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President’s Forum

"Thoughts on Health Care Delivery (2) - Medical Hub"

Singapore has been a service hub for medicine for some years. The positive factors for its being a medical hub are: its geographical location, ease of travel to and from it, the standard of care it is able to provide and also an on-going Health Manpower Development Programme (HMDP) to develop its medical manpower. On the negative side is the uncertainty due to economic ups and downs that will determine the number of people able to visit the hub. Another factor is the competitiveness of Singapore in comparison with other centres of treatment in our part of the world and beyond. What is also important in the long run is the development of medical expertise in the countries around the region; this may make our services redundant.

What will make Singapore expand further to continue to be a medical hub for the Asia Pacific Region and beyond? This is obviously not an easy question to answer but yet we should try.

Upgrading

There is a need to continue to upgrade. The HMDP has been one important avenue. Inviting experts to Singapore and sending our doctors to train abroad help to enlarge our doctors’ expertise through the transfer of technology. As the countries of the region develop their medical expertise, there is no doubt that they will also be able to treat at home as many of the patients as possible who for now have to go abroad. Thus to remain competitive, there is a need for us to continue to upgrade our medical talent pool to be able to manage high-end medical problems.

Paying attention to training the future generations of healthcare providers in Singapore will ensure that our doctors are competent and conversant with the latest developments in medical science. Only by continuing to invest heavily in both undergraduate and postgraduate medical education will we be able to produce doctors capable of meeting this demand.

Reliance on foreign talent or institutions, whether because they are cheaper or because they are the ‘best’, is only a temporising measure. There is no guarantee that they will continue to be here if greener pastures are available elsewhere in the region or the world, for their reason for being here is economic gain. It would be unacceptable to Singaporeans if the foundation of our healthcare system is based on foreign talent, unlike for example, the construction industry. Our only insurance against this is for our local doctors, who have a long-term stake in Singapore, to be just as qualified.

Mutual support

As a medical hub, there is a need to muster all the resources that the country has to provide consistently high-quality services. Perhaps, this is where competition could be given a break, and the private and public sectors can work collaboratively and mutually support each other to provide the services that the overseas patient needs. The moment of truth for the patient must be a positive one. There is no doubt that such mutual co-operation occurs informally across the two sectors. What is needed is an ideological shift to accept that there is a place for injecting friendly cooperation into the competitive spirit to be efficient.

Collaborating with the countries we serve

There is also wisdom in collaborating with the doctors from the countries whose people we serve. Getting close to them to complement and augment their capability, rather than compete with them for the patients who they can serve is likely to promote their acceptance of Singapore as a medical hub.

It is therefore heartening to note that several groups of our private specialists have seen the wisdom of doing that. They visit the neigbouring countries from where their patients come from and work with the specialists there to provide the necessary consulting advice and the transfer of technology.

This collaboration with doctors in neighbouring countries brings us to the topic of extending the service hub paradigm to become a training hub as well. In this process, our doctors will also benefit. A training hub will boost Singapore’s image to achieve our professed aim of being a medical hub for the region. The United States and the United Kingdom have followers around the world who attest to the excellence of the state of their medical science, partly because they have invested in the training of doctors from other countries. Word of mouth is the most effective form of advertisement of our medical capabilities. It would be far more effective than any advertisement campaign, which might even earn the wrath of the health authorities in our neighbours. Investment in this area is thus also justified to bring us closer to our neighbours and gain their acceptance of us as a medical hub. We are useful to them in their endeavours to help their patients and not to take their patients from them.

Investment is needed not only in monetary terms but also time, time for our medical teachers to teach. The learning of medicine is an apprenticeship, unlike the other sciences or professions. One cannot become a good doctor just by reading textbooks without the guidance of a good teacher. Overzealous emphasis on the provision of services will deprive the subsequent generations of doctors the opportunity to learn from the experience of the previous. Time must be provided for those who are able to teach and those who are willing to learn for the happy marriage to succeed.

Also, by developing Singapore into a training hub, Singapore would be more likely to be consulted in dealing with the high end spectrum of medical problems. This will no doubt provide us the type of work that many of our specialists aspire to be good in.

There are two economic benefits of investing time, money and manpower in medical research, in addition to the advancement of medical science and resulting in improvement in the medical care of the population. Firstly, making medical discoveries and reporting them in peer-reviewed indexed medical journals demonstrate to the medical community of the world and the public the standards of medical care in Singapore. This would have positive implications on Singapore’s attempt at establishing itself as a centre of medical excellence. Nothing the EDB or TDB can do will have the same impact as having excellent doctors who are able to demonstrate to medical professionals around the world by such means that they are indeed excellent. Investment in medical research is thus justified.

Secondly, some of the largest and most profitable multinational companies in the world are involved in the manufacturing of medical products. It does not take a large population base to generate ideas for marketable medical products. This is an economic sector which Singapore should not be left out of if our economy is to continue to grow. Leaving the funding to foreign companies would also necessarily mean that they reap the larger part of the profits. Singapore must invest in the training of manpower capable of this sort of research; in addition to providing time and money for the process of such research.

Perhaps Singapore should set its sights to being more than just a service hub. By being a training and research hub, these ideologies will strengthen our capability to be a medical hub. What is more important, there will be positive spin-offs of developing ourselves and our medical colleagues in the region to be even more capable doctors.

Thanks are due to Drs Yue Wai Mun and Wong Tien Yin for their contribution of ideas and their writing part of this President’s Forum.

A/PROF GOH LEE GAN