The last SMA Anniversary Dinner of this millennium was held on 1 May 1999. It was also the 40th Anniversary Dinner of the SMA.

This was followed by a cake-cutting ceremony by some of the past and present Presidents of the SMA Council.

The Guests

The Guest-of-Honour was Mr Yeo Cheow Tong, the Minister For Health and Environment. Honouring the occasion were the Presidents and representatives of the national medical bodies of the ASEAN countries (excluding Cambodia), Britain and China.

The Ministry of Health was well represented by the First Permanent Secretary, Mr Koh Yong Guan, the Second Permanent Secretary, Mr Moses Lee and the Director of Medical Services, Dr Chen Ai Ju.

SMA Honorary Membership

Honorary memberships were conferred on Emeritus Professor K Shanmugaratnam, for his renowned work and teaching in Pathology, and Dr Robert Loh, for his development of tertiary eye care in Singapore.

Inauguration of SMJ Corresponding Editors

The Editor of SMJ, Prof Kua Ee Heok, inaugurated the Panel of Corresponding Editors of the SMJ.

Speeches

1. In his Welcome Address, A/Prof Cheong Pak Yean acknowledged the fruitful meeting SMA had that morning with the overseas guests on the developments in healthcare in the respective countries, as well as their gifts for the occasion. Also, the 40th Anniversary Committee, chaired by Dr Yue Wai Mun, and the Dinner Organising Committee, chaired by Dr Ang Peng Tiam, were acknowledged for their hard work.

2. The Minister of Health, in his speech, commended the efforts of SMA in bringing together members of the medical profession in the region and beyond, to collaborate and share their findings and experiences. The SMA was urged to strengthen its role as an active advocate and organiser of Continuing Medical Education, and thereby help doctors to better serve patients in Singapore and the region.

The Minister then highlighted 2 key healthcare issues for the next millennium.

The first was the problem of our very rapidly aging population and, its health and social implications. By the year 2030, there would be 800,000 elderly (a 5-fold increase), each supported by 3.5 working persons, a decline from 10 persons presently.

As the medical and health needs of the elderly persons were vastly different, the grand challenge to the medical profession would not only be the treatment of individual problems, but also to identify the risk factors early in order to control and minimise the effects of the aging. The purpose is to enable the elderly to live an active and independent life for as long as possible.

The recent national health survey done by the Ministry of Health showed one-third of those between 60 - 69 years old are diabetic, two-thirds have high blood pressure and half have high cholesterol. Two-thirds with diabetes and half of those with hypertension, are not aware of their condition.

SMA has been called upon to raise public awareness by encouraging its members to take an active role in health promotion and education.

The second issue was healthcare financing. The philosophy of the Ministry has been for the individual to be responsible for his own health, and to help him co-pay part of the cost, through Medisave, Medishield and Medifund.

The next evolution in the system of healthcare funding would be through the Casemix system, which would be the tool for funding public hospitals by the year 2000. It would be extended to the private sector in 3 to 5 years’ time.

Casemix classifies patient episodes into clinical categories that utilise similar amounts of resources. This would enable the government and medical profession to compare treatment outcomes, and to draw up treatment paradigms. Ultimately, the purpose was to have a cost effective high standard of healthcare in Singapore.

The Minister recognised that Casemix is a complex system and will be adapted to local conditions and needs.

We welcome the initiative of SMA in forming a workgroup to look into Casemix issues, especially SMA’s inputs on how to apply Casemix fairly to private sector charges for those patients using Medisave funds.

In conclusion, the Minister encouraged SMA to assume a greater role in the healthcare milieu of the next millennium, as it was not possible, nor wise for MOH to take the lead in everything in the new information age. "Good ideas have to come from all quarters."

3. In his Out-Going President’s Address, A/Prof Cheong Pak Yean posed 3 strategic planning questions:

He addressed the first two, and left the third to the in-coming President.

The evergreen issues of professional image, the relationships between government and the medical profession, between doctor and patient, and ethical challenges of the business aspects of medical practice would continue to demand much of SMA’s attention.

The time specific issues in the next 5 to 10 years, would be the control of healthcare costs, consumerism and confusion in the fact of rapidly changing technology and values.

SMA must provide the leadership to work with the government, the medical profession and the public to find constructive solutions to these challenges.

He touched on the achievements made so far by his council in maintaining a positive relationship with MOH, and making a stand assertively on ethical issues eg. the "profit guarantee" issue in 1997. The landmark resolution passed against it was subsequently reaffirmed by the Singapore Medical Council and MOH. Plans have been made to set up the "SMA Centre for Ethics and Professionalism" to be the think-tank and education centre for the study and understanding of the dilemmas of medical practice, and thereby empower doctors to deal with them in their daily work.

Other issues during his tenure include the study on GP fees in 1996 (of which information was used by the Select Government Committee to determine the amount of polyclinic patient subsidy), the development on managed care, and Casemix funding (a team headed by Dr Lim Teck Beng, went to Australia in February 1999 for research into this).

The Presidents’ Forum in the SMA News was developed to become an open letter to communicate the views, ideas and concerns between the medical profession and the outside world. Regionally, the SMA has also helped the sister medical organisations to improve their healthcare systems through training, via MASEAN (whose secretariat was hosted by SMA), and bilateral contacts.

He ended his speech with expressed confidence in A/Prof Goh Lee Gan, the President elect, to continue the work and to scale greater heights.

4. A/Prof Goh, after accepting the Chair of office, spoke on the direction the incoming Council would take to focus their energies on 3 areas: Empowerment, Relationship and Proaction (ERP).

Empowerment at various levels were discussed:

- The education of the public through public forums, and work with the mass media, to invest in their health and be rewarded with a better health status.

- The doctors for better understanding of health-related technical, etiquette, emotional and ethical issues of the day.

- The Singapore Medical Journal as a high impact journal for high quality papers, and a forum for continuing medical education of doctors through an Educational Section. Local researchers were to be persuaded to publish some of their best papers in the SMJ.

- The regional level, through working closely with ASEAN and Asia pacific members towards better health care for mutual empowerment.

Continued good relationships between the SMA and its members, the government, sister professions, the press and the public would be pursued constructively through transparency and the desire to work for the good of the patient and country.

For proactive projects for the coming years, 5 areas have been identified viz: community health education initiatives, Casemix funding problems and solutions, membership services, developing the Centre for Ethics and Professionalism, and CME on practice management and medical ethics. (Domain specific CME would be left to the College of Family Physicians and Academy of Medicine.)

He concluded his speech by introducing the new Council office bearers

Other highlights

A video presentation on "40 Years of SMA" was shown just after the Minister’s speech. It was a commendable effort by Drs Tan Lip Hong, Lee Kheng Hock and A/Prof Goh Lee Gan.

Long Service Awards were given to Council Members, and Committee members who have served the medical profession through SMA. They included Dr Chan Kah Poon, A/Prof Chee Yam Cheng, Dr T Thirumoorthy, A/Prof Ti Teow Yee, A/Prof Lee How Sun, Dr Tan Chay Hoon, Prof Feng Pao Hsii and Dr Tan Hooi Hwa.

The evening was enhanced by good company, good food and service, and a musical quartet who provided good atmospheric music.