|
 |
|
Source:
www.gov.sg
|
|
Promoting Clinical Research In Public Hospitals |
|
Speech By Khaw Boon Wan Venue: Merchant Court
Hotel, Singapore 26 Mar 2008 |
|
|
Over the past 40 years, the standard of our
healthcare services has gone up from third world to first. |
|
We achieved this at a relatively low
total cost to society. While other developed countries spend at
least 7% of their GDP on healthcare, our spending at 4% puts us
in the same band as the developing countries. |
|
We Have Done Not Too Badly |
|
How was this possible? |
|
First, we waste less. As patients co-pay
their fair share of the cost, there is less over-consumption. This link
between payment and consumption is a fundamental pillar of our
healthcare financing policy. |
|
Second, there is less over-servicing and
our doctors generally do not over-treat their patients. The recent
public debate over questionable aesthetic treatments by some doctors
suggests an exception but over-zealous consumers are part of the
cause. |
|
I was reading the Sunday Times over the
weekend and the Sunday Times did a good job of surveying a range of
opinions on patients who have used some of these treatments like
mesotherapy and the opinions expressed not surprisingly covers a
wide range. |
|
While many agreed with the decision the
MOH has taken, but as you can see, there are some who wanted us to
do even more than we should - ban it and prevent people from putting
out such treatments. |
|
But on the other hand, there are others
who think we should just leave things alone and leave the doctors to
decide for themselves and the government should not interfere. |
|
So there lies the difficulty of
regulating this business called the beauty business. It is thankless
job. But all I know is if tomorrow a bad accident happens and some
patients end up with severe complications, all these people who
expressed different opinions will gel together and condemn us for
not regulating more tightly and say: “I told you so.” So that’s our
karma. |
|
I take a practical approach. Let us
focus on where safety potentially can be compromised and regulate
tightly those areas and leave the rest of the treatments to the
professional bodies such as academies like the college of family
physicians. |
|
The professions ought to self regulate.
As they do, I hope everyone sees the larger picture that one of the
strengths of Singapore healthcare is our pool of ethical doctors.
The vast majority practice ethical medicine and as a result there is
trust and confidence of Singaporeans looking up so the medical
profession remains respectable and people look at it with great
respect. |
|
I think it would be a pity if the
profession for whatever reasons began to erode those ethical values
and therefore the profession as a group must start thinking about
how to regulate this very tricky area of beauty business. Do not
allow a small minority who do this for personal financial reasons
tarnish the reputation of the entire community. |
|
Third, public hospitals are dominant
players and we actively prescribe lower-cost alternatives, whether
it is generic medicine or standard implants. We do so without
compromising clinical quality. |
|
But there is constant pressure to change
the status quo. Patients demand higher subsidies to lower their
co-payments. Doctors would prefer greater freedom to practice
medicine without having to worry about the cost of treatment. |
|
I once had a very good discussion with
this professor from St Jude in the US. They are so well endowed with
charity funds that he said for doctors working with St Jude, its
like heaven. We never need to worry about how much things cost. Do
as you wish, as you think best for your patients, he said. And often
for the patients’ families, they fly in the families to visit the
patients, with hotels and flights all paid for. So that is heaven. |
|
But we are not in heaven. Certainly not
in Singapore. Many consumers equate the latest drugs and high-tech
equipment as better care. |
|
In healthcare, the fundamental problem
is that of demand exceeding supply. But demand is not always
necessary. Hence public expectations have to be managed to reduce
unnecessary demand. We have not done too badly in this regard. |
|
Policies Need Regular Adjustments |
|
First, we evolved our own healthcare
financing model based on the 3Ms framework to support the co-payment
philosophy while keeping healthcare affordable to all. |
|
Second, we systematically rebuilt our
hospitals and clinics and brought them up-to-date with the practice
of modern medicine. |
|
Third, we modernized hospital
management, corporatised the hospitals and subjected them to greater
commercial discipline. |
|
Fourth, we re-organised the hospitals
and polyclinics into vertical clusters to promote greater
integration of care between the specialists and polyclinics and GPs.
Patients will benefit if healthcare can be delivered more
seamlessly. Vertical integration is the way to go, but it has taken
time and will take us some more time to execute this well. |
|
Going forward, we will continue to make
adjustments and refinements in response to changes in the external
environment. Tonight, I want to discuss a recent policy change and
that is our decision to promote clinical research in public
hospitals. I thought its worth discussing the implication of this
recent change. |
|
Promoting Clinical Research |
|
Clinical research is not a new activity.
We have always dabbled in it and all hospitals have included it as
part of their core missions. |
|
There have been some success stories.
Prof SS Ratnam’s research on infertility in the old KKH was
exemplary. In more recent years, Prof Ariff Bongso’s pioneering work
on human embryonic stem cells helped pave the way for stem-cell
research globally. There were many other examples. |
|
But clinical research in public
hospitals was largely confined to a small group of doctors whose
achievements were due more to their passion rather than the active
support of hospital administrators. There was an important
consideration which underpinned such a tight-fisted policy in MOH. |
|
Research was not a priority in MOH. Our
priority has been to deliver affordable healthcare through a lean
and cost-effective system. Cost control takes precedence over
discretionary activities. There was only a nominal budget for
clinical research and we had to beg from the Tote Board and other
charities to support our researchers. |
|
The concern was that clinical research
would lead to more costly treatment options. This would increase
healthcare costs and also fan up public expectations for esoteric
treatment which our society might not be prepared to pay. |
|
We used to look at the huge NIH research
budget in the US which runs into billions of dollars a year and
concluded that we could not afford such a luxury. Let the Americans
do the research and we will send our doctors there to learn the new
treatments and procedures after they have been established. It is a
cheaper way to raise our medical standards. |
|
I wanted to stress that these
considerations were neither frivolous nor trivial. Indeed, many
aspects of those considerations remain valid today. |
|
But in 2006, MOH revised the policy and
obtained the Cabinet’s approval to include clinical research as part
of MOH’s mandate. MOH would henceforth promote clinical research in
public hospitals and seek appropriate funding support for its
researchers. Why did we change the policy? |
|
This is not because we think we have
arrived, that we are now a developed country and we are rich enough
to support clinical research. We are not. Funding will remain tight
and cost control will remain an MOH priority. |
|
But we assessed that the time had come
for Singapore to do more in the area of clinical research because
such research, if suitably directed, could benefit healthcare. |
|
More..... |
|
Source:
www.gov.sg News 26 Mar 2008 |
|
 |
|
Important
Notice |
|
Our FrontPage
Editions are a historical record of our Web site and reflect
the changing of the times, and also of our Web site through
time. We do not and will not update the links and stories on
these FrontPages even if they have become obsolete. |
|
FrontPage Edition: Sun 30 March 2008
All rights reserved
