SMA Members,

It is indeed my pleasure to be here tonight, to celebrate with you the 40th Anniversary of the Singapore Medical Association. I am also very heartened by the presence of so many leaders of the medical profession from other countries, and would like to take this opportunity to warmly welcome our visiting friends to Singapore.

SMA has over the years been organising various medical meetings and events in Singapore. In the process, it has helped to bring together in Singapore members of the medical profession from the region and beyond. In fact, the presence here tonight of so many medical dignitaries from abroad is a good reflection of the outcome of SMA’s efforts over the years. With medical science and technology advancing rapidly, there is certainly much that doctors from different countries can learn from one another. With governments and people everywhere facing the same constraints of resource limitations, it is even more important for the medical profession and scientists to collaborate and co-operate closely with each other, share their findings and experiences, so that they need not re-invent the wheel.

As SMA reaches 40, it can be compared with a doctor who has also attained the age of 40. Such a doctor would have risen to become a consultant if he were a specialist, or he would be considered a very experienced family practitioner. His wealth of medical expertise and knowledge would make him a valuable teacher, and society would, in fact, expect him to contribute to society and his profession by helping to nurture and train the next generation of doctors. However, because medicine is developing so rapidly, we would also expect him to keep abreast of medical developments and upgrade himself, through a process of continuing education and training.

I would therefore encourage SMA to continue to forge closer ties with fellow medical associations in and outside the region, share its experience as well as learn from the experiences of the others. I would also urge SMA to strengthen its role as an active advocate and organiser of continuing medical education, and help the profession to better serve patients in Singapore and from the region.

Challenges of the next millennium

Let me now take a few minutes to briefly share with you two key healthcare issues which the Ministry of Health will be addressing as we enter the next millennium. The first is the problem of our aging population and its implications on our health and social infrastructure.

As you know, our demographic profile will be changing dramatically in the coming years, resulting in Singapore having a very much older population by the year 2030. In the next 30 years, the total number of elderly will increase to about 800,000, or a staggering 5-fold increase. The number of working persons supporting each elderly will, on the other hand, decline from 10 persons today to 3.5 persons in 2030. To put it starkly, we are in the midst of one of the most rapidly aging populations in the world.

The medical and health needs of elderly persons are vastly different. This represents a grand challenge to the body corporate of the medical profession as well as to the individual doctor. I hope SMA and every individual doctor can and will rise up to this challenge. It is a challenge not just of treating individual problems, but of maintaining the overall mental, physical and social well-being of the elderly.

The challenge isn’t just one of how best to treat geriatric conditions after they have arisen. It is also one of how to identify the risk factors early, and take active steps to control and minimise the risks.

It may be useful for me, at this stage, to cite some figures from the recent national health survey conducted by my Ministry. The survey found that about one-third of those aged between 60 and 69 are diabetic, half have high blood cholesterol levels, and two-thirds have high blood pressure. These are alarming figures, indeed.

But it gets worse. The same survey found that almost two-thirds of those who were diabetic did not know about their condition prior to the survey; while more than half of those with high blood pressure were unaware of their condition.

The problem is also not just one of being unaware of one’s medical condition. Even amongst the known diabetics, more than half had poor control of their blood sugar. The corresponding figure for poor control of high blood pressure was 70%.

The picture is very alarming, and I would hate to imagine the pressures on society in general, and our medical system by the year 2030, if the trend is not checked. We need urgent and sustained action to check the trend, and help the elderly to age gracefully, and to live an active and independent life for as long as possible. But the government cannot carry out this challenging task on its own. Civic and grassroots organisations will also have to play their parts.

SMA, in particular, can play an important role. The Association can help to raise public awareness on medical issues affecting the elderly. It could also help by encouraging its members and other members of the medical profession to take an active role in health promotion and education. Patients have great trust and faith in their doctors. They are therefore more likely to be motivated to translate their knowledge on healthy living into action, when their own doctors offer such advice in a face-to-face setting.

Role of SMA in Casemix

The last point I want to touch on tonight, is the issue of health care financing. Our philosophy has always been to emphasise that every individual must be responsible for his own health. We will extend subsidies only where necessary, and only to the extent that the cost becomes affordable. Therefore, even though subsidised healthcare is available, patients are made to co-pay part of the cost. To help the individual pay for his share, we have in place the 3Ms; Medisave, MediShield and Medifund.

While the current method of health care financing has served us well thus far, we recognise that there are weaknesses in the system that need to be addressed. The next evolution in our system of healthcare funding will take place with the implementation of the Casemix system. The government will use Casemix as a tool to fund our public hospitals by the year 2000, and Casemix will be extended to the private sector in 3 to 5 years’ time. Casemix represents a fairer method of funding health care, as it classifies patient episodes into clinically meaningful categories that use similar amounts of resource use.

The other benefit, and it is a significant one, is that it will enable both the government and the medical profession to compare treatment outcomes, and help the profession draw up appropriate clinical pathways. This will help us to maintain a high standard of healthcare in Singapore, and ultimately, benefit all patients.

The Casemix system, while well-established in many developed countries, is nonetheless a very complex system. We will have to adapt it to our local conditions and needs. While my ministry has been working with the public sector hospitals on adapting Casemix for the public sector, we will also need to involve private sector organisations and bodies as we prepare to extend the system further. I understand that SMA has recently formed a workgroup to look into Casemix issues. My Ministry welcomes this SMA initiative, and we look forward to SMA’s inputs, particularly how Casemix could be applied fairly to private sector charges for those patients using Medisave funds. My Ministry will be holding dialogues with private sector healthcare professionals and organisations on Casemix, and SMA’s involvement will certainly help to make such discussions more meaningful and productive.

Conclusion