Mr Speaker, according to the Healthier SG White Paper, all residents will be encouraged to enrol with a family doctor or a family physician, who (I quote the White Paper) “will serve as the point of contact to holistically manage the residents’ health” (unquote), focusing on providing holistic care, prevention and to improve chronic care. Each family doctor will develop an appropriate health plan for each enrolled resident and would also administer the appropriate health screenings and vaccinations.
Good to have a regular doctor
Mr Speaker, I agree with the intent and merits of having a specific family doctor to holistically manage each resident’s health. Needless to say, any doctor would be familiar with his or her regular patients over time. I believe that there are already many Singaporeans who have the habit of seeing the same GP over a long period of time each time they fall ill or need prescription and appreciate the benefits of a GP who is familiar with their medical history over time. I have known my current family GP since I was in secondary school.
Importance of appropriately developed health plans
The proposed requirement of a family physician having to develop an appropriate health plan for each enrolled resident and having an annual check in with each enrolled resident, to find out how the resident is doing in terms of his health and how he or she is adhering to his or her health plan should be a significant departure beyond the current common practice of only seeing the doctor when we do not feel well or when we require prescription. I agree with these proposals but the devil is of course in the details. The health plans, screenings and annual check-ins will hopefully provide a sufficiently regular opportunity for the doctor to be able to help us to pick up any signs of any health issue earlier, before it manifests into something serious or chronic.
That said, it is important that such health plans are appropriately developed for residents of different age groups and dealing with prevention of a range of diseases and health conditions.
Beyond the mentioned first three chronic illnesses, may I ask the minister to elaborate more on the 12 care protocols, and the time it is expected to take for the care protocols to be fully rolled out beyond the first year of Healthier SG?
Mental Health
The White Paper also mentioned that mental health and end of life care will subsequently be covered (see page 37). I hope that mental health will certainly not be at the end of the queue but some priority be given for its earlier introduction. The White Paper itself gave a (I quote) “special mention” of mental health at page 52. The family physician will certainly be ideally positioned to help residents with regular checks on their mental health and, importantly, early detection of any problem.
May I ask whether the Inter-Agency Taskforce on Mental Health and Well Being has been specifically tasked to integrate the new plans under Healthier SG?
Will the Taskforce consider how the family physician’s role in managing the mental health of their residents can be enhanced?
Will the Taskforce help to integrate the family physician’s new role alongside other resources and stakeholders which are already part of the Taskforce’s efforts to date?
Getting maximum buy-in with an appropriate public education campaign
Mr Speaker, in order for the proposed programme under Healthier SG to work, it will also require the cooperation of all enrolled residents, to be able to adopt the right attitude in adhering to the health plan developed for them and to be actively concerned for their health and physical and mental well-being. Everyone must be willing and able to accord it priority alongside other demands of their everyday life and treating the plans and the appointments with the family doctor seriously and taking full advantage of them. In the hustle and bustle of modern living, I am not sure everyone may be able to do so.
I do hope MOH will have an appropriate public education campaign not just to encourage enrolment but to encourage enrolled residents to take this programme seriously and be diligent in adhering to the health plans and recommendations and advice of their family doctors, and to make full use of what is provided under the programme.
As many people need to sign up
Mr Speaker, I also believe that for this programme to work to the best benefit of most Singaporeans or residents, we need to ensure that as many people will enrol under the programme. I am aware that many Singaporeans currently visit GPs or clinics which are on the panel of their employers’ corporate medical insurance plans. These GPs are often not their usual family GPs. When employees change employment or if their employers change their insurers, the GPs or clinics may also change. I would like to ask how does MOH intend to harmonize this situation with its proposed programme under Healthier SG to have more people stick to one regular family doctor? Would MOH also engage different stakeholders including both the medical practitioners and the insurance industry to see how corporate medical insurance plans can be tweaked to enhance the Healthier SG objective of having more people stay with one family physician?
The Polyclinic services and how they affect Healthier SG’s objectives
There are also many people who have regularly gone to see GPs in polyclinics ostensibly for reasons of cost and subsidy. Can MOH give an indication of the size of this group of Singaporeans?
Besides MOH’s plans to make available more prescribed drugs under CHAS subsidy in GP clinics, how will MOH ensure that the cost of consultations and prescriptions with the family physician will not discourage them from switching to Healthier SG?
Following the introduction of Healthier SG, how does MOH see the role of GPs in polyclinics with respect to primary care and would MOH be reviewing the role of GPs in polyclinics?
Change of family doctors allowed
The Healthier SG also proposes to allow for a change of family doctor once each year. While I understand there may be a need for some flexibility e.g. when a resident changes his or her place of residence or even changes his employment, allowing changes of doctors within a short period of time may not be conducive for the greater goal of Healthier SG to get more people to have one family doctor to manage their health.
Working with eldercare centres and reaching out to all seniors
Mr Speaker, the White Paper also mentioned that the number of eldercare centres (ECs) will be expanded from 119 to 220 by 2025 and that under Healthier SG, the offerings for eldercare centres will be expanded as follows:
- Eldercare centres will serve as a community connector for seniors to help them follow through with the lifestyle interventions as recommended by family doctors;
- Eldercare centres will offer community based monitoring of vital signs such as blood pressure in between their visits to the family doctor, following care protocol requirements to be worked out under Healthier SG;
- Eldercare centres will also help to roll out health screenings and other healthcare initiatives.
I welcome the above but I do see that this must come with additional manpower as well as IT resources. I would like to ask the minister whether and how will MOH help with the provision of additional manpower, IT, training and other necessary resources and support for both the eldercare centres as well as the family physicians’ practices.
More assistance may be required by both stakeholders in managing the additional responsibilities as well as ensuring that all interventions, screenings or other measures recommended by the family physicians are well coordinated.
Mr Speaker, I do appreciate what the eldercare centres, the senior activity centres and indeed the day care centres in Hougang are doing to take care of the seniors under their charge. It is not an easy task for the eldercare or senior activity centres to reach out to all seniors within their designated cluster and trying to ensure that the seniors are in good shape and that help can be given if required. The response of our seniors may vary between individuals. While many are happy to know of the support they can reach out to and many also get involved in activities in eldercare centres and welcome being connected to such centres, some seniors may not be open when eldercare centres try reaching out to them. Some may not want to keep in touch with their eldercare centres. Some keep to themselves and may not socialise with others. Some of these seniors live by themselves and may not have family members at hand to keep an eye on them in their homes.
I am concerned that for this group of people, the family doctors under Healthier SG may also experience difficulty in outreaching to them or ensuring their committed participation. I hope MOH can study how outreach efforts can be improved to such seniors so that all can actually benefit from these programmes under Healthier SG and most of all, their health and well-being can be enhanced.
Dental and oral care
Mr Speaker, the Healthier SG White Paper is silent on dental care. While I understand the White Paper may focus on chronic care management and prevention of chronic disease, dental health is important – good dental and oral health can also enhance our overall health and prevent complications to other areas of our health including prevention of certain chronic or other diseases. Moreover, there is some overlap in similar lifestyle factors causing problems to dental/oral health and to other aspects of our health e.g. consumption of sugary products. In my view, a similarly structured programme akin to Healthier SG may also help to promote better dental and oral health. 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 healthcare.
Still on the topic of dental health, recently, a resident provided some feedback to me about the cost of dental treatments not covered by Medisave. Payments through Medisave can only be made for treatments where surgeries are involved. Dental treatments like tooth extraction, root canal treatments and affixing of crowns, while not necessarily regarded as under the category of surgery, can be relatively expensive to many people. For retirees, the outlay in cash for dental treatments can be a burden especially if they have recurring issues. While there are subsidies available for limited categories of CHAS and other card holders, my resident wishes that the Government can consider making Medisave available for at least some of the treatments and/or consider increasing the extent of CHAS subsidies currently available for these treatments e.g. for Orange CHAS card holders and even beyond. If need be, the Government can look into including more measures to deter possible abuses by minority practitioners.
Resourcing
Mr Speaker, before I end, I would like to touch briefly on the issue of resourcing. Under Healthier SG, family doctors have new responsibilities towards the care of residents enrolled under them, regardless of age. While they will be paid a fee per enrolled resident, if the patient numbers do not reduce for any family doctor, what is the expectation of MOH on the effect of the additional work or additional patient loading brought about by Healthier SG and how the doctors are expected to cope with the additional work and responsibilities?
Mr Speaker, in Mandarin please.
议长先生，我支持【健康SG计划白皮书】所提倡的每位国人选择一名固定家庭医生以提供医疗服务并进行全面健康管理。 如要顺利推行计划，我们必须确保多数国人的参与，以及参与者本身对于为他们设定的健康规划有着正面、积极的态度。
另外，我希望在【白皮书】中所提到的心理健康方面能够被给予优先，并尽早纳入‘健康SG计划’内。
【白皮书】也计划将在2025 年之前把现有的乐龄综合服务中心数量从119所提升到220所，这些中心将承担更多的责任和服务，并与家庭医生协同工作。我希望政府能够提供多一些人力资源 、科技、培训以及其它所需的资源来支持医疗各方应对这项新的合作模式。
目前，乐龄综合服务中心除了要确保年长者的健康、给予协助、还需同时以不同方式联系区内年长者并与他们沟通，任务具备意义兼挑战性。 许多年长者获知乐龄综合服务中心能够提供所需的帮助后感到欣慰，并且乐意参与由服务中心所举办的活动。然而，仍有一些年长者选择不联系或参与任何服务中心相关的活动。 这样的趋势会给’健康SG计划’带来一定的挑战，例如，家庭医生该如何有效的联系并劝服这群选择不联系或不参与的年长者参与计划，尤其是独居的年长者。我希望卫生部能够探讨如何改善对于这群年长者的外展工作及沟通，以便让所有国人能够在‘健康SG计划’下受惠。
议长先生，虽然口腔保健目前不在【健康SG计划白皮书】的规划范围内，然而口腔护理对于个人的整体健康有着相关影响，比如能避免引发其它的身体慢性疾病。我希望口腔保健也能够被纳入‘健康SG计划’内。
Mr Speaker, notwithstanding the concerns I have raised, I support the motion.