STATE OF HEALTH STATE Report of the Director of Medical Services of Medical of the Director Report State of Health Report of the Director of Medical Services 2003 - 2012 2003 - 2012 Ministry Of Health (College Of Medicine Building) 16 College Road ISBN 978-981-07-6828-7 Singapore 169854 9 789810 768287 College of Medicine Building Ministry of Health Contents Chapter 1 Chapter 2 Foreword by Director 01 of Medical Services 05 Overview of the 15 Control of Health Status in Communicable Singapore Diseases Chapter 3 Chapter 4 Chapter 5 27 Surveillance and 35 Health Services 49 Healthcare Standards Control of Chronic Planning, Delivery and Clinical Quality Diseases and Cancers and Development Improvement Chapter 6 Chapter 7 Chapter 8 61 Promoting Medical and 71 Healthcare Manpower 83 Health Regulation and Health Services Research Standards and Enforcement Development Chapter 9 Chapter 10 Selected Speeches 95 Emergency Preparedness, 105 International 111 Response and Medical Cooperation Support for National Events – 01 – Contents Foreword The last annual report of the Director of Medical challenges underscored the importance of a high level Services, entitled “State of Health”, was published in of vigilance and surveillance. Some of these included 2001. Major events involving the Ministry of Health Severe Acute Respiratory Syndrome (SARS) in 2003, (MOH) were subsequently documented annually in the first report of indigenous chikungunya fever in the Singapore Yearbook published by then Ministry of Singapore in 2008 and the arrival of the first influenza A Information, Communications and the Arts. Publications (H1N1-2009) pandemic of the 21st century in 2009. however ceased from 2009. These outbreaks not only caused significant economic The report of the Director of Medical Services impact, morbidity and mortality, but also tested the consolidates developments, achievements, as well resilience of our healthcare delivery systems. Our as lessons learnt. By providing a record of significant healthcare workforce remained steadfast and showed developments and achievements, we hope that our its fortitude, enabling Singapore to overcome these healthcare workforce, partners and stakeholders will challenges in commendable fashion. We remember the have a better understanding of recent developments sacrifices that many of our colleagues have had to make. and build on past experiences even as we chart the Their dedication and professionalism are etched in our course for the future. hearts -- they are standard-bearers for the healthcare profession. Infectious diseases will continue to emerge The last decade or so was especially characterised by and threaten our way of life. Our people must remain several outbreaks of infectious diseases. These new vigilant; surveillance systems must continue to be – 02 – Foreword tested and relevant; our response must be nimble and inception has brought about credible clinical quality adaptable when faced with uncertainty. improvements in the institutions. Outstanding projects have also been deservedly recognised at international Singapore has to face in the longer term the rising conferences and published in acclaimed journals. MOH prevalence of chronic disease which not only increases will continue to provide platforms which incentivise and the demand for health services but will also change the recognise contributions towards quality improvement. way that care is delivered. The move from a provider Hospitals and institutions, however, must take on to a more holistic patient-centric care will require a re- the responsibility of sustaining and translating these think of the way we deliver our healthcare services. achievements into better outcomes for the patient. The Khoo Teck Puat Hospital (KTPH), officially opened Our greatest asset in healthcare is our workforce. by then-Minister Mentor Lee Kuan Yew on 15 November A high-quality healthcare workforce is needed to 2010, heralds this approach to seamless patient- meet the growing disease burden and to sustain our centric healthcare delivery which was envisaged to pursuit of medical excellence. The residency system meet increasingly complex healthcare needs. KTPH for postgraduate medical education was implemented will form the anchor of the northern medical hub, in 2010. We incorporated the best-practices from together with a polyclinic and a community hospital, developed countries and customised it to meet local to provide continuing care, hassle-free for the patient. needs. These changes were made as we recognised This approach also formed the blueprint for the that medical education and training was a serious development of the western JurongHealth cluster. commitment which required investment of resources; Slated for completion in 2014, the western medical hub and that our training system must produce specialists will similarly be anchored by Ng Teng Fong General and family physicians in a manner that could meet Hospital and twinned with a community hospital. evolving local healthcare needs. Palliative and end-of-life care will become increasingly The Ministry is continuously looking for ways to improve important as the population ages. These can become primary care. The Register of Family Physicians serves highly emotive issues if not handled sensitively and to recognise medical practitioners with relevant sensibly. Patients should receive quality care according to qualifications and sets the standards of practice their wishes, and in a way that preserves their dignity. We for Family Medicine. Entry into the Register can be must strive for dignity and peace, both in life and in death. obtained by diploma and practice routes. The practice route is designed to be flexible and inclusive so that MOH has been traditionally viewed as the enforcer general practitioners with years of experience can be and regulator. Legislations will always be necessary recognised as family physicians. to safeguard the interests of patients, given the degree of information asymmetry between doctors This decade saw the implementation of a wide range and patients. We have recognised the need, however, of initiatives. The success and progress achieved to be innovative and adaptive in the way we engage so far would not have been possible without the our partners. “Smart regulation” is the preferred understanding and support from organisations and approach as it minimises the use of legislative individual healthcare professionals from both public powers, facilitates self-regulation, and leverages and private sectors. I would like to take this opportunity market forces or instruments, whenever possible. to acknowledge and commend their contributions and unwavering commitment. As healthcare continues to Similarly, we have taken on roles as facilitator and evolve at a rapid pace, we can expect exciting changes collaborator on the clinical quality journey and and trying challenges in the future. The Ministry looks established various platforms for institutions to innovate forward to continuing the strong partnerships, and and direct its own quality improvement. The Healthcare together, forging a legacy of better health for the nation. Quality Improvement Fund, launched in 2005, was set up to provide seed funding to pilot-test patient safety and Professor K Satku quality improvement projects. This was later merged Director of Medical Services with the Health Innovation Fund and was renamed the Healthcare Quality Improvement & Innovation Fund, with increased annual funding to support innovative approaches towards quality improvement. The Ministry’s investment in over 130 projects since its – 03 – Foreword – 04 – Foreword Chapter Overview1 of the Health Status in Singapore Singapore spends a little less than 4% of its GDP on health. Life expectancy at birth is 81 years, and the infant mortality “ rate is 2.2 per 1,000 births, which is the lowest in the world. Our population has doubled in the last 30 years, and is also aging rapidly. The number of elderly has doubled in the last 20 years, and is expected to triple in the next 20. This has resulted in an increasing prevalence of chronic diseases and greater demand for healthcare. Professor K. Satku, ” Accreditation Council for Graduate Medical Education (ACGME) Educational Conference, 2011 – 05 – Chapter 1 – Overview of the health status in Singapore Overview of the Health Status in Singapore by: A/Prof Derrick Heng Population Profile The resident population of Singapore (comprising Singapore citizens and permanent residents), was 3.82 million as of end June 2012, as compared with 3.38 million in 2002. The total population (including non- residents) increased from 4.18 million in 2002 to 5.31 million in 2012. The ethnic distribution in the resident population remained stable with 74.2% Chinese, 13.3% Malays, and 9.2% Indians. The ageing trend in Singapore (Fig 1) continued with the number of elderly aged 65 years and above increasing from 7.4% in 2002 to 9.9% in 2012. In 2012, the old-age support ratio had declined to 6.7 residents aged 20-64 years for each elderly resident aged 65 years and above compared to 8.7 in 2002. In 2012, the median age of the resident population was 38.4 years, up from 34.7 years in 2002. – 07 – Chapter 1 - Overview of the Health Status in Singapore Life Expectancy and Health-adjusted Life Expectancy Longevity has improved significantly for Singapore Health-adjusted life expectancy (HALE) estimates the residents over the years. Life expectancy at birth for number of healthy years an individual is expected to all