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Singapore makes strides in palliative care

SINGAPORE — Singapore now provides better care for terminally ill patients, but there is room to improve the capacity and financing of palliative care, philanthropic organisation Lien Foundation said today (Oct 6), as it announced findings of the 2015 Quality of Death Index.

SINGAPORE — Singapore now provides better care for terminally ill patients, but there is room to improve the capacity and financing of palliative care, philanthropic organisation Lien Foundation said today (Oct 6), as it announced findings of the 2015 Quality of Death Index.

Singapore emerged 12th among 80 countries in the latest index, up six places from 2010 when the first assessment involving 40 countries was released.

For the latest index, the Economist Intelligence Unit (EIU) surveyed countries in five categories: Palliative and healthcare environment, human resources, the affordability of care, the quality of care and the level of community engagement in the country.

Singapore did well in affordability of care (6th), quality of care (8th) and human resources (8th). Lien Foundation attributed improvements to the implementation of a National Strategy for Palliative Care from 2012.

There are now 51 registered palliative care specialists here, compared with 33 in 2011. A new graduate diploma in palliative medicine targeted at family doctors was launched last year.

Daily Medisave withdrawal limits for palliative care have also gone up, and there is no longer a cap on Medisave usage for patients with terminal illnesses such as cancer or organ failure, noted Lien Foundation, which commissioned the index.

But, the financing model for palliative care needs a re-look, and the planning target for capacity may need to be higher as demand for palliative care rises, said the foundation.

The Government’s projection of more than 10,000 patients per year needing palliative care in 2020 means that about half of all deaths could be touched by palliative care. But, a recent study in the United Kingdom suggested that 69 to 82 per cent of all deaths in high-income countries would require palliative care, the foundation noted.

Charity operators still play a key role in keeping home hospice services free, with donations funding a significant portion of their operations, the foundation noted.

And although palliative care services are means-tested and funded by a mix of Government subvention, Medisave and Medifund, the existing structure is biased towards acute care — insurance companies and MediShield Life do not cover care in hospices, for instance. This leads to some patients being “stuck in hospital” because insurance plans do not cover care at a hospice, said Dr Cynthia Goh, senior consultant at the National Cancer Centre Singapore.

Singapore fared less well in capacity to deliver palliative care (20th) and community engagement (22nd).

Coming out tops in the index again was the UK, followed by Australia and New Zealand. The UK’s success was partly attributed to its “extensive integration of palliative care into the National Health Service”.

Singapore can also learn from Taiwan — ranked 6th in the index and top in Asia — which introduced discussions of life and death in the education system. This helped to de-stigmatise death and dying in “an Asian society with ingrained taboos against discussing death like Singapore”, said Lien Foundation.

Lien Foundation chief executive Lee Poh Wah called for mandatory palliative care training for all healthcare professionals taking care of the critically ill, and said Singapore has built a “firm foundation” to develop a more responsive and high-quality palliative care system.

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