Projected Costs of Primary and Secondary Healthcare Services for Next Five Years

20 Mr Shawn Huang Wei Zhong asked the Minister for Health (a) what are the current projections on the cost of primary and secondary healthcare services for the next five years; and (b) whether there are active plans to flatten the curve of rising medical cost and medical insurance.

Mr Gan Kim Yong: From 2012 to 2017, National Healthcare Expenditure increased from $13 billion to $22 billion at a rate of about 11% per annum. Healthcare costs are rising due to various factors. First, with an ageing population, we have more seniors who require more medical attention. Second, medical advances in the form of better drugs and other technologies, which may promise better patient outcomes and quality of life, often come at a price. Third, operating costs such as salaries of our healthcare workers may increase over time.

MOH will continue to work with stakeholders to manage healthcare costs so that healthcare remains affordable for Singaporeans. This includes healthcare costs in the primary and secondary care settings, such as our General Practitioner (GP) clinics, polyclinics and specialist outpatient clinics.

For example, chronic disease prevalence will rise as our population ages. In line with our strategy to shift care from the hospital to the community, we can anchor chronic care management in primary care for better outcomes and avoid more expensive specialist outpatient clinics and hospitals when it is not required. Therefore, in November 2019, we enhanced the Community Health Assist Scheme (CHAS) to provide increased subsidies for chronic disease management to all Singaporeans at all CHAS GPs regardless of income in support of this shift.

We will also need to strengthen primary care capability in managing chronic diseases to help prevent complications, avoid hospital admissions and help avoid unnecessary healthcare bills. MOH launched the Primary Care Networks (PCN) scheme in 2018 to encourage private GP clinics to organise themselves into networks to support more holistic and team-based care. This allows the anchoring of care with a regular family doctor, which would enable the doctor to better understand the patient’s health history and facilitate early identification of conditions. This helps to improve, control, as well as prevent complications that require costly treatment downstream. MOH is also actively leveraging technology to transform our care models. For example, we are adopting telehealth to facilitate service delivery and make it more convenient for patients so that they do not miss their appointments.

Another key strategy MOH has embarked on to manage the rise in healthcare costs is to enhance support for preventive care to keep Singaporeans healthy. For example, we enhanced the subsidies for the Screen for Life programme in 2017 to encourage Singaporeans to go for early screening and timely follow-up to reduce complications. We also recently introduced enhanced subsidies for nationally recommended vaccinations at polyclinics and CHAS clinics island-wide, to better protect Singaporeans against vaccine preventable diseases.

In addition to these initiatives, MOH is also managing drugs costs. The Agency for Logistics Procurement and Supply (ALPS) was set up to aggregate demand and secure better prices for drugs and other supplies, as well as streamline and reduce supply chain costs. We are also encouraging the appropriate use of drugs, including the use of cheaper generic drugs when they are equally effective as branded alternatives.

MOH has rolled out various measures to help Singaporeans pay for their primary and secondary care bills. As mentioned above, MOH has progressively expanded CHAS over the years. Pioneer and Merdeka Generation seniors are also eligible to special subsidies for medical care at CHAS clinics. In 2018, MOH increased the annual MediSave withdrawal limits for outpatient treatment from $400 to $500 and lowered the minimum age for Flexi-MediSave age from 65 to 60.

Healthcare providers play a major role in ensuring that quality and affordable care is delivered to Singaporeans. Since May 2017, MOH has issued appropriate care guidances on medical treatments and drugs, to guide healthcare providers in making decisions that are based on clinical and cost effectiveness. In addition, MOH has also introduced fee benchmarks for common surgical procedures in November 2018 and published them on our website to guide private sector healthcare providers in charging appropriately.

Ultimately, the most effective way to manage healthcare costs is for Singaporeans to stay healthy. MOH has worked closely with our partners, including the Health Promotion Board, to promote healthy living habits. We will continue to invest in preventive health efforts such as our War against Diabetes, to tackle upstream behavioural risk factors and keep the population in good health. To achieve this, everyone has to play their part and take good care of their health and wellness.

Collectively, these efforts form part of MOH's continual focus to ensure quality and affordable healthcare services for all Singaporeans. We will continue to work closely with our stakeholders to achieve this goal.