Improve equity of S'pore healthcare by better meeting needs of the marginalised: Panellists at Yale-NUS College forum

• The panellists were speaking at a Yale-NUS College forum
• They spoke about how healthcare financing and accessibility can be improved by considering the experiences of marginalised communities
• They also said red tape can be eliminated to make the system more efficient
• Dr Paul Tambyah called for Singapore to move to a single-payer system

SINGAPORE — Singapore’s healthcare system can do better by taking into consideration the experiences of people from marginalised communities in order to more effectively meet their healthcare needs.

This point was raised by several speakers on Friday (Jan 29) during a panel discussion held at Yale-NUS College on how the healthcare system here can be made more equitable to meet the needs of marginalised individuals such as migrant workers, people with mental health conditions, and those who battle with substance abuse.

The panellists also talked about how red tape and bureaucratic hoops faced by patients need to be eliminated to improve the healthcare system here and make it more efficient.

The panel was organised by the college as part of its annual “Diversity Week” programme and was conducted online over video conferencing platform Zoom.

The panellists were:

• Dr Paul Tambyah, senior consultant at the National University of Singapore and president-elect of the International Society of Infectious Diseases

• Ms Anthea Ong, former Nominated Member of Parliament and founder of social enterprise Hush TeaBar

• Dr Blanche Lim, senior resident of the department of ophthalmology at the National University Hospital

• Mr Rayner Tan, a postdoctoral fellow at the Saw Swee Hock School of Public Health

During the discussion, each panellist spoke up about the issues facing the specific marginalised communities they focus on in their work.

Mr Tan, who is also the director of research at the substance addiction recovery non-governmental organisation The Greenhouse, said more can be done within the system to understand the factors that could lead a person to abusing substances.

He added that research has shown that many people who struggle with substance abuse report doing so because they were unable to get access to a proper counsellor through the system, and abuse substances as a substitute.

“(The question is) how do we bridge the gap between the lived experiences of people who might be suffering on the ground with the kind of health coverage that we are trying to roll out from the top down?” he said.

Ms Ong, who is a vocal advocate for mental health support in Singapore, raised the issue of accessibility to relevant clinicians for people who struggle with mental health conditions.

She pointed to statistics which show that for every 100,000 people in Singapore, there are only four psychiatrists and eight psychologists.

And while the community care facilities have stepped up to bridge some of these gaps, Ms Ong said challenges remain such as ensuring that adequate training is given to counsellors from this sector to ensure that quality mental health care is provided.

CUT RED TAPE, BUREAUCRATIC DRAG

To illustrate how bureaucratic healthcare processes interfere with the affordability of patient care, Dr Tambyah recounted an incident where he asked a patient — referred to him by a general practitioner — to get a separate referral at a polyclinic so that he could get his magnetic resonance imaging (MRI) scan at a subsidised cost.

If the patient had not done so, he would have had to pay a large sum for the scan because he was registered as a private patient, even though he was eligible for a subsidy.

That is why policymakers have to come “out of their bubble” and be aware of the realities of what happens on the ground to minimise such red tape, said Dr Tambyah.

Echoing his sentiments, Dr Lim raised the example of the Project Silver Screen initiative as an instance where understanding forged between different stakeholders yielded positive results by avoiding redundant processes.

Launched in 2018, the initiative aims to provide those above 50 with access to proper screening for vision, hearing and oral health.

Dr Lim recalled how initially, the plan was for the seniors to apply for subsidised care through the traditional route of getting a referral from the polyclinic after first being screened at a community care centre. Only then, the patient would have gone to the relevant tertiary institution to get properly screened.

This back and forth would have placed an unnecessary burden on the primary care institutions, said Dr Lim. Not only that, but seniors would also struggle with having to go back and forth in order to get a simple screening done.

Dr Lim said the problem was ultimately avoided because healthcare workers at the tertiary and primary institutions spoke out on the issue. Seniors can now go straight to the tertiary institutions for screening after the pre-screening at the community care centre where they can obtain the subsidy.

Therefore, she said all stakeholders need to be present during policy discussions to ensure that processes are efficient and simple for patients to follow.

“It cannot be a one sided process,” she said.

BETTER PUBLIC EDUCATION

Public education also plays a key role in getting more on board the fight of making healthcare more equitable for all, said Dr Lim, who expressed disappointment over the attitude of some Singaporeans who feel that their right to healthcare is compromised when funds are invested in providing healthcare for foreigners.

She raised the example of the vision care project that was launched last year as part of the Essilor Vision Foundation which provided 300,000 migrant workers living in dormitories with free eyecare education and reading glasses.

Dr Lim, who was involved in the project, recalled the “gut punching” feeling she experienced when she saw the many negative comments left by netizens on a news report on the initiative.

“A lot of the comments were centred around the fact that a lot of Singaporeans actually feel that their rights are compromised in preference over (the migrant workers),” she said.

Dr Lim added that part of the problem lies in the fact that Singaporeans often do not know that similar programmes and initiatives are available to them through other channels.

Therefore, she said, more needs to be done to educate Singaporeans about these initiatives and to reassure them that healthcare is not a zero-sum game.

SINGLE-PAYER HEALTHCARE FINANCING

During the discussion, the panellists were asked to outline their vision for healthcare equity in Singapore.

Dr Tambyah said his hope is for Singapore to switch to a single-payer universal healthcare system, where the costs of essential healthcare for all residents are covered by a single public system.

Raising the examples of the healthcare systems in Scandinavia, Taiwan and the United Kingdom, Dr Tambyah said a similar model can be explored here.

“(The Scandinavians) have a pretty good track record, and that may be something that we can look at,” he said.