NICE 2

Interesting letter from Dr Tan Min-Han in the ST Forum today.


June 16, 2006
How to keep Singapore health-care top-notch

IN THE two overview articles published in Review (ST, June 9), the Singapore health-care system came in for high praise. Few doubt that Singapore has a top-notch health-care system, allowing near-universal access to high-quality services.

Both articles alluded to, but did not expand upon, the forces for change in the Singapore health-care system.

While Singapore has developed a very successful health-care system over the last two decades, our changing environment demands equally nimble adaptation on our part. Upcoming challenges include an ageing population, steeply priced new technology and drugs, rising public expectations and the need to develop clinical research infrastructure to accompany investment in basic life sciences.

Even as we seek to maximise each dollar spent, our national expenditure on health is likely to continue its inexorable rise over the next few decades.

Today, novel drug regimens and surgical intervention can easily cost tens of thousands of dollars. It is no surprise that health-care costs are one of the main concerns of the man in the street.

With ever-increasing demands on national resources, a transparent and independent forum for technology and pharmaceutical appraisal is urgently required at the national level.

As cost-benefit ratios vary from society to society, Singapore must develop its own system for technology appraisal, possibly modelled after the National Institute of Clinical Excellence in Britain.

This forum should examine not just the clinical usefulness of a particular new drug, but also the societal benefits and costs in the local context from implementation.

For this to happen, substantial investments in health-policy research must occur, together with greater visibility of socioeconomic, financial and health-care data for accurate determination of societal outcomes.

Critically, an approach integrating both clinical and accounting principles will have the dual benefit of addressing both the supply and demand sides of expanding health-care costs, as organisations and the public are likely to respond to independent guidelines which are perceived as impartial.

As there is wide acceptance in Singapore of the premise of shared responsibility, this forum can be a basis for establishing degrees of co-payment for the pillars of our 3M health-care system: Medisave, MediShield and Medifund.

Non-governmental organisations such as charities will find this helpful in appropriate fund allocation and avoidance of wastage.

If truly worthwhile interventions can be distinguished from the over-hyped, funding and subsidy should be allocated correspondingly, ensuring that the dollars of the Government and the patients are well spent.

Dr Tan Min-Han


Dr Tan (if he is the same Dr Tan I am thinking of) is an intelligent person, and I used to enjoy reading his posts on an online forum. Heck, anyone who says 'drug regimens' instead of 'drug regimes' is in my good books.

He mentions the National Institute for Health and Clinical Excellence in his letter; I think I will be browsing through their site over the weekend.

Locally, a similar system in the form of MOH Clinical Practice Guidelines issued to all doctors has been in operation. But as Dr Tan noted, these guidelines do not yet go into cost-effectiveness in the context of our subsidised healthcare system.

Let's wait and see what the Ministry's response to his letter will be like.