Differences in Life Expectancy, Incidence of Chronic Illnesses and Acute Hospital Re-admission Rates between Highest and Lowest 20% Income Groups and Progress Made in Tackling Health Inequalities
Ministry of HealthSpeakers
Summary
This question concerns Ms Anthea Ong's inquiry regarding health disparities between income groups, specifically life expectancy, chronic illness prevalence, and hospital re-admission rates. Minister for Health Gan Kim Yong stated that while income-specific data is unavailable, educational level serves as a proxy for socio-economic status in measuring health outcomes. He noted that lower-educated individuals achieve comparable disease management through regular medical visits and are supported by the Hospital-to-Home programme and Screen for Life subsidies. Minister for Health Gan Kim Yong highlighted that cost barriers are reduced for CHAS cardholders and the Pioneer Generation to ensure equitable access. The Ministry for Health remains committed to monitoring health inequalities and ensuring all Singaporeans have access to quality and timely healthcare.
Transcript
2 Ms Anthea Ong asked the Minister for Health for each of the last three years, comparing between Singaporeans in the highest 20% and lowest 20% income group (a) what is the difference in life expectancy; (b) what is the difference in percentage of Singaporeans who suffer from (i) one chronic illness and (ii) two or more chronic illnesses respectively; (c) what is the difference in the acute hospital 30-day re-admission rate; (d) how does the Ministry measure health inequalities in Singapore; and (e) whether Singapore has made progress in tackling health inequalities.
Mr Gan Kim Yong: Data on life expectancy, hospital 30-day re-admissions and prevalence of chronic conditions by income groups is not available.
There are many factors that influence hospital re-admissions. For example, the patient's age, presence of any pre-existing conditions, reason for initial hospital admission, quality of inpatient care, transition to community care, and follow-up care. Home environment and family support are also important contributing factors. Public hospitals have introduced various programmes to reduce re-admissions. This includes the Hospital-to-Home (H2H) programme, which supports patients' transition home and links patients and care-givers with appropriate community-based services. The H2H programme has served more than 14,000 patients.
For chronic conditions, using educational levels as a proxy for socio-economic status (SES), men with primary education and below were more likely to have diabetes (1.3 times), but less likely to have hypertension (0.9 times) or high cholesterol (0.6 times) when compared to men with post-secondary education. However, for women with primary education and below, the chances were higher at 3.4 times for diabetes, 1.9 times for hypertension, and 1.4 times for high cholesterol compared to those with post-secondary education.1
Persons in the lower SES group with chronic diseases have good access to healthcare services and health outcomes. Among Singaporeans with primary education and below who have chronic conditions like diabetes, hypertension and high blood cholesterol, more than 90% had visited their doctor in the previous year for their condition. They had comparable disease outcomes with better educated Singaporeans in managing their blood sugar and cholesterol levels, although less so for blood pressure control.
Individuals can achieve good health outcomes by taking charge of their health, seeking timely treatment and adopting healthy lifestyles. MOH facilitates this by reducing cost barriers to healthcare. For example, on health screening, subsidies under Screen for Life were enhanced in September 2017. Under this revised scheme, Pioneer Generation pays $0 for screening whereas Community Health Assist Scheme (CHAS) blue/orange cardholders (as well as Merdeka Generation since November 2019) pay only $2, and all other Singaporeans pay $5. This payment covers screening tests, doctor's consultation as well as the first follow-up consultation at CHAS GP clinics.
MOH will continue to monitor health inequalities and put in place measures to ensure that all Singaporeans have access to quality and timely healthcare.