Public Health Indicators to be Published to Enable Public to Track Health Outcomes and System Pressures

1 Mr Pritam Singh asked the Coordinating Minister for Social Policies and Minister for Health beyond bed occupancy rates, ward admission waiting times and emergency department attendances, what additional public health indicators the Ministry will publish on a monthly or bi-weekly basis to enable the public to better track health outcomes and system pressures, in light of Singapore’s transition to a super-aged society.

The Minister of State for Health (Ms Rahayu Mahzam) (for the Coordinating Minister for Social Policies and Minister for Health): Mr Speaker, the Ministry of Health (MOH) publishes various public health indicators related to the health system and population health outcomes. For example, several capacity related indicators are available on the MOH website. The annual National Population Health Survey covers lifestyle risk factors and practices such as smoking, screening and vaccinations. The National Nutritional Survey informs us of the dietary patterns and nutritional status of the population. The annual MOH Revenue and Expenditure Estimates – that is, the Budget Book – also published various key performance indicators, such as life expectancy, mortality rates from diseases, disease prevalence, medical resources and so on. In addition, indicators on cancer, chronic kidney failure, stroke and heart attack are also published by the National Registry of Disease Office annually.

Health outcomes take time to shape and evolve, and it would not be appropriate to report fortnightly or monthly.

Mr Speaker: Mr Singh.

Mr Pritam Singh (Aljunied): Mr Speaker, thank you and I thank the Minister of State for the reply. My question really starts from the debate at the Committee of Supply. The Minister of State referred to the Budget Book. There are two particular key performance indicators (KPIs) there, for example. One is "the percentage of patients who wait less than or 100 minutes for consultations at polyclinics". There is another one which says "the percentage of patients who waited more than or equal to 60 days for new subsidised specialist outpatient clinic appointments".

My question was framed with regard to our super-aged society. The consideration that I am suggesting that MOH looks into is whether there could be a public health dashboard for Singaporeans that gives us a one-stop identifiable datapoint on what our public healthcare outcomes are looking like on a bi-weekly or monthly basis. So, these two KPIs in the Budget Book, for example, could potentially be on that dashboard. There are other Organisation for Economic Cooperation and Development (OECD) countries which also have public health dashboards.

My query ultimately is, how is MOH going to look at improving reporting of these public health outcomes in the context of a super-aged society and not prior to this Rubicon that we have now crossed?

Ms Rahayu Mahzam: Mr Speaker, I appreciate the input and insight that the Member has raised. Perhaps I could just give some insight also as to how we have framed this.

When we look at how we are tracking and measuring, we look at an end-to-end and a full suite approach to things: we look at the preventive efforts that we are doing, and that is why we are tracking screening rates, enrolment to Healthier SG; we look at the aspect of the systems and the pressures on that; the access to care is also one dimension; we also look at the larger health outcomes. There is actually a full range, and in that sense, many of these are already available, that datapoint is already available to the public to scrutinise and look at.

Secondly, I think in deciding what are some of the KPIs or items for us to track, there needs to be an appreciation as to whether or not that is meaningful. I take note of some of the items that the Member has raised. There needs to be a balance in what we are tracking, because just providing the information may not provide any meaningful insight or will necessarily encourage the right behaviours.

For example, when we look at Emergency Department timings, the point of it is really that at the end of the day for Emergency Departments, if it is an emergency case, it will be attended to immediately. Regardless of the median waiting times or whatever, there is already a protocol that is in place. The point is, we also want to then nudge behaviours. That particular measure may not necessarily reflect the efforts we are taking in that space.

There is also cost to tracking and the measuring, so we want to make sure that whatever we decide on to measure must be meaningful, must then lead to better behaviours and the correct approaches to then respond to some of those indicators.

But I do take the point and we are actually reviewing to see what is a meaningful way to put out this information so that the public can understand, so that we can all track properly whether the good health outcomes are a result of the efforts that we are making. I will take the feedback back and we will continue to review this.

Mr Speaker: Mr Singh.

Mr Pritam Singh: Thank you, Speaker. The Minister of State mentioned meaningful impact a few times, so I will give an example. The KPI in the Budget Book, "the percentage of patients who waited less than or at least 100 minutes for consultations at polyclinics", for example, for each fiscal year, 2023, 2024, 2025 – the number is 99%. So, it is very high degree in terms of hitting the KPI. But at some point we have to ask, is that a meaningful representation of what constitutes a good public health outcome? Is 100 minutes too lax or two permissive a KPI?

So, I think if you have a public health dashboard, for example, with a little bit more granularity, I believe the public would have a better sense of the stressors on the healthcare system and where improvements can be made, and where changes also can be advanced in Parliament and out of Parliament to achieve better outcomes for the population at large.

Ms Rahayu Mahzam: I appreciate the Member's feedback. As I said earlier, this is something that we will continue to consider. But we do also have to appreciate that the information that we get is live, in terms of waiting times and all that. So, the Member is right in that we will constantly review as to whether that measure is actually a good reflection of the state of the health systems. But as you know, we give feedback all the time to MOH and we do respond quite immediately to some of these issues, especially with, say, waiting time at the polyclinics, how they are utilising the online systems. And on the go, our public healthcare providers are constantly trying to improve and adapt.

So, I want to give that assurance that we do take note of these: one, in respect of making sure that whatever we are measuring is meaningful; two, there is always a quick response to immediately and promptly respond to the needs on the ground as to the healthcare utilisation and to respond to the changing landscape with regard to ageing.