Impact of Unhealthy Ageing on Medical Inflation

Mr Leon Perera asked the Minister for Health (a) what is the contribution of unhealthy ageing to medical inflation; (b) what has the Ministry learnt from implementing numerous programmes over the years to address unhealthy ageing, including the National Steps Challenge; and (c) how is the Government further evolving its approach to preventive and early intervention measures for chronic illnesses after consolidating data from the Public Consultation on MediShield Life 2020 Review.

On average over the last five years, close to 30% of the increase in healthcare expenditure on medical services is due to population ageing and growth. We do not have data on the extent to which this increase can be attributed to poor health in a senior’s golden years due to unhealthy lifestyle habits.

As we seek to mitigate medical cost pressures that come with ageing, we recognise that healthy ageing should be viewed as a part of a broader population health strategy. This is because the health of seniors is heavily influenced by the cumulative effect of socio-economic, biological, and environmental influences when they were young. We have therefore adopted a comprehensive life-course approach that places great emphasis on preventive health, health promotion and disease management for all Singaporeans across all life stages and settings to cater to the evolving needs of the individual.

We have comprehensive preventive health programmes from young to old. This starts with Childhood Developmental Screening from birth, to regular screening for school-going children. For example, Singapore’s School Health Services has extensive educational programmes to promote healthy lifestyle activities. The School Health Service also conducts regular check-ups and immunisation for students. For adults, we encourage Singaporeans aged 40 and above to go for regular recommended health screenings and follow up. We have provided heavy subsidies for ‘Screen for Life’, our national screening programme. Under this programme, both the health screening and the first follow-up consultation if required are effectively free or cost no more than $5 per visit. This encourages early detection and timely intervention for chronic conditions. We have seen a rise in screening rate for common chronic conditions from 45% in 2010 to 66% in 2019. For seniors, we launched Project Silver Screen, a Public-Private Partnership with business and community, which provides community-based functional screening for Singaporeans aged 60 and above to pick up common age-related decline in vision, hearing, and oral health as well as to provide them with appropriate follow-up interventions, such as treatments and assistive devices. Apart from screening, we have a comprehensive vaccination programme for adults and children. Last November, we enhanced subsidies for vaccinations recommended under the National Childhood Immunisation Schedule (NCIS) and National Adult Immunisation Schedule (NAIS), with these subsidies now available at polyclinics and CHAS GP clinics nationwide. This will support Singaporeans in protecting themselves and loved ones from vaccine-preventable diseases.

We regularly refine our health promotion efforts based on ground feedback and focus group discussions. Seniors have shared that health is one of their top three priorities and they want to remain healthy so as to continue living independently. However, some seniors have also shared that they were not aware of the opportunities or knowledge to remain healthy. To this end, we have adopted a whole-of-government and whole-of-society approach, working with various organisations including the Health Promotion Board (HPB), Sport Singapore (SportSG), People’s Association (PA), healthcare clusters and community partners to offer a range of active ageing programmes. For example, HPB’s active ageing programmes comprise of group exercises and interactive health workshops, which are readily accessible in the community. These programmes are tailored specifically to seniors’ health needs such as exercises focusing on improving their strength, balance and flexibility. In the workplace setting, HPB also has customised health programmes for sectors with a greater proportion of older workers, including the healthcare, retail, food and beverage, education, cleaning, security, transport and logistics sectors. Programmes such as 'Health in Heartlands' in the malls and 'Health Chats @ Hawker Centres', are designed with the workers’ schedules in mind, so that they can attend health coaching sessions during the lull periods of their work hours. Since 2014, 94,000 mature workers across the seven priority sectors have benefitted from these programmes.

Seniors have also shared that social interaction and relationships form an important part of their preferred group activities. To address this need, all our Active Ageing Programmes are designed to promote social interaction. For instance, HPB introduced the Silver Challenge as part of the 5th season of the National Steps Challenge™, which is our first nation-wide physical activity movement where participants can earn rewards with increased physical activity levels. The first season of the Silver Challenge attracted 174,000 participants, which is more than a ten-fold increase of seniors reached through National Steps Challenge™ compared to Season 1. In aggregate, the National Steps Challenge™ has seen a total of 1.7 million participants across all five seasons and the movement has habituated participants to take more steps during pre-challenge periods, from 4,512 steps in Season 1 to 7,596 steps in Season 5. In addition, given that social and health needs are closely intertwined, having strong community support is key to ensuring that seniors can enjoy good health in their old age. Hence from May this year, we will be rolling out a new eldercare service model. Eldercare centres will serve as key touchpoints for all seniors in their community, providing services such as Active Ageing Programmes, and befriending/ buddying services for seniors at risk of social isolation.

For those who develop chronic conditions, we have put in place measures to support them in managing their conditions and delay disease progression. This will further help to improve health outcomes and reduce healthcare consumption. Under the Community Health Assist Scheme (CHAS) and Chronic Disease Management Programme (CDMP), we provide subsidies and MediSave coverage for approved chronic conditions to defray the cost of care and encourage Singaporeans to seek regular follow-up with their primary care provider. A critical factor is patients’ ability to take charge of their health. We worked with patients and families to develop the Patient Empowerment for Self-care Framework under the War on Diabetes, including the National Diabetes Reference Materials, to empower patients to co-own their care journey, with the support of their care team and family and friends. We will continually innovate to better support patients.

The Government remains committed to keeping Singapore and Singaporeans in good health. All of us have to play our part to lead healthy lifestyles, go for regular health screening as well as receive nationally recommended vaccinations, and exercise responsibility.