Healthier SG White Paper

Mdm Deputy Speaker,

I welcome the plans outlined in the White Paper to bring about healthier Singaporeans.

I have a number of questions on the funding model and manpower requirements, which I hope the Minister can provide answers to.

Firstly, on the funding model for healthcare. I welcome the change in funding model to incentivise efforts towards preventive and early intervention measures and better health outcomes. Since we are paying the GPs and regional health managers on a capita basis, and learning from the SportsHub experience, will there be provisions for clawback of fees paid or termination for non-performance? What are the KPIs for family doctors?

I note from the White Paper that MOH is still in the process of working out the KPIs for the healthcare clusters. I would like to request for these to be presented to Parliament once they have been worked out, as they will be of much interest not only to the Members here, but also to members of the public.

Apart from KPIs based on the performance of the healthcare clusters at the regional level, I hope to also see KPIs based on outcomes at the national level as well for the regional clusters. This will provide incentives for the regional clusters to cooperate with one another for a better outcome at the national level. After all, the outcome at the national level is of greater importance to us and the KPIs should reflect that.

Apart from KPIs for the healthcare organisations, the performance appraisal and reward system of key personnel should also be revealed for the same reasons.

For the service fees that the Government will be paying to GPs and healthcare clusters, will there be any difference between foreigners and locals? Would there be any financial reasons for GPs or healthcare clusters to lean more towards one group?

Next, I have some questions on the manpower requirements. What are the number of doctors, nurses, and other healthcare professionals now and projected in the next decade? How does MOH intend to reach those numbers? Would it be via an increase in enrolment in relevant courses at our universities, polytechnics and other training centres? If so, what is the planned enrolment for these courses in the next decade? How many is expected to be via recruitment from outside Singapore? And does MOH plan to change the terms and conditions of these healthcare professionals to attract and retain them?

I also have some questions on chronic diseases. The White Paper showed that the rate of diabetes has fallen slightly, while that for obesity has risen slightly. However, the rate of high blood pressure and high blood cholesterol has risen sharply.

Unbalanced diet and low level of physical activity were cited as reasons. These two reasons would, however, cause rises in all four categories. And since the magnitude of change is so different, could there be other contributing factors apart from diet and exercise? For example, would stress levels and poor work life balance be contributing factors? Can MOH also provide more details on what ways is our diet unbalanced?

The White Paper also mentioned that the prevalence of chronic diseases have risen across many age groups including the young. Can MOH provide the prevalence rate with breakdown by age?

Lastly, I have a couple of suggestions for the Minister to consider. I have raised this before and I will raise it again. MediSave can currently be used for hospitalisation and limited outpatient treatment. I have heard anecdotes of how some people chose inpatient treatment for something that can be treated as an outpatient and at a lower cost, because the former can be paid via MediSave while the latter require cash outlay. Therefore, demand is skewed towards the more expensive inpatient treatment due to MediSave rules.

In line with the efforts outlined in the White Paper to move our healthcare more towards preventive and primary healthcare, will MOH consider allowing MediSave to be used for all outpatient treatment?

Secondly, healthier food tends to be more expensive than unhealthy food. Can we find ways to make healthy food less expensive compared to unhealthy food? One option to consider is a tax on unhealthy food that goes towards subsidising healthy ones.