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Healthier SG White Paper: Ong Ye Kung warns of high costs of 'instant gratification'

People wearing protective masks exercise at a park during the COVID-19 pandemic in Singapore. (PHOTO: NurPhoto via Getty Images)
People wearing protective masks exercise at a park during the COVID-19 pandemic in Singapore. (PHOTO: NurPhoto via Getty Images)

SINGAPORE — It is almost human instinct to be tempted by instant gratification when it comes to food but persistently doing so could lead to serious health consequences, said Health Minister Ong Ye Kung on Tuesday (4 October).

Speaking in Parliament during the debate on the White Paper on the Healthier SG reform programme, Ong acknowledged some of these temptations that Singapore residents face.

"Have a puff to destress now and worry about your health later, eat the cheesecake now and worry about the sugar later, eat the fried chicken now, laze around instead of exercising, binge watch a series instead of having a good night’s sleep," he said.

While nothing bad will happen immediately, such habits accumulate to cause serious diseases or can aggravate existing illnesses later, according to Ong.

"If you keep dropping every grain of sand, it becomes a bucket and by then it would cause us a big burden, which can cost us our organs, our limbs, our minds, our lives."

Urging moderation while enjoying things in life, especially good food, he said, "So let us try to live without regrets."

Initial costs of Healthier SG

Healthier SG is a programme aimed at expanding preventive care for residents in Singapore. Among the measures is enabling residents to choose their family doctor to build a long-term preventive care relationship to cover their healthcare needs.

The programme will require an estimated setup cost of over $1 billion over the next three to four years, Ong said.

The funds will go towards new information technology (IT) systems, ground support capabilities, and support to provide general practitioners (GPs) with the necessary IT enhancements.

Another $400 million per year will go towards recurrent costs for Healthier SG. These cover measures such as free health screenings for cancers and selected chronic conditions as well as annual service fees for GPs.

"We spend about six per cent of our healthcare budget on preventive care annually, such as to fund HPB (Health Promotion Board). With Healthier SG, we will and we want to grow this – perhaps to double the share of total healthcare expenditure," Ong said.

Singapore's national healthcare expenditure is currently about $22 billion a year. This is expected to multiply some threefold in the coming 10 years to $60 billion in 2030.

"In making these investments, our main and primary motivation is to reduce disease burden and the suffering of our people and their loved ones," Ong said.

What will Healthier SG mean for Singapore residents?

Healthier SG is a transformation of Singapore's healthcare system not only to focus on preventive care instead of curative care, it is also to steer care away from hospitals toward the community.

"To rely less on doctors for health, but depend on communities, our families, and ourselves. Live up to the name of Ministry of Health, not Ministry of Sickness," Ong said.

The reforms include:

  1. Encouraged enrolment with a family doctor: Enrolment with these doctors will be opened to those aged 60 and above in the second half of 2023, followed by those in the 40 to 59 age group in the next two years.

    Residents can change their doctors up to four times for the first two years to find one they are comfortable with. Thereafter, they can make one change a year according to their preferences and changes in life circumstances, such as moving house.

    They will still be free to continue to visit their current doctors, including specialists. The doctor whom a resident regularly visits will be at the top of the enrolment list, said Ong.

    Singapore's healthcare clusters – National Healthcare Group, National University Health System, and SingHealth – will partner with family doctors to help residents.

  2. Free health screenings and vaccinations: Once enrolled with a family doctor, residents will get free health screenings as well as nationally recommended vaccinations.

    They will include free screenings for breast, cervical, and colorectal cancers and three common chronic conditions: type 2 diabetes, hypertension, and hyperlipidaemia (high cholesterol).

    More complex screenings, like colonoscopy, will not be free but will remain heavily subsidised at hospitals.

  3. Chronic illnesses to be covered fully under MediSave: Those using MediSave to pay for treatment of chronic illness will not need to co-pay 15 per cent of the bill using cash.

    Ong said these changes are a departure from most government subsidy schemes, which often require some co-payment from residents.

  4. Additional subsidies at GPs: An additional subsidy tier will be added to Community Health Assist Scheme (CHAS) for common chronic disease drugs and drug price limits.

    This will help level the significant drug price differences between GP clinics and polyclinics, and ensure that residents stick with a family doctor.

    All enrolled Singaporean CHAS card holders, including Pioneer Generation and Merdeka Generation card holders, can enjoy this subsidy.

    Ong, however, said prices will not be able to be equalised "down to the last cent" due to the different basis of calculating subsidies at polyclinics and under the community scheme.

  5. More health-related activities: Community partners such as the HPB, People’s Association, and Sport Singapore will organise more health-related activities and connect residents to them. They range from brisk walking, Zumba classes to community gardening.

    Seniors will benefit from additional support from Eldercare Centres. Public infrastructure like sports facilities, parks and park connectors will also be enhanced.

  6. Points for being healthy: The Healthy 365 mobile app, already used for the National Steps and Eat Drink Shop Healthy challenges, will award "health points" to residents for living an active lifestyle and making healthier food purchases.

    These points can be exchanged for rewards for public transport and at participating merchants. "The reward may not be large but it gives us a certain psychological satisfaction. It can be a very effective nudge, especially when gamified," said Ong.

    The app will also be enhanced to help monitor calorie intake. It will be compatible with other apps such as Apple Health Kit, Fitbit, and Samsung Health so that the data on them can be transferred over and help residents claim "health points".

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