SINGAPORE, Oct 6 — The Ministry of Health (MOH) is looking at how traditional Chinese medicine (TCM) can complement the Government’s Healthier SG plan, though this will depend on the outcome of two work groups, said Health Minister Ong Ye Kung.
Addressing Parliament on Wednesday (Oct 5), Mr Ong said that these work groups have been focused over the past year on issues such as enhancing TCM clinical training and improving career development.
The reasons the work groups were set up by his ministry and the TCM community is that TCM is self-regulated with “varying standards of practice”, said Mr Ong.
“Once completed, (the findings of the work groups) can be a basis to explore how to involve TCM in support of Healthier SG,” said Mr Ong.
He was speaking at the end of a two-day debate on a motion over the Healthier SG White Paper, which outlines how the Government plans to carry out a multi-year reform of the healthcare sector to focus more on preventive care over acute care.
The Healthier SG programme, which will begin next year in stages, was first announced by Mr Ong during his ministry’s budgetary debates in March.
This week’s debate, which took place over a course of around nine hours, saw a total of 28 Members of Parliament (MPs) from the ruling and opposition parties — as well as Nominated and Non-Constituency MPs — rising to speak about the White Paper, which was eventually endorsed by Parliament.
Aside from Mr Ong, three of his colleagues from MOH — Senior Parliamentary Secretary for Health Rahayu Mahzam, Second Minister for Health Masagos Zulkifli and Minister of State for Health Janil Puthucheary — also spoke in response to the questions raised by MPs.
The role of TCM within Healthier SG was among the questions asked by several MPs — including Mr Yip Hon Weng, MP for Yio Chu Kang Single Member Constituency; Ms Hany Soh, MP for Marsiling-Yew Tee Group Representation Constituency (GRC); and Ms Joan Pereira, MP for Tanjong Pagar GRC.
Leader of the Opposition and Workers’ Party chief Pritam Singh had also noted in his speech on Wednesday that TCM and other alternative therapies “have not been covered in any substantive detail” in the White Paper.
“TCM practitioners do not have a small footprint in the mindshare of Singaporeans when it comes to our health, particularly in the heartlands,” he added.
Mr Singh said Singapore should not “underestimate the wide reach of the local sin-seh (a TCM doctor) in our neighbourhoods”.
He added that MOH should not only tap them to help share healthy living tips and preventive healthcare strategies, but also not rule out subsidising TCM practitioners.
This is, of course, subject to their contributions towards the objective criteria under Healthier SG, said Mr Singh.
In response to these questions, Mr Ong said that his ministry has always recognised the value of TCM, and the benefits it brought to the community.
“During Covid-19 pandemic, I personally wrote to our TCM clinicians to say: ‘Please advise your patients to take the vaccines’. I think they were a great help (in moving) the needle to get heartlanders to take the vaccine.’’
In any case, Mr Ong said that TCM is very strong in preventive care, which is in line with Healthier SG’s goal.
“Therefore I believe when we focus on preventive care under Healthier SG, we hope TCM can play a role,” said Mr Ong.
“While we work that out, in the meantime, we encourage TCM practitioners to continue to do what (they’re) good at (and) advise their patients to take care of their health, pick up good habits, live healthily and take care of their health holistically.”
Of performance indicators and manpower shortages
In his round-up speech, Mr Ong also addressed other points raised by various MPs, such as the delivery of key performance indicators (KPIs) and outcomes for the Healthier SG programme, as well as the matter of the healthcare sector’s manpower crunch.
Mr Ong also mentioned that ageing in the community is the next major area of reform in healthcare that needs to be tackled,
During the debate, several MPs spoke about the importance of setting metrics and targets for the programme.
Mr Gerald Giam, an Aljunied-Hougang GRC MP, said in his speech on Tuesday that “what gets measured gets done”, and that both performance metrics and targets should be set before embarking on Healthier SG.
Broadly, Mr Ong did not disagree with the MPs, and highlighted that short, medium and long term KPIs are already set out in the White Paper.
This includes targets such as resident enrolment rates, health plan completion rates and keeping track of the prevalence of diseases such as diabetes mellitus, hypertension, and mental health, among others.
However, Mr Ong warned against blindly chasing KPIs, and spoke of the downsides of penalising doctors who do not meet the targets set by clawing back annual fees given to them.
As part of the healthcare reform, the funding model for healthcare clusters will shift from a workload-based model to one that is capitation-based, where clusters get a predetermined fee for every resident assigned to them based on geographical boundaries.
This is similar to the approach taken by the healthcare system in New Zealand, the White Paper states.
As for family doctors, the MOH will pay them annual service fees to care for their enrolled Healthier SG participants.
Referencing a speech by Dr Lim Wee Kiak, MP for Sembawang GRC, on Tuesday, Mr Ong said if the Government takes back the service fees from doctors who fail to meet targets, they will first refuse to participate in Healthier SG. As for those who do, he said they will “cherry pick only healthy residents” to serve.
Said Mr Ong: “If in our zeal...we penalise people for not meeting KPIs in the middle of a big change, that is when people become cynical, lose heart.”
In his speech, Dr Lim, a practising ophthalmologist, said many general practitioners have told him they were concerned with the remuneration model because they believe that the new scheme will mean a greater workload for them.
He added that if these doctors feel that they are not compensated visibly for their time and effort, some will choose not to be not to participate in the scheme.
Turning to the issue of manpower shortages, particularly for nurses, Mr Ong said that the normal annual attrition rate among local nurses has been about 6.4 per cent.
This, he said, is not high by any industry standard.
In fact, when the pandemic struck in 2020, it went down to 5.4 per cent, though it rebounded to 7.4 per cent last year. This year, he said the numbers have gone back to that of normal years.
“There was no mass exodus of local nurses,” he said.
However, Mr Ong acknowledged that the attrition of foreign nurses has gone up from 8.9 per cent in normal years, to 14.8 per cent in 2021.
The reason for this, said Mr Ong, is that the Covid-19 pandemic has led to an increase in demand for nurses around the world, and Singapore’s pool of foreign nurses were being poached by other countries that include New Zealand, Australia, and the United Kingdom.
“An expanding aged population needs more healthcare and more healthcare manpower,” said Mr Ong. “A shrinking young population limits the number of new local talents that we can bring into healthcare.”
As such, he said it is not possible to just rely on local nurses to fill up the manpower needs.
Said Mr Ong: “The great majority of the nursing workforce will still be locals. But the number and role of foreign nurses will need to grow.”
To that end, he said that MOH is securing “various pipelines of good foreign healthcare workers” from different countries to be trained and developed.
Tech support for seniors
Earlier on Wednesday, Second Minister for Health Masagos reassured seniors who need help either navigating apps such as HealthHub and Healthy 365, or with enrolment, that they will receive such help if they need it.
The MOH has described the apps as the “digital front doors” of the Healthier SG scheme.
For instance, residents taking part in Healthier SG will have a “digitally enabled plan” on HealthHub, where they can access key discussions with their family doctors and track their health progress.
However, several MPs raised concerns on Tuesday that some elders may not be digitally savvy enough to use the apps.
To this, Mr Masagos said such seniors “need not worry”.
He said that help will be available at community centres, Eldercare Centres or through Singapore’s Silver Generation Ambassadors.
Notwithstanding this, he pointed out that 280,000 people aged 50 and above have already participated in the National Steps Challenge on the Healthy 365 app.
Mr Masagos also said that there are about 230,000 seniors above 55 who are using HealthHub.
“We will outreach to more seniors and ensure they will be able to easily navigate the apps and locate the information they want.” — TODAY
