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Healthier SG: Questions galore from MPs on tech support for seniors, funding, cybersecurity and how to measure results

SINGAPORE — Several Members of Parliament (MPs) on Tuesday (Oct 4) questioned how technologically averse seniors will be able to access digital tools such as smartphone applications that will be used as part of the Government’s Healthier SG plan, as well as the financing model under the healthcare reform.

During a debate on the Healtheir SG White Paper, Parliament heard that it may be essential to have digital channels to promote better healthcare, but there should still be traditional touchpoints for older residents who may not be savvy using digital tools.
During a debate on the Healtheir SG White Paper, Parliament heard that it may be essential to have digital channels to promote better healthcare, but there should still be traditional touchpoints for older residents who may not be savvy using digital tools.
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  • Members of Parliament had several concerns about the Government’s Healthier SG plan
  • Some questioned how older Singaporeans who are technologically averse will be able to get up to speed with it
  • The use of smartphone apps will be part of the Healthier SG programme
  • They also asked if other members of the healthcare fraternity such as psychologists and Traditional Chinese Medicine practitioners can be included in the scheme
  • Health Minister Ong Ye Kung is expected to respond to some of the questions and suggestions in a wrap-up speech on Oct 5

SINGAPORE — Several Members of Parliament (MPs) on Tuesday (Oct 4) questioned how technologically averse seniors will be able to access digital tools such as smartphone applications that will be used as part of the Government’s Healthier SG plan, as well as the financing model under the healthcare reform.

For close to four hours before Parliament was adjourned, 17 MPs from the ruling and opposition parties — as well as Nominated and Non-Constituency MPs — debated a motion over the Healthier SG White Paper, which outlined how the Government plan to carry out a multi-year reform of the healthcare sector to focus more on preventive care over acute care.

The MPs in general supported the motion, noting that the reform spelt out in the White Paper is necessary given Singapore's ageing population and the Government's rising healthcare expenditure.  

One MP suggested that to help onboard more older Singaporeans onto the scheme, the Government may consider having someone like the neighbourhood postman be the point of contact for vulnerable elders who are less likely to be digitally savvy. 

Other concerns the MPs raised included whether other members of the healthcare fraternity such as psychologists, dentists and Traditional Chinese Medicine practitioners can be included in the scheme, as well as potential issues in executing the changes, such as how healthcare insurance companies tagged to a patient’s workplace can support this programme. 

The Healthier SG programme, which will begin next year in stages, was first announced by Health Minister Ong Ye Kung during his ministry’s budgetary debates in March.

Under the plan, residents will, among other things, be encouraged to register with a family doctor to be their first port of call for all their healthcare needs.

Mr Ong, in a speech opening the debate earlier on Tuesday, said that the programme is estimated to cost S$1 billion over the next three to four years, with another S$400 million going yearly towards recurrent costs.

He also gave some details on the free health screenings that will be offered to residents, as well as announced improvements to the government-developed Healthy 365 mobile application that will serve a key component in getting residents to lead healthy lifestyles.

WHAT ABOUT PATIENTS WHO AREN’T DIGITAL-SAVVY?

The Healthier SG White Paper states that apps such as HealthHub and Healthy 365 will be the “digital front doors” of the 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 are concerned that some elders may not be digitally savvy enough to use the apps.

We must make sure the digital window does not become a digital bottleneck.
Dr Tan Wu Meng, oncologist and Member of Parliament for Jurong Group Representation Constituency

Dr Tan Wu Meng, MP for Jurong Group Representation Constituency (GRC) who is also a medical doctor looking after cancer patients, asked: “What happens for seniors who don't have a smartphone… who are not digital savvy… not comfortable using a smartphone app?

“We must make sure the digital window does not become a digital bottleneck.” 

Agreeing, Jalan Besar GRC MP Wan Rizal said that the fear of falling prey to online scams may even drive some seniors away from using these digital platforms. 

Jurong GRC MP Xie Yao Quan said that the digital tools available may add convenience to users, but it may also serve to confuse them. 

“While digital is essential, and we must have digital channels, we have to also preserve traditional touchpoints… by providing both traditional and digital options, rather than substituting the traditional with the digital,” he said. 

Chiming in, Nominated MP Janet Ang suggested that to help people who are “digitally naive” and likely to be from lower-income households, the Government may consider Japan’s example, where neighbourhood postmen become “the point of contact for this group of vulnerable seniors”. 

HOW TO TELL IF PROGRAMME IS SUCCESSFUL?

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 Ministry of Health (MOH) will pay them annual service fees to care for their enrolled Healthier SG participants.

Ideally, the implementation age should be 40 years and younger, not older. The earlier the start, the easier (it is) to manage chronic diseases
Dr Lim Wee Kiak, ophthalmologist and Member of Parliament for Sembawang Group Representation Constituency

Two MPs on Tuesday asked how the Government will measure whether the programme is working and that patients are achieving better health outcomes.

Mr Gerald Giam, Aljunied-Hougang GRC MP, noted that although the White Paper has set some short- and long-term metrics for the programme, such as health screening rates and hospital admission rates, no targets for these metrics were provided.

“Without targets, these metrics hold much less meaning,” the opposition Workers’ Party MP said. “Given the huge investment in Healthier SG, the public should expect an improvement in both the short- and long-term metrics.”

Dr Lim Wee Kiak, MP for Sembawang GRC who is also a practising ophthalmologist, noted that the annual service fees given to family doctors will be tiered based on factors that include the enrolled residents’ progress in preventive care or chronic disease management, which could be challenging to measure objectively.

Dr Lim said that many GPs have told him they were concerned with the remuneration model because they believe that the new scheme will mean a greater workload for them.

Furthermore, younger patients are typically more receptive to medical advice than older patients who may be more resistant to lifestyle changes, he said as he asked the Government to provide a clearer outline on how GPs will be remunerated.

Dr Lim also said there is a risk that family doctors may choose not to be part of the scheme if they feel that they are not being compensated reasonably for their time and effort.

We should aspire to… the United Kingdom’s model, for example, where GPs can eventually refer patients for direct admission to a hospital within the healthcare cluster without the need to go through an emergency department.
Mr Xie Yao Quan, Member of Parliament for Jurong Group Representation Constituency

Similarly, his Sembawang GRC teammate Mariam Jaafar raised concerns that the capitation model could create incentives for the cherry-picking of healthier patients or the limiting of access to required care.

And instead of having MOH remunerate the family doctors directly, Mr Xie suggested that the payments be made through Singapore's three healthcare clusters instead as a way to drive greater integration within the cluster.

“We should aspire to… the United Kingdom’s model, for example, where GPs can eventually refer patients for direct admission to a hospital within the healthcare cluster without the need to go through an emergency department.”

WHAT ABOUT MENTAL HEALTH AND DENTAL CARE?

Since the Healthier SG scheme will primarily involve enrolling residents with a family doctor, it led MPs to ask if other healthcare services may also be considered. 

MPs He Ting Ru, Dennis Tan and Wan Rizal asked if mental health services could also be included as part of the scheme.

Not having adequate treatment or support while suffering from mental health conditions has an impact on all aspects of one's life, ranging from economic output to physical health.
Ms He Ting Ru, Member of Parliament for Sengkang Group Representation Constituency

Ms He, a Sengkang GRC MP with the Workers’ Party, said that although the Healthier SG White Paper did mention that mental health protocols will be developed, mental health was not among the first few protocols that will be rolled out to family doctors. 

“Not having adequate treatment or support while suffering from mental health conditions has an impact on all aspects of one's life, ranging from economic output to physical health,” she added.

“So it is important that our plans to address mental health illnesses are firmly anchored within the primary health care system.” 

Hougang MP Dennis Tan, also from the Workers’ Party, noted that the mention of dental care was missing from the Healthier SG scheme, adding that maintaining good dental health could help prevent chronic diseases, but at the same time, dental care can often be expensive. 

“I would therefore like to know whether in the future, MOH will also look at extending Healthier SG to the coverage of dental and oral health.” 

Mr Xie also noted that doctors seemed the “centre of gravity” of the scheme, and the roles of healthcare professionals such as nurses, pharmacists and allied health professionals were not touched on as much. 

He asked if there could be more equal roles and co-leadership among different healthcare providers and workers to shape preventive care in the community.

The absence of Traditional Chinese Medicine (TCM) practitioners from the Healthier SG scheme was also noted by Tanjong Pagar GRC MP Joan Pereira. 

“TCM practitioners have been playing a significant role in helping residents, particularly the elderly, to better manage their health over the long term,” she said. 

MOH could consider setting up a system “similar to our present western medical framework” to ensure the integration of TCM into the healthcare system, she proposed.

WHAT IF DOCTORS MOVE TO SERVE OTHER CLINICS?

As for how the programme will be rolled out, there were questions on what happens if the resident’s chosen family doctor belongs to a medical group and moves to a different branch away from the resident’s neighbourhood? 

Many people in Singapore visit clinics that are covered under their company’s medical insurance benefits, several MPs noted. What happens when the insurance firm changes its appointed panel of doctors? 

What will happen if a patient’s preferred GP chooses not to join the network due to the clinic’s constraints?
Ms Joan Pereira, Member of Parliament for Tanjong Pagar Group Representation Constituency

And in line with the digital slant of the programme, Ms Pereira said that manpower will be needed especially to ensure high levels of cybersecurity around patient data.

“What will happen if a patient’s preferred GP chooses not to join the network due to the clinic’s constraints?” she asked.

MOH will provide a one-off information technology (IT) support grant to family doctors to offset the costs of IT adoption for sharing clinical notes, monitoring patient outcomes as well as data collection and sharing.

“Some residents are also concerned that more costs for the GPs will be involved and as a result, the medical costs will be higher,” Ms Pereira added.

Dr Lim of Sembawang GRC asked why the enrolment with a dedicated family doctor is being opened in phases to residents aged 60 and above first in the second half of next year, followed by those in the 40 to 59 age group in the next two years.

“Ideally, the implementation age should be 40 years and younger, not older. The earlier the start, the easier (it is) to manage chronic diseases. We are not managing chronic diseases, we’re trying to prevent chronic diseases.”

About 10 other MPs are due to speak on the debate when Parliament resumes on Wednesday and Mr Ong is expected to respond to some of the questions and suggestions in a wrap-up speech.

Related topics

Healthier SG healthcare GP GP clinic doctor app seniors Parliament TCM mental health

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