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In this Explainer, find out...
What challenges does Singapore’s ageing population pose?
What healthcare initiatives are being implemented to meet Singapore’s current and future healthcare demands?
Are these healthcare initiatives effective?
Introduction
Healthcare is a perennial issue for countries and Singapore is no exception. From ageing to epidemics, Singapore’s healthcare needs are expected to grow. These myriad needs have required the Ministry of Health (MOH) to expand and strengthen Singapore’s healthcare infrastructure, and to promote good health.
MOH pursues several different avenues to achieve this goal. MOH has encouraged individuals to take greater responsibility for their health, such as through the widespread adoption of platforms like HealthHub, and initiatives like Healthier SG. MOH has also made strides in improving healthcare infrastructure, investing in the technology, equipment, and facilities needed to support Singapore’s healthcare needs.
This Policy Explainer will focus on what is arguably the biggest long-term challenge facing Singapore’s healthcare system – its ageing population. It will then explore some of the policies and initiatives introduced to tackle this challenge, before evaluating their impact.
The Ageing Population at a Glance
By 2030, it is projected that one in four Singaporeans will be over the age of 65, a marked increase from one in ten in 2010. This demographic trend is contributing to a rising demand for healthcare services. This includes caring for their mental health as they face higher risks of cognitive decline, depression, and social isolation.
Besides mental health, the elderly often present with multiple chronic conditions requiring coordinated care. In a 2017 survey, 37 per cent of respondents aged 60 and above reported having three or more chronic conditions, almost doubling that in 2009. Current healthcare models are struggling to effectively address these complexities because of manpower constraints and inefficiencies, among other reasons.
Demand is even greater when long-term needs are accounted for. This includes long-term care facilities as many elderly individuals require ongoing medical attention, rehabilitation, and palliative care. The importance of adaptable care delivery models cannot be overstated: failure to evolve these models could result in overburdened hospitals, inadequate long-term care, and poor health outcomes. Countries that fail to adapt to similar demographic changes risk becoming overwhelmed, exacerbating healthcare inequities and creating public health crises. Ensuring a functioning and effective healthcare system that can meet the needs of an ageing population is all the more critical to maintaining stability in the long run.
What Are Some Policies That Have Been Put in Place?
Singapore’s healthcare policies can be loosely categorised as either responsive or preventive ones. The former focuses on addressing health issues as they arise to provide timely and appropriate medical attention to individuals. The latter focuses on proactive health management strategies that prevent the onset of diseases. Both strategies complement one another, altogether alleviating the pressure on the healthcare system.
Responsive Care Policies
Mobile Inpatient Care @ Home
A key initiative is the Mobile Inpatient Care at Home (MIC@Home) programme, which allows patients to receive hospital-level acute care in the comfort of their homes. This programme, launched in April 2022, has been broadened to include more medical conditions such as urinary tract infections and pneumonia. This alleviates pressure on hospitals by providing remote care for patients with conditions typically classified under general medicine. Patients participating in this programme will benefit from round-the-clock support from healthcare professionals via teleconsultations and home visits until discharge.
Physical Infrastructure Expansion
In addition to MIC@Home, MOH has planned for physical expansions, including the construction of a new integrated hospital in Tengah that is expected to be operational by the early 2030s. This facility will help meet the healthcare demands of Singapore's growing population. MOH also plans to increase the number of public hospital beds by about 4,000 from now to 2030. This includes either converting non-clinical spaces into wards or the development of new locations.
As for polyclinics, Singapore’s network is set to expand to 32 facilities by 2030, consisting of both new and redeveloped polyclinics. This expansion is part of a broader strategy to enhance access to primary care services across the country. By investing in community health infrastructure and innovative care models like MIC@Home, patients can look forward to receiving comprehensive and continuous care while hospitals manage healthcare costs more effectively.
Adoption of Technology in Acute Care Settings
To ensure that these facilities are run efficiently, technology has been leveraged in some hospitals to enhance the quality of care patients receive. For instance, in Changi General Hospital, robots are now being used to deliver medication and guide patients to the triaging area, reducing the workload of nurses and other healthcare professionals. In Tan Tock Seng Hospital, robotic beds are now being used to turn patients automatically to lighten the workload of healthcare workers, who would otherwise need to do this laborious task.
At a more macro level, seamless integration between different healthcare providers is essential to deliver effective care for complex cases. The Government works closely with technology companies like Synapxe to enhance digital health systems. Through these partnerships, technology can enhance coordination, data sharing, and patient monitoring, in turn improving the overall efficiency of healthcare services.
Preventive Care Policies
Healthier SG
MOH rolled out Healthier SG in 2023 to empower Singaporeans to take responsibility for their own health and prevent the onset of disease. Individuals who have enrolled in Healthier SG will co-design a unique Health Plan with a family general practicioner (GP). Individuals are recommended the screenings and vaccinations they should undergo to reduce the chance of developing chronic illness or needing acute care.
Individuals are also encouraged to seek support from their community in leading healthier lifestyles. By leading more physically and mentally stimulating lives, older individuals can reduce their chance of developing chronic illnesses. Community-based solutions that encourage physical activity and good diets can further help to reduce the incidence of chronic illness.
One avenue of community support is the Active Ageing Centres (AACs). AACs can help individuals identify their care needs and provide more information or raise referrals. Furthermore, the establishment of a community and relationships can stem issues like loneliness, an increasingly serious problem faced by Singapore’s seniors. With loneliness being shown to increase a senior’s risk of death by seven per cent, creating communities has the potential to improve public health.
MOH has also attempted to improve how individuals keep track of their health. The Healthy 365 application, created by the Health Promotion Board (HPB) is an example of this. In this application, users can track their meals and steps, and gain points when they make ‘healthier’ choices, incentivising the development of better lifestyle habits.
What Are These Policies’ Impact?
MIC@Home
MIC@Home has seen some success in providing an alternative location that is similarly safe and conducive for recuperation. This alternative is especially appealing for those who want a more comfortable alternative at their own homes and minimise the burden on their loved ones.
On the other hand, the implementation of hybrid initiatives like MIC@Home presents other challenges, particularly in ensuring that elderly patients can effectively utilise these services. While MIC@Home allows patients to receive hospital-level care in their own homes through teleconsultations and home visits, there is a concern that many elderly patients may not be familiar with technology or may find it difficult to navigate telemedicine platforms. This could potentially limit their access to timely medical care and support, and reduce the quality of care they receive.
Furthermore, the integration of digital health solutions introduces significant cybersecurity risks that must be addressed. Should the technology be hastily developed with poor safeguards, our systems would become vulnerable to cyberattacks. The 2018 SingHealth data breach, where personal information of 1.5 million patients was compromised, is a stark reminder of this. This incident highlights the potential risks associated with electronic health record and telemedicine platforms, which can serve as attractive targets for hackers seeking sensitive patient data.
Physical Infrastructure Expansion
The selection of locations for new polyclinics and hospitals in Singapore is strategically informed by demographic trends and healthcare needs, particularly in areas with growing and maturing estates such as Tengah. There is a necessity to provide accessible healthcare services to a growing population without them having to travel long distances.
However, one persistent challenge remains to recruit and retain the healthcare professionals who will operate new polyclinics and hospitals. MOH has expressed that it aims to increase its number of healthcare staff to 82,000 by 2030, but it could be difficult to meet this goal. For example, nurses are a critical part of ensuring that these newly built facilities can function at all. However, Singapore has been facing a shortage in the number of nurses in recent years. Nurses from Malaysia and the Philippines, who previously came to Singapore, now seek opportunities abroad in countries like Australia and New Zealand, where the cost of living may be more affordable. Attempts have been made to recruit from other countries and to retain existing nurses, such as introducing monetary incentives for staying. Nevertheless, due to the stressful work environment nurses function in, it is still unclear if this will be enough to ensure that Singapore has the labour force necessary to support its investment in new facilities.
Healthier SG
This wide-ranging initiative has marked an increased focus on encouraging and supporting lifestyle choices that avoid chronic disease. In a nation with an ageing population, preventing illness and reducing the burden on hospitals is a crucial sustainable solution.
The move to encourage individuals to build closer ties with their family GP has been welcomed by those in the medical profession. This would put GPs in a better position to advise patients to undergo health screenings or vaccinations, for instance. The important role primary care centres such as GP clinics play was spotlighted during the COVID-19 pandemic: leveraging them was key to ensuring a swift vaccination rollout. Fostering a close doctor-patient relationship could allow for the elderly, a particularly vulnerable group, to be better protected should a contagious disease spread in the country.
Making health screenings and vaccinations more affordable is highly beneficial as well. Under this programme, health screenings and vaccinations are fully subsidised for eligible individuals. Those suffering from chronic diseases benefit too as they receive subsidies on medications for chronic conditions, and can use Medisave to cover medical bills.
Senior citizens also stand to benefit greatly, especially those who require more frequent health screenings and may need to spend a significant amount of money on medication for chronic conditions. One in three senior citizens worry that they will not be able to afford necessities, especially medical services and prescription medicines. As such, by making healthcare much more affordable, MOH can relieve the financial strain and anxiety on this group of seniors.
These measures could reduce the socio-economic gap in care, where individuals from lower socio-economic backgrounds tend to have worse health outcomes and are more likely to require such healthcare services. At the same time, they are least likely to be able to afford healthcare, especially costs from chronic diseases that accumulate over time. Thus, by making these services highly affordable, the gap in health outcomes between socio-economic backgrounds could be narrowed.
However, there are obstacles as well. Since COVID-19, many seniors have begun adapting to accessing services online, but this transition is still ongoing. As of January 2023, only 20 per cent of seniors used HealthHub, with many citing language barriers and confusing user interfaces as the reason for not using the app. While community support for seniors to learn digital skills exist, as more services move online, it may be difficult and overwhelming for some to adapt and make the transition. As a result, they may lose out on some of the recommendations and tools that can help them make healthier lifestyle choices.
On the side of healthcare providers, GPs have expressed concerns on the expanded role they play in this initiative. As part of the Health Plan, GPs are supposed to recommend community services that can help patients lead healthier lifestyles. However, the type of community services and their providers vary across different neighbourhoods, complicating the job of GPs. GPs, who often run small individual practices without large administrative teams, may find it difficult to reach out to and recommend community service providers to their patients. In fact, as of April 2023, only less than 50 per cent of Singapore’s GP clinics were enrolled as Healthier SG clinics. Therefore, for Healthier SG to succeed, more effort is likely needed for GP clinics to be well integrated with community services.
Conclusion
Being ready for a future where more Singaporeans require care for chronic illnesses is important. To address these growing needs, MOH has adopted measures to improve both preventive and responsive healthcare strategies, endeavouring to adapt Singapore’s healthcare system to this existential issue. The recent Healthier SG initiative has been welcomed as a change that will improve preventive care and contribute to a healthier population. These policies reflect MOH’s long-term commitment to ensuring that the healthcare system continues to run efficiently while not compromising the standard of care given to all Singaporeans.
However, as with many policies, they can be imperfect. Improving the uptake of digital services, maintaining an adequate labour force, and ensuring primary care providers have the bandwidth to contribute to the Healthier SG programme are all challenges that have to be tackled. These issues are complex and will require cooperation between various public and private stakeholders. Therefore, while optimism remains, whether Singapore will be able to build a healthcare system ready for its future needs is yet to be seen.
This Policy Explainer was written by members of MAJU. MAJU is an independent, youth-led organisation that focuses on engaging Singaporean youths in a long-term research process to guide them in jointly formulating policy ideas of their own.
By sharing our unique youth perspectives, MAJU hopes to contribute to the policymaking discourse and future of Singapore.
The citations to our Policy Explainers can be found in the PDF appended to this webpage.
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