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"SMA Council Meets Health Minister"

The SMA Council met Minister for Health, Mr Lim Hng Kiang on 19 August 1999. The meeting was also attended by the Parliamentary Secretary, Mr Chan Soo Sen, Permanent Secretary, Mr Moses Lee, Acting DMS, Dr Lam Sian Lian and other ministry staff.

Minister agreed that it would be useful to meet regularly. Since he had just taken over the health portfolio, he suggested that the meeting be held once every 6 months initially. He was also agreeable to meetings as and when the SMA had matters to raise with him.

As requested, the SMA submitted a background paper on a cost effective healthcare delivery system, Singapore as a medical hub, and tax exemption for continuing education activities.

On a cost effective healthcare delivery system, the SMA world view is to take a systems approach across the health care delivery system and to to enhance primary care nation-wide by three strategies. They are, to limit the subsidy in the public sector to only the needy and the aged, to promote continuing care and elderly care, and to consider departments of primary care to co-ordinate and develop service, training and relevant practice based research.

On the medical hub, the SMA world view is to expand the paradigm of medical hub beyond the service centre to be a centre of excellence for training and research to complement service delivery. There is a need to define more clearly the role of foreign medical talent.

On tax exemption, SMA requested for support from the Ministry of Health for tax exemption on continuing education be extended to include conferences on broad subjects beyond the practitioner’s immediate specialty, such as subjects relating to ethics, practice or management of clinic and IT. Also, SMA asked for the support by Ministry of Health for tax exemption to be extended to include locally held conferences and not be limited to only recognised world conferences. There is a need to support local conferences.

On the medical hub, the Minister commented that the Ministry of Health’s bottom-line is to ensure good and affordable health care for Singaporeans. Achieving a medical hub status is a bonus. There should be no confusion between the two aims.

Given the political sensitivity of healthcare, it is necessary to build a firewall between high-end, expensive medicine and affordable healthcare. The high costs and prices of the former would not be allowed to adversely affect the affordability of the basic healthcare package for the general population.

However, the firewall was still a concept and the specific mechanism and measures had yet to be worked out. The SMA suggested that the Medisave coverage for hospitals could serve to operationalise the firewall, namely to deny Medisave coverage for the high-end market. Minister noted the suggestion.

Minster said that unlike most ministries, there is a clear policy framework for the Ministry of Health to operate within. This was articulated in the Government’s White Paper on Affordable Health Care. The main principles remain valid.

He also said, "The role of the polyclinics is to cater to the lowest income groups. They should not compete with the private sector for a larger share of the primary healthcare market."

"There is scope for the GPs to improve their standards and scope of healthcare services and thus strengthen their role as gatekeepers to hospital care. One way to instil greater public confidence in the quality of GP care is through CME."

"In terms of acute hospital care, the White Paper target of achieving the 70:30 public to private market share is still valid, although the Ministry has not spelt out specific measures to achieve it."

SMA observed that GPs are not able to compete with the polyclinics because the latter could obtain drugs more cheaply than the private sector. The GPs are unable to compete and are forced to discharge their patients to the polyclinics rather than manage the patients themselves.

Minister agreed with the need to repackage the polyclinics to deal with such problems. Integrating them with hospitals would also enhance discharge planning from hospitals to the GPs. He hoped that GPs would eventually collaborate with the regional general hospitals and the polyclinics to further enhance integrated care for patients.

SMA noted the entry of Johns Hopkins Singapore (JHS) had raised concern among the local medical community.

Minister responded that where JHS is concerned, we should adopt a wait and see attitude and not to be unduly upset by the publicity surrounding the institution’s entry into Singapore. He reassured SMA that MOH will lay down ground rules and apply the same regulatory framework to both foreign and local players.

SMA noted that JHS’ reply to the SMA’s letter was positive. JHS recognised the need for greater understanding on their part on how they can fit in with local medical practices and advertising guidelines

Minister decided that MOH should simplify the administrative procedure for getting tax exemption for CME activities. Instead of going through MOH, SMC should administer the process based on the IRAS guidelines for tax exemption. In time, the Ministry should request IRAS to give automatic tax exemption for all courses under the compulsory CME system.

SMA said that it had offered to SMC to provide the administration of CME free to its members and charge at cost-recovery for non SMA members. SMC had not responded to the offer. Minister said that Ministry could work with both SMA and SMC to set up an enhanced CME system.

The meeting with Minister provided an opportunity for an exchange of ideas and vision of the health care scene for the near future. The SMA leadership looks forward to a continuing dialogue with the Minister for Health and his Ministry on the common goal of caring for the people of Singapore.

A/PROF GOH LEE GAN