of the Myanmar government from coming to Singapore for medical treatment.
He said: "I think we have to decide whether we're trying to influence the policy of a government or whether you want to do petty indignities to individuals, which is really against human nature.
"Somebody who is sick, he wants to come to Singapore, he needs treatment and you're telling me that I shouldn't treat him because he is not a good man? It goes against the Hippocratic oath of doctors."
Separately, Mr Lee spoke on the phone with UN Secretary-General Ban Ki-moon on Friday.
The UN chief invited Singapore, in its capacity as the current ASEAN chair, to make a statement at a UN Security Council meeting on developments in Myanmar.
PM Lee told Mr Ban that he has written to China, India and Japan to work together with ASEAN and the UN to help the parties in Myanmar find a way towards national reconciliation. - CNA/ir
Professor Ho Lai Yun, Master of Academy of Medicine Singapore,
Distinguished guests,
Ladies and Gentlemen
1. I am honoured to accept the honorary fellowship from the Academy of Medicine. I am also happy to join you tonight for your Golden Jubilee, and for the 41st Singapore-Malaysia Congress of Medicine. I understand that members of the Hong Kong Medical Academy are here as well for the Congress. To all our foreign guests, let me extend a very warm welcome to Singapore.
2. Healthcare in Singapore has come a long way since the Academy was founded. Half a century ago, we were struggling to keep malnutrition and infectious diseases under control. Today, Singaporeans enjoy standards of healthcare equal to or exceeding the advanced countries. Internationally, Singapore healthcare stands for quality and ethical practice. The growing numbers of foreign patients who seek advanced medical treatments in Singapore each year is testimony to this.
3. We owe this position to past generations of doctors who served with compassion, humility and high ideals. Indeed, Singapore is fortunate to have had a pioneering batch of doctors deeply steeped in the ethics and values of medicine. Professors Ransome, Sheares, Seah Cheng Siang, S S Ratnam – they, together with many others, served selflessly with the single purpose of providing the best possible care for their patients, whether rich or poor. They inspired subsequent generations to aspire to the highest standards of professional excellence.
4. We must cherish and build on this precious legacy. This is particularly so because moving forward, our healthcare system faces some daunting challenges.
5. One challenge is the rapidly growing demand for healthcare services. Ours is one of the fastest ageing populations in the world. On current demographic trends, the number of Singaporeans aged 65 years and above will double in 15 years. Older people are hospitalised more often, and each time stay in hospital longer on average. Our public hospitals already run at near capacity. The existing infrastructure clearly will be inadequate to meet the needs of this surge in elderly numbers, plus the steady growth of our overall population year by year.
6. The Government is investing to expand the capacity of our healthcare system. The Khoo Teck Puat Hospital in Yishun is already under construction, and should be completed by 2010. MOH has begun planning for another hospital in the Western part of Singapore. We will also reserve several sites scattered across the island, so that new hospitals can be built when the population and patient load builds up.
7. But building hard infrastructure is the easier part. We also need to train and recruit the people – doctors, nurses, other healthcare workers – to staff the new institutions and make them work. Without them, quality of care will be compromised, and we will fall short of the high standards that Singaporeans have rightly come to expect.
8. The numbers involved are large. MOH, for example, projects that we will need to recruit over 2,000 more doctors by 2015. Given our small local talent pool and competing needs from other sectors in the economy, there are limits to how far we can expand the local supply. It will not be a simple matter of just investing more money to train more Singaporeans to become doctors or healthcare workers. We have been raising the intake of medical students each year, but this will not be enough. Increasingly, we will have to recruit medical talent from abroad. We must be open minded in accepting such imported talent, while maintaining medical standards and helping foreign trained doctors to adapt to conditions in Singapore.
9. While we will invest more in healthcare, it is even more important to get the economics of healthcare right. Countries all over the world have taken different approaches. Their experience shows that more resources do not necessarily improve healthcare outcomes. The reality is that demand for healthcare is unlimited and has to be rationed. Some countries have gone for free healthcare at point of use, only to face the intractable challenges of meeting insatiable demand and curbing abuse while keeping high standards of healthcare. Problems are compounded as populations age and vast amounts of high-tech resources are marshalled to manage the last few weeks of the terminally ill, delivering poor quality of life to the patients at very high cost to society.
10. The practice of medicine has its limits. It takes wisdom to know these limits and the true needs of the dying. Heedless pursuit of “pure” medicine to prolong life, without regard to cost or the wishes of the patients, cannot be sustained in the long term, not even in the wealthiest countries. This is a serious problem plaguing the US healthcare system today. Alas fixing it is politically difficult. We must not get into such a situation.
11. Singapore has opted for pricing and co-payment to bring market forces into play, minimise waste of resources, and incentivise efficient delivery of healthcare. MOH has been pushing for greater transparency, publishing information on bill sizes of hospitals and encouraging hospitals to track and publish clinical quality indicators. This will enable patients to make more informed choices and the market to function better.
12. Our system relies on compulsory savings through Medisave and risk-pooling through MediShield, a medical insurance scheme to cover large hospital bills. Medifund provides the final safety net. This approach has helped us avoid the problems experienced elsewhere and contain national healthcare expenditure, yet with very good outcomes. But managing healthcare cost escalation requires continuous effort, particularly with the ageing population. We must keep on identifying better ways to keep Singaporeans healthy and help those with chronic diseases to manage their illness, so as to avoid future complications. We need to maintain our market-based system, while exploring new and creative approaches to improve it.
13. This includes exploiting IT to the full. The National Healthcare Group, for example, has introduced tele-radiology at its polyclinics, where x-ray images are sent to Bangalore to be read. As a result, prices have been reduced and turnaround time has been cut dramatically from 2 – 3 days previously to an hour or less. Increased competition has also led to local radiologists charging less for x-rays and reporting the results faster. Patients benefit all round, saving money and time as they no longer need to make return trips for their results.
14. We must press on with such initiatives. There are other applications of telemedicine, such as tele-pathology, where technology has advanced to a stage where it makes economic sense and improves the quality of care, while assuring patient safety. Complete computerisation of hospital information systems is an ideal goal which is still some way away. These changes may be unsettling for incumbent practitioners. But the response cannot be to dig-in and resist. Just like in other industries, incumbents must look for new niche areas on the value chain, where our more advanced capabilities and recognised quality standards justify our higher costs.
15. Finally, we must not lose sight of the core values which underpin and provide the moral compass for our healthcare community. Senior members of the community must lead by example, teaching and mentoring their younger colleagues. Financial incentives play a role, and successful specialists can do very well, particularly in the private sector. There is nothing wrong in this. But values built up over many years, such as caring and compassionate service to patients and striving for the highest standards of professional excellence, must never be diluted or lost in the midst of change. Senior doctors must pass them on to the younger generation of doctors, so that they will in time produce a new generation like Gordon Ransome, Seah Cheng Siang and the other pioneers. This is perhaps the most fundamental challenge of all for the medical profession.
16. The Academy of Medicine is committed to advancing the art and science of medicine in Singapore, and promoting and maintaining the highest professional standards of competence and ethical integrity. It plays a leadership role in keeping the profession true to its mission of providing the highest quality of patient care in Singapore. I am confident that you will draw upon the rich values that have guided your profession through the years, to guide your way forward.
17. I congratulate you on the 50th Golden Anniversary of your Academy, and wish all participants of this Congress a fruitful and productive meeting.
Statistics show annuities' risk-pooling model may disadvantage poor old-old
Letter from Dr Vincent Chia Wei Meng
I refer to the compulsory annuity scheme. I would like to point out that there is good statistical evidence to support a strong correlation between socio-economic status and life expectancy in developed countries. As such, the compulsory annuity scheme should take this fact into consideration.
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It is well-known among sociologists and epidemiologists that social class or socio-economic status is a prominent life expectancy indicator, and is assessed through occupation, income, housing or educational level.
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We can begin by looking at epidemiological data from the United States. From the paper published last year by Gopal K Singh and Mohammad Siahpush in the International Journal of Epidemiology, entitled Widening Socioeconomic Inequalities in US Life Expectancy, 1980–2000, it is clear that life expectancy for less-deprived groups is notably higher than that for more-deprived groups.
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An extract states: "Those in less-deprived groups experienced a longer life expectancy at each age than their counterparts in more-deprived groups. Between 1980 and 1982, the overall life expectancy at birth was 2.8 years longer for the least-deprived group than for the most-deprived group (75.8 years versus 73.0). By the 1998 to 2000 period, the absolute difference in life expectancy at birth increased to 4.5 years (79.2 years vs 74.7)."
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Singh and Siahpush concluded that: "Between 1980 and 2000, those in higher socio-economic groups experienced larger gains in life expectancy than those in more-deprived groups, contributing to the widening gap."
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Thus, there is not only a greater life expectancy for those with a higher socio- economic status but the gap in life expectancy between the higher and lower socio-economic groups is progressively widening.
Not surprisingly, we see a similar trend in the United Kingdom. A paper by its Office for National Statistics (ONS) gives figures on trends in life expectancy by social class in England and Wales between 1972 and 2001.
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The data shows that while life expectancy at birth for both the higher and lower social classes have improved, it is evident that life expectancy at birth for those from a higher social class is significantly better than those from the other end of the spectrum. There is likewise an increasing gap in life expectancy between the two classes.
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Apart from life expectancy, it is interesting to note that socio-economic status is an important determinant of disability among older Asians. The effect of socio-economic characteristics is also strongest when predicting perceived health. According to the National University of Singapore's Department of Sociology and the Asia Research Institute, sociologists have discovered that perception of income adequacy is the most important predictor of health.
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Closer to home, The Old-Old in Singapore, a paper published by Ang Seow Long and Edmond Lee from the Singapore Department of Statistics, suggests a similar link between socio-economic status and life expectancy.
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The old-old refers to those 85 years and above. If the home of an old-old Singaporean is any indication of his socio-economic status, then it is significant that in 1999, 43.5 per cent of the old-old live in HDB four-room or larger flats. In comparison, 29.1 per cent of old-old Singaporeans live in HDB three-room flats, while the remaining 11 per cent live in HDB one- or two-room flats.
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In other words, a large proportion of those who live to 85 years and beyond do not live in one- or two-room flats. Close to half of them, in fact, live in four-room or larger flats.
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If it is true that a majority of the old-old are from higher socio-economic groups, there might be a weakness in the compulsory annuity scheme. As it works on the principle of risk pooling, CPF members who die early may not live to see the benefits of the scheme. In fact, their premiums may go towards paying the annuity payouts of other members.
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We must ensure that lower socio-economic groups are not unduly burdened with the care of old-old from higher socio-economic sectors. Only then can the annuity scheme be of greater aid to those old-old Singaporeans who are truly in need of such payouts.
