July 6, 2023
SINGAPORE – Through three decades of planning and investments in healthcare, a 76-year-old Singaporean has a similar age-related burden of disease today as the average 65-year-old in the world. Only the Japanese have a better outcome.
But with chronic diseases such as hypertension and high cholesterol on the rise because of a rapidly ageing population, it is time to transform healthcare once again, starting with a national preventative and chronic care programme, Healthier SG, that kicked off this month, said Singapore’s chief health scientist, Professor Tan Chorh Chuan.
Speaking at the plenary session for the World Congress on Dermatology on Wednesday, he said Singapore has focused strongly on promoting good health, with the White Paper on Affordable Healthcare in 1993 as a blueprint. For example, new even townships are planned to enable walkability.
The weeklong congress, which is on till Saturday at the Suntec Singapore Convention & Exhibition Centre, is the largest medical event ever held here. More than 11,400 delegates are attending it, with the largest overseas delegations coming from the United States and China.
Prof Tan told the delegates that while Singapore has successfully brought down premature deaths from diseases like cancer and heart problems, chronic problems like diabetes and obesity have held steady while the incidence of hypertension and high cholesterol has shot up.
In the decade since 2010, hypertension in the population has gone from 19.8 per cent to 31.7 per cent while 36.9 per cent of the adult population has high blood cholesterol, up from 26.2 per cent.
This is why Singapore again needs to transform its healthcare system, to ensure its people “continue to achieve good health outcomes at relatively lower expenditure in the future, even as our population ages rapidly and chronic diseases rise”, he said.
The MOH Office for Healthcare Transformation, which he heads, is among those leading the effort.
Prof Tan noted that older people are four times as likely to be hospitalised, and stay three times as long as younger adults.
In preparing for the future, he said: “We have to be better in preventing disease and preserving function. We have to do even better to ensure that care is not fragmented, that it is more continuous, coordinated and comprehensive. This must occur particularly in primary care.
“And finally, we have to challenge our ourselves to achieve better outcomes while reducing cost increases for better value-based outcomes.”
Prof Tan said there are two fundamental mismatches in the healthcare system here.
The first is that 80 per cent of hospital care is by the public sector, while 80 per cent of primary care is delivered by general practitioners (GPs) in private practice. Their different models have an impact on the continuity and integration of care, he said.
The second mismatch is in 85 per cent of GP clinics being solo or small group practices, so “they often lack the scale to provide the kind of team-based care necessary to manage chronic diseases”.
The same problem occurs in community services and long term care sector. There are many small organisations involved which have served Singapore well in the past.
But, Prof Tan said: “Because we have many providers, often quite small ones, the capacity is inadequate. The coordination between all these different parties operating in the community is not optimal. And the data sharing the data flows needed to enable much better and effective health promotion and care management in the community is affected.”
He said the launch of Healthier SG this month aims to correct some of these problems.
For instance, it will allow much better digitalisation and data sharing by the different parts of the health ecosystem. GPs will form part of a larger network with access to the national electronic health records system with improved data flows.
They will have incentives to spend more time on preventative care and chronic disease management. They will also be partnered with one of three public health clusters for clinical and specialist support.
He said: “Healthier SG is a major transformation initiative. It strengthens our health system, addresses challenges of population ageing, and the rising chronic disease burden. It will also provide critical foundations for healthcare of the future, enabling the faster deployment of innovations at scale.”