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Medifund-Silver
Medifund provides the ultimate safety net to catch anyone who
drops through the Medisave and MediShield nets above. We aim to
build up Medifund to a capital sum of $2 billion. This year,
Government has topped up with $200 million, making it $1.5 billion.
Every year, we make use of the interest income to help those who
fall through the nets. Our hospital Medifund Committees work hard
to prevent any Singaporean from falling through the cracks. They
are good-hearted, busy and successful people who volunteer their
time and expertise to help us manage this piece of social welfare in
a wise and compassionate manner.
Last year, Medifund handed out $40 million to 290,000 applications
for financial assistance. About one-third of these beneficiaries
are over the age of 65. With ageing, we know such demand will only
grow. We need to build up Medifund when our economy is doing well
and whenever there are budget surpluses.
Some elderly patients are worried if their Medifund needs will be
squeezed out by the needs of their younger applicants. We get such
feedback occasionally. We have reassured them that all cases would
be assessed based on needs and that we do not bias our decisions
towards the young or the old.
However, if it will give our senior citizens added peace of mind, I
am prepared to think about carving out a portion of Medifund and
ring-fence it as a "Medifund for the Elderly". We can call this "Medifund-Silver",
protected for the use of needy senior citizens above 65. It can
have a capital sum of $500 million, about a third of the entire
Medifund. This way, we can address the needs of the elderly
patients in a more targeted manner.
(b) Physical
Resources
With financial resources through the 3Ms system, we can then work to
match supply of physical resources with demand. Just to maintain
2007's standard of care in the year 2020, we will need more hospital
beds, more clinics, more doctors and more nurses than what we have
today. That is why we are building a new general hospital of 550
beds in Yishun. When it fully opens in 2010, our acute hospital
beds in the public sector will hit 6,500 in total. Between now and
then, we will add beds where there are opportunities to do so. This
year, for instance, we will add 120 beds in TTSH, CGH and NUH.
In parallel, we will continue to expand day surgeries to move away
from unnecessary hospitalisation. Last year I mentioned the Jurong
Medical Centre idea. It has now materialised. I visited it and am
pleased with its progress. AH, which runs it, has started to
systematically transfer their day surgeries and outpatient
follow-ups for their patients living in Jurong. This brings good
specialist services closer to their homes. The patients I spoke to
were happy with the change.
The private hospitals will also need to expand to cope with rising
demand. They are important partners, serving the middle and higher
income groups, or about 20% of the national patient load. They
provide Singaporeans with more choices. As our medical standard is
high and our fees internationally competitive, naturally we attract
many foreign patients. In the last few years, the growth of foreign
patients has been high, averaging 20% per annum. It could actually
have been higher but the private hospitals had under-invested in the
past and are now missing out on opportunities.
EDB's feedback is that private hospitals are now ready to invest and
expand their capacity. There are also international investors who
are interested in setting up in Singapore. The Government intends
to launch two land sites for private hospital use in the second half
of this year: one near the Novena MRT station by URA, another within
One-North by JTC. Both sites can add about 400 beds to the private
hospital bed capacity. We are also preparing other sites for
possible release in the next few years.
Step-Down Care
(Intermediate and Long-Term Care)
The beds described above are acute hospital beds. But healthcare is
more than that. As emphasised by Mdm Halimah and Dr Lily Neo, with
ageing, there will be increasing demand for longer-stay, lower-cost,
lower-tech facilities in the step-down care sector. There will be
needs for more community hospitals, nursing homes and hospices and
day-care facilities for rehabilitation and home-nursing services.
We have not had to pay much attention to this sector as our
population is still young. But by 2020, the needs for step-down
care will be significant. To gear up for 2020, we have to ramp up
supply and systems from now on. Briefly, we need to do four things
for step-down care.
First, we need to expand capacity. We are reviewing the
requirements for community hospitals and nursing homes, and will
facilitate investments at the appropriate time.
Second, we need to widen participation in this sector by all
providers as the needs of the elderly are diverse, from the
higher-income to the indigent. Today, our step-down care facilities
are largely run by charities which do a pretty good job. But
higher-quality nursing homes to serve the needs of the middle-income
elderly are still in the early developmental stage. We must widen
the range of choices, at different pricing levels and at different
service standards. It costs much more to run Ritz-Carlton than Hotel
81. If Ritz-Carlton were to charge less than Hotel 81, there would
be a long queue outside Ritz-Carlton and Hotel 81 will be empty.
But because hotel pricing is sensible and undistorted by Government
subsidy policy, both businesses are full with their respective
clientele. I know some might not agree that the economics of
healthcare should be the same as the economics of hotel services.
But the reality is that healthcare services need to be financially
viable in the long run, and there is no other way - even if the
Government pays for it, it is still with taxpayers' money.
Third, we need to attract more allied health staff to this sector,
with better skills and higher education level, to service the rising
demand for a higher level of care. We will need more
physiotherapists, speech therapists, occupational therapists,
podiatrists, counsellors and psychologists, and also doctors and
nurses with skills in geriatric medicine, as highlighted by both Dr
Lily Neo and Dr Fatimah Lateef. We will also push up the skills of
our nurses so that they can take over those routine tasks from
doctors, as advocated by Mr Zainudin Nordin. We call them Advanced
Practice Nurses. We discussed this in this House when I moved the
Nurses and Midwives (Amendment) Bill two years ago. I have noted the
point about liability issues and we will look into it.
Fourth, we need to address the financing of this sector. The needy
will need some subsidy by Government or charities. But with healthy
competition among providers, the majority of patients should be able
to self-fund either through savings and/or long-term disability
insurance, like ElderShield. ElderShield as a product is rather new
to Singaporeans. I agree with Mr Yeo Guat Kwang that we should
educate the public more on the various types of insurance products.
For example, there is still confusion between MediShield and
ElderShield. MediShield is for acute hospitalisation with payouts
based on reimbursements. ElderShield is a cash supplement for
step-down care in the community, often at home or in a nursing home.
I am reforming ElderShield to make it work better for Singaporeans
with their needs in 2020 in mind. I shared my thoughts on this
during my recent Ministerial Walkabout. I will continue the public
consultation and welcome feedback and suggestions. We will get the
reform implemented this year.
(c) Human
Resources
Beyond financial and physical resources, human resources are the key
to a good healthcare system as noted by Mdm Halimah and Mr Zainudin
Nordin. Our doctors, nurses, allied health professionals and other
support staff work very hard in public hospitals and polyclinics.
To keep healthcare cost low, we run our facilities at high occupancy
rates. Our doctors and nurses see more patients than their
counterparts elsewhere. If not for their sense of public duty, many
would have quit to have an easier time.
Yes, we may have service lapses at times. But most of the time, our
healthcare workers do a competent job, and often go beyond the call
of duty. They do not expect gratitude, although we do receive many
complimentary letters that cheer them up and keep their morale
high. Please give them your moral support. They are the unsung
heroes and heroines of our excellent healthcare system. They
deserve our appreciation and our understanding.
Medical specialists take a long time to train. It is especially
difficult to get manpower planning right in Singapore as we have a
significant foreign patient load which fluctuates from year to
year. I have noted Mdm Halimah's comment on SingaporeMedicine and
foreign patients and their impact on local patients. I will address
them in my next speech. Meanwhile, we are recognising more good
medical degrees and we are recruiting more foreign-trained doctors.
From about 85 a year in 2003, we took in 180 foreign-trained doctors
last year. This is good, but we remain particularly short of
certain specialists who are also in huge global demand, like renal
physicians, neurologists and cancer specialists. We have to devise
more effective schemes to attract such specialists from abroad to
augment our team.
As I said earlier, we will also pay attention to the allied health
professionals. The positive news is that many more excellent
students have been entering nursing, pharmacy, radiography, therapy
and other courses in recent years. They are bringing up the profile
of our allied health workers. Many existing staff are also
upgrading themselves. We encourage and facilitate this through many
scholarships and overseas attachment programmes. Our healthcare
team is getting stronger.
Students and mid-career Singaporeans are discovering the
satisfaction of a healthcare career. We must be doing something
right in our hospitals. We will press on. Recently, I suggested to
NTUC Sec-Gen Lim Swee Say and WDA's CEO that we work together to get
more mid-career workers to work in hospitals. We have a successful
scheme for nurses. Let us now promote other professions like
physiotherapists and speech therapists. At the same time, we will
work hard to retain staff. This requires us to keep our wages
competitive. This is also the reason why medical fees need to be
raised periodically as manpower cost is a major component of medical
cost.
Conclusion
Let me conclude. Gearing up for 2020 does not mean that we can
simply do more of the same, because patients' expectations are
changing. Patients Google the latest information on illnesses and
treatment options, and want to engage the doctors in our treatment
choices. This is good but it means a longer consultation time.
Such patients will not be satisfied with a 10-minute consultation.
But if everyone demands a 20-minute consultation, we will have to
double our doctor-patient ratio, double the number of doctors we
have today and double the unit cost.
We will maintain our current subsidy policy of Class C patients
paying 20% of cost, polyclinics 50% of cost and so on. But when
unit cost goes up in line with a higher standard of care, the dollar
co-payment by patients will have to go up accordingly. These are
the types of adjustments that Singapore will need to make over the
next 13 years, if we want the medical standard of Singapore at 2020
to match the expectations of Singaporeans and to stay ahead of our
neighbours. In practice, let me assure Mdm Halimah that we will
weave in such adjustments gradually, compassionately and
pragmatically.
We will pace the adjustments according to what Singaporeans can
afford. A couple of hospitals can perhaps move ahead slightly
faster than others. All hospitals will receive the same unit
subvention from my Ministry for the same illnesses and all patients
will receive competent medical care. But the hospitals which can
offer shorter waiting times because they have a higher
doctor-patient ratio, will need to cover their higher operating cost
with slightly higher fees.
My mission is to ensure that our healthcare services remain
affordable to Singaporeans in general, particularly the lower half
of the population. It requires careful planning and co-operation
from all the stakeholders. It requires all of us to have realistic
expectations.
My Ministry will do its
best to expand our capacity and our service levels to meet up with
the rising demand and expectations. That is why the Finance
Minister in his Budget Statement talked about a health budget rising
from about $2 billion to $3 billion within 5 years. This is a
substantial expansion in the Government's commitment to healthcare.
My job is to make sure that the additional funds are used wisely.
Source:
www.gov.sg Media Release 6 Mar
2007
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Gearing up Singapore for its 2020
healthcare needs
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