1 00:00:00,000 --> 00:00:02,250 Speaker 1: This is a C. N. A. Podcast. 2 00:00:04,760 --> 00:00:07,220 Speaker 1: Hello and welcome back to Heart of the matter. I'm 3 00:00:07,220 --> 00:00:11,310 Speaker 1: your host, Stephen Chair today, we're talking about healthier S. G. A. 4 00:00:11,310 --> 00:00:15,460 Speaker 1: Nationwide health plan to personalize healthcare and make it more 5 00:00:15,460 --> 00:00:20,720 Speaker 1: preemptive rather than reactive. And here is Health Minister describing it. 6 00:00:20,730 --> 00:00:26,000 Speaker 1: It is a fundamental reorientation and reform of our health 7 00:00:26,000 --> 00:00:31,740 Speaker 1: care system. Focus on preventive care instead of curative care, 8 00:00:31,750 --> 00:00:33,580 Speaker 1: emphasize on health 9 00:00:33,780 --> 00:00:35,150 Speaker 1: instead of sickness, 10 00:00:35,979 --> 00:00:39,890 Speaker 1: shift the center of gravity of care away from hospital 11 00:00:39,900 --> 00:00:41,310 Speaker 1: into the community. 12 00:00:41,870 --> 00:00:44,790 Speaker 1: Singapore's health care system is always evolving and there have 13 00:00:44,790 --> 00:00:47,820 Speaker 1: already been several tweaks along the way. So what's different 14 00:00:47,820 --> 00:00:51,200 Speaker 1: with this plan? Is it just the same old suggestions, 15 00:00:51,200 --> 00:00:55,630 Speaker 1: wrapped in new words? Or is this really something fundamentally different? 16 00:00:55,640 --> 00:00:58,670 Speaker 1: How will it affect the vast majority of patients who 17 00:00:58,670 --> 00:01:02,800 Speaker 1: flocked to general practitioners? And in turn, what burdens will 18 00:01:02,800 --> 00:01:05,670 Speaker 1: it place on them? And will all of this helps 19 00:01:05,680 --> 00:01:07,720 Speaker 1: reduce spiraling health care costs 20 00:01:09,760 --> 00:01:14,140 Speaker 1: with me to discuss this are Professor Benjamin Ong, senior 21 00:01:14,140 --> 00:01:17,709 Speaker 1: Vice President. Health, Education and Resources at the National University 22 00:01:17,709 --> 00:01:21,729 Speaker 1: of Singapore was also the former Director of medical services 23 00:01:21,740 --> 00:01:24,220 Speaker 1: for six years up to the year 2020 24 00:01:24,500 --> 00:01:25,690 Speaker 2: steve. Nice to be here. 25 00:01:25,700 --> 00:01:27,370 Speaker 1: Dr Raymond on general practice 26 00:01:27,390 --> 00:01:30,590 Speaker 1: from Dr anywhere. Thank you very much for inviting us 27 00:01:30,590 --> 00:01:35,240 Speaker 1: here today and Dr medical director at phoenix medical group? 28 00:01:35,250 --> 00:01:38,470 Speaker 1: Good afternoon steve and everyone else. Okay, gentlemen, thanks so 29 00:01:38,470 --> 00:01:40,970 Speaker 1: much for joining us. Let's start off talking about what's 30 00:01:40,970 --> 00:01:42,480 Speaker 1: different about this plan 31 00:01:42,610 --> 00:01:46,290 Speaker 1: and the importance of pivoting. So what is healthier S. 32 00:01:46,290 --> 00:01:49,120 Speaker 1: G all about first. Let me ask Gps, perhaps from 33 00:01:49,120 --> 00:01:52,080 Speaker 1: your point of view what is healthier S. G. And 34 00:01:52,090 --> 00:01:55,310 Speaker 1: is it better? Raymond. So I think healthier S. G. 35 00:01:55,320 --> 00:01:57,520 Speaker 1: Is a whole rethinking of how we look at health 36 00:01:57,520 --> 00:02:00,640 Speaker 1: care as a nation. And to focus on the fundamentals 37 00:02:00,640 --> 00:02:03,820 Speaker 1: of healthcare, mainly in the fact of preventive care 38 00:02:04,120 --> 00:02:07,500 Speaker 1: and to actually focus resources where they can make the 39 00:02:07,500 --> 00:02:13,020 Speaker 1: biggest difference which is preventing or reducing healthcare burden when 40 00:02:13,020 --> 00:02:16,340 Speaker 1: it comes to the major chronic disease groups. Very much 41 00:02:16,340 --> 00:02:19,590 Speaker 1: focused on your cardiovascular diseases as well as maintaining a 42 00:02:19,590 --> 00:02:21,680 Speaker 1: very good state of health. That to me is the 43 00:02:21,680 --> 00:02:27,370 Speaker 1: main focus of healthcare. S. G. Prevention and reducing any 44 00:02:27,380 --> 00:02:30,290 Speaker 1: already present chronic disease burden and sean, what do you think? 45 00:02:30,290 --> 00:02:31,180 Speaker 1: Do you agree with that? 46 00:02:31,350 --> 00:02:34,810 Speaker 1: Absolutely. I think Raymond has got the summary there for me. 47 00:02:34,810 --> 00:02:36,720 Speaker 1: I'll just add on one point. I think it's really 48 00:02:36,720 --> 00:02:40,120 Speaker 1: a case of how to reshape not just what the 49 00:02:40,120 --> 00:02:43,459 Speaker 1: health system thinks or what the doctors think, but it's 50 00:02:43,460 --> 00:02:47,730 Speaker 1: really how the nation actually thinks about their illnesses. Because 51 00:02:47,740 --> 00:02:50,840 Speaker 1: to actually have a successful healthier as Japan, not only 52 00:02:50,840 --> 00:02:53,109 Speaker 1: must you have buy in from the physicians and the 53 00:02:53,110 --> 00:02:54,180 Speaker 1: allied health stuff, but you 54 00:02:54,197 --> 00:02:57,047 Speaker 1: also must have it from the populist and that's really 55 00:02:57,047 --> 00:03:00,127 Speaker 1: the crux of the issue because for many, many years 56 00:03:00,127 --> 00:03:02,347 Speaker 1: and decades I think what has happened is that we've 57 00:03:02,357 --> 00:03:05,427 Speaker 1: always gone through what we think is normal. You see 58 00:03:05,427 --> 00:03:07,507 Speaker 1: the doctor when you're unwell see the doctor go to 59 00:03:07,507 --> 00:03:10,627 Speaker 1: the hospital, see especially see the Gpu based on what 60 00:03:10,627 --> 00:03:14,967 Speaker 1: you feel about it. Well healthier S. G. Puts the 61 00:03:14,977 --> 00:03:17,027 Speaker 1: emphasis back onto the pitch and it's sort of like 62 00:03:17,044 --> 00:03:19,184 Speaker 1: going back to school, you know, going back to primary 63 00:03:19,184 --> 00:03:21,573 Speaker 1: school and saying, hey look, we've got to look at 64 00:03:21,574 --> 00:03:24,304 Speaker 1: this from a completely different perspective. I've got to look 65 00:03:24,314 --> 00:03:26,844 Speaker 1: after myself, you know, I've got to look after my family, 66 00:03:26,844 --> 00:03:29,964 Speaker 1: my loved ones, my relatives and get them to see 67 00:03:29,964 --> 00:03:32,404 Speaker 1: the doctor and get a family physician in charge of 68 00:03:32,413 --> 00:03:34,543 Speaker 1: their health so that they can guide them and to 69 00:03:34,544 --> 00:03:38,994 Speaker 1: teach them how to actually look at themselves prior to 70 00:03:38,994 --> 00:03:39,874 Speaker 1: even any of the 71 00:03:39,891 --> 00:03:42,311 Speaker 1: illness is setting in. So I would go even one 72 00:03:42,311 --> 00:03:44,671 Speaker 1: step further to say that not only when they have 73 00:03:44,671 --> 00:03:47,951 Speaker 1: already had a chronic illnesses, although they do not have 74 00:03:47,961 --> 00:03:51,421 Speaker 1: the end stage problems, but even before they developed the 75 00:03:51,431 --> 00:03:54,981 Speaker 1: promises that will be what really healthier S. G. So 76 00:03:54,981 --> 00:03:56,851 Speaker 1: from the sounds of it, it is quite a fundamental 77 00:03:56,851 --> 00:03:59,961 Speaker 1: shift because it's about me going to see the doctor 78 00:03:59,961 --> 00:04:02,740 Speaker 1: when I actually don't need to see the doctor. 79 00:04:02,940 --> 00:04:06,220 Speaker 1: So it's preventive, right? I mean, you know, for those 80 00:04:06,220 --> 00:04:08,920 Speaker 1: years as director of medical services, when you look at 81 00:04:08,920 --> 00:04:11,200 Speaker 1: our health care system, what was wrong with it, I mean, 82 00:04:11,200 --> 00:04:12,990 Speaker 1: why are we doing this now, why are we shifting 83 00:04:12,990 --> 00:04:14,120 Speaker 1: in this direction? But 84 00:04:14,120 --> 00:04:16,740 Speaker 2: steve I would actually just extend a little bit from 85 00:04:16,740 --> 00:04:19,500 Speaker 2: what my two colleagues essentially have said. It's just that 86 00:04:19,510 --> 00:04:23,210 Speaker 2: point that we've always talked about health care and we've 87 00:04:23,210 --> 00:04:25,950 Speaker 2: concentrated a lot on rescue care. But if you look 88 00:04:25,950 --> 00:04:28,539 Speaker 2: at Singapore as a whole, what really is important to 89 00:04:28,540 --> 00:04:31,890 Speaker 2: everyone is something that we value most when we lose it, 90 00:04:32,670 --> 00:04:34,589 Speaker 2: and that is the ability to do the things that 91 00:04:34,589 --> 00:04:37,020 Speaker 2: we like to do, the things that we love to do, 92 00:04:37,029 --> 00:04:39,909 Speaker 2: go running, eat the food we like take a holiday, 93 00:04:39,910 --> 00:04:42,240 Speaker 2: spend time with people we love and when we talk 94 00:04:42,240 --> 00:04:44,620 Speaker 2: about that, the perspective I wanted to lay on the 95 00:04:44,620 --> 00:04:45,530 Speaker 2: table is this 96 00:04:46,180 --> 00:04:49,370 Speaker 2: Singapore has one of the longest lived populations in the world. 97 00:04:49,380 --> 00:04:53,340 Speaker 2: Our longevity is really wonderful. Mid 80s for female, early 98 00:04:53,339 --> 00:04:54,820 Speaker 2: 80s for men in general, 99 00:04:55,360 --> 00:04:58,780 Speaker 2: but if you look at the healthy longevity is actually 100 00:04:58,779 --> 00:05:00,990 Speaker 2: shorter and what we really want to do is make 101 00:05:00,990 --> 00:05:02,940 Speaker 2: sure that people can do the things that they want 102 00:05:02,950 --> 00:05:06,450 Speaker 2: for as long as possible and for that you can't 103 00:05:06,450 --> 00:05:09,640 Speaker 2: wait until something happens. You must try to reduce the 104 00:05:09,640 --> 00:05:13,360 Speaker 2: chance of that happening. So shifting from health care to 105 00:05:13,360 --> 00:05:15,950 Speaker 2: health as much as possible would be key in this 106 00:05:15,950 --> 00:05:18,660 Speaker 2: whole journey. So I'm actually very pleased m O. H. 107 00:05:18,660 --> 00:05:22,950 Speaker 2: Has taken this major step to try to emphasis health 108 00:05:23,140 --> 00:05:27,210 Speaker 2: rather than continue to just move on health care alone, 109 00:05:27,220 --> 00:05:27,660 Speaker 2: it 110 00:05:27,660 --> 00:05:30,719 Speaker 1: really is a preventive approach. You know, we start building 111 00:05:30,720 --> 00:05:33,140 Speaker 1: up your health instead of waiting for you to get 112 00:05:33,140 --> 00:05:36,550 Speaker 1: sick and then go and seek help. How fundamental a 113 00:05:36,550 --> 00:05:39,400 Speaker 1: shift is this pro form for your point of view? 114 00:05:39,589 --> 00:05:43,320 Speaker 1: Are we really changing the way we approach health care 115 00:05:43,330 --> 00:05:46,279 Speaker 1: after all these years? Is this really changing the direction 116 00:05:46,279 --> 00:05:47,469 Speaker 1: we take moving forward? 117 00:05:47,480 --> 00:05:50,010 Speaker 2: This is actually an expansion of one of the beyond 118 00:05:50,020 --> 00:05:52,470 Speaker 2: from health care to health, if you remember what was 119 00:05:52,470 --> 00:05:55,919 Speaker 2: actually mentioned earlier on, it's actually building on top of 120 00:05:55,930 --> 00:05:59,020 Speaker 2: and putting a lot more meat on what that means. 121 00:05:59,029 --> 00:06:03,529 Speaker 2: It's really shifting resources, is actually shifting the emphasis is 122 00:06:03,529 --> 00:06:04,730 Speaker 2: really trying to get 123 00:06:04,980 --> 00:06:07,640 Speaker 2: every single member of the public involved in this whole 124 00:06:07,640 --> 00:06:12,260 Speaker 2: endeavor to try to create a much more healthy society 125 00:06:12,270 --> 00:06:15,900 Speaker 2: as a whole right from very early on in life, ideally. 126 00:06:16,210 --> 00:06:19,650 Speaker 2: But certainly starting with where I think the ministry is 127 00:06:19,650 --> 00:06:22,470 Speaker 2: most concerned that we're going to have the greatest challenge 128 00:06:22,480 --> 00:06:23,820 Speaker 2: those that are older. So 129 00:06:23,820 --> 00:06:25,900 Speaker 1: why wait this long? Is it only now? Because we're 130 00:06:25,900 --> 00:06:28,820 Speaker 1: seeing quite an aging population, it really is an issue. 131 00:06:28,830 --> 00:06:31,710 Speaker 1: The idea of having family doctors is something so common 132 00:06:31,710 --> 00:06:33,890 Speaker 1: elsewhere in the world. Why are we only doing it now? 133 00:06:33,900 --> 00:06:35,790 Speaker 2: I don't think we're only doing it now. I think 134 00:06:35,790 --> 00:06:39,120 Speaker 2: we've been actually gradually building up to it. We have 135 00:06:39,120 --> 00:06:42,250 Speaker 2: first to build an ecosystem very early on, we didn't 136 00:06:42,250 --> 00:06:44,290 Speaker 2: have the community health assistance scheme, 137 00:06:44,940 --> 00:06:47,670 Speaker 2: We didn't have a system where the GP clinics were 138 00:06:47,670 --> 00:06:50,000 Speaker 2: linked up to each other and then linked up to 139 00:06:50,000 --> 00:06:52,080 Speaker 2: the health care system. We had to build that trust, 140 00:06:52,080 --> 00:06:55,180 Speaker 2: we had to build a common language, We have to 141 00:06:55,180 --> 00:06:58,270 Speaker 2: build an overall game plan and roll. We also have 142 00:06:58,270 --> 00:07:00,410 Speaker 2: to find a way to organize it because there are 143 00:07:00,410 --> 00:07:04,380 Speaker 2: so many GP clinics scattered around Singapore, they were not 144 00:07:04,380 --> 00:07:07,630 Speaker 2: really so connected overall to the health systems. The three 145 00:07:07,630 --> 00:07:10,700 Speaker 2: clusters per se and the clustering had to occur first. 146 00:07:11,490 --> 00:07:15,140 Speaker 2: But of course, we're talking essentially about the health providers 147 00:07:15,140 --> 00:07:17,720 Speaker 2: right now, we've been gradually building to this point. 148 00:07:17,920 --> 00:07:20,000 Speaker 2: I think it's a very important step that we now 149 00:07:20,000 --> 00:07:23,560 Speaker 2: need to make in Singapore to actually shift the emphasis 150 00:07:23,560 --> 00:07:26,890 Speaker 2: where community care becomes not only the first port of call, 151 00:07:26,890 --> 00:07:28,500 Speaker 2: but the principal part of court 152 00:07:28,510 --> 00:07:32,270 Speaker 1: Raymond chan, what do you think to echo on? The 153 00:07:32,270 --> 00:07:36,380 Speaker 1: general principle of having a family doctor to have one 154 00:07:36,380 --> 00:07:38,860 Speaker 1: single point of care has always been the kind of 155 00:07:38,870 --> 00:07:42,100 Speaker 1: theory of which we practice. But in order to develop 156 00:07:42,110 --> 00:07:42,910 Speaker 1: a system, 157 00:07:43,100 --> 00:07:45,130 Speaker 1: it is very important to have all the building blocks 158 00:07:45,130 --> 00:07:47,820 Speaker 1: in place. And the most important bit of it is 159 00:07:47,820 --> 00:07:52,150 Speaker 1: actually the way that we document data, the way that 160 00:07:52,150 --> 00:07:56,280 Speaker 1: we document treatment as well as lab tests and all 161 00:07:56,280 --> 00:08:00,340 Speaker 1: these kind of results into a unified system where everyone 162 00:08:00,340 --> 00:08:03,750 Speaker 1: talk the same language for the continuity of care and 163 00:08:03,760 --> 00:08:07,080 Speaker 1: only then, are we able to truly build something that 164 00:08:07,090 --> 00:08:10,780 Speaker 1: patients can rely on for the entire care journey from 165 00:08:10,790 --> 00:08:11,470 Speaker 1: end to end 166 00:08:11,690 --> 00:08:14,440 Speaker 1: and as well as all the entire funding mechanism. The 167 00:08:14,440 --> 00:08:17,400 Speaker 1: whole trust that was actually developed over the past few 168 00:08:17,400 --> 00:08:19,930 Speaker 1: years is also very pivotal to be able to start 169 00:08:19,940 --> 00:08:23,530 Speaker 1: having the entire ecosystem to be able to finally be 170 00:08:23,530 --> 00:08:26,180 Speaker 1: in a position to announce this to the general public. 171 00:08:26,190 --> 00:08:28,930 Speaker 1: That we are ready to embark on this pivotal change 172 00:08:28,930 --> 00:08:30,790 Speaker 1: in the health care system. But do we really have 173 00:08:30,790 --> 00:08:30,890 Speaker 1: that 174 00:08:30,915 --> 00:08:33,855 Speaker 1: ecosystem? I've been to some clinics and sometimes they say sorry, 175 00:08:33,855 --> 00:08:36,195 Speaker 1: I don't have access to your records even though everything 176 00:08:36,195 --> 00:08:39,315 Speaker 1: is supposed to be e filed. Right. Are we really 177 00:08:39,325 --> 00:08:42,095 Speaker 1: that ready for that? That's one of the big changes 178 00:08:42,095 --> 00:08:44,554 Speaker 1: in health care S. G. That is coming this next 179 00:08:44,554 --> 00:08:48,845 Speaker 1: year when all clinic management systems all have to conform 180 00:08:48,845 --> 00:08:50,140 Speaker 1: to a singular standard 181 00:08:50,450 --> 00:08:54,460 Speaker 1: of documentation as well as information flow back so that 182 00:08:54,470 --> 00:08:56,030 Speaker 1: this is what I viewed to be one of the 183 00:08:56,040 --> 00:08:59,910 Speaker 1: cornerstones of this entire healthy msg as well sean have 184 00:08:59,910 --> 00:09:02,660 Speaker 1: you ever found that a problem as well? Because you 185 00:09:02,660 --> 00:09:05,000 Speaker 1: don't have all the information you need of the patients 186 00:09:05,000 --> 00:09:08,750 Speaker 1: you're seeing. Absolutely. I think that's always one aspect of 187 00:09:08,760 --> 00:09:11,310 Speaker 1: care that we are always very mindful about where there's 188 00:09:11,309 --> 00:09:13,090 Speaker 1: fragmentation of care, 189 00:09:13,100 --> 00:09:15,600 Speaker 1: where you have pieces of information lying all over the 190 00:09:15,600 --> 00:09:19,340 Speaker 1: place because one of the things about easy and accessible 191 00:09:19,340 --> 00:09:22,300 Speaker 1: health care is that patients are able to doctor hawk 192 00:09:22,300 --> 00:09:26,710 Speaker 1: fairly easily and hence therefore will have records lying over 193 00:09:26,720 --> 00:09:30,840 Speaker 1: various clinics or hospital settings. Hence pulling all this information 194 00:09:30,840 --> 00:09:34,210 Speaker 1: together is a linkage that will help her pull the 195 00:09:34,210 --> 00:09:35,750 Speaker 1: health care system together. 196 00:09:35,890 --> 00:09:39,650 Speaker 1: The system is still in its infancy. But over the 197 00:09:39,650 --> 00:09:42,360 Speaker 1: next few years I'm pretty certain that if this is 198 00:09:42,360 --> 00:09:45,140 Speaker 1: the direction that the country would like to head in, 199 00:09:45,150 --> 00:09:48,280 Speaker 1: I'm sure it will be done. Common central club system 200 00:09:48,280 --> 00:09:52,000 Speaker 1: where our medical information can be sought would be the 201 00:09:52,000 --> 00:09:52,620 Speaker 1: way to go 202 00:09:52,630 --> 00:09:54,610 Speaker 2: steve if we could just add to what Sean is 203 00:09:54,610 --> 00:09:57,730 Speaker 2: essentially said, we've had many opportunities and I'm actually glad 204 00:09:57,730 --> 00:10:00,079 Speaker 2: Raymond is here because dr anyway was something that we 205 00:10:00,080 --> 00:10:03,220 Speaker 2: started discussing earlier on before we had covid 206 00:10:03,429 --> 00:10:05,160 Speaker 2: if not for the fact that we do have a 207 00:10:05,160 --> 00:10:08,780 Speaker 2: backbone called the national electronic health record. This conversation that 208 00:10:08,780 --> 00:10:12,939 Speaker 2: we're having won't actually happen. The national electronic health record 209 00:10:12,940 --> 00:10:16,910 Speaker 2: of any HR is supposed to be the record that 210 00:10:16,920 --> 00:10:21,280 Speaker 2: follows the individual and all the health care clinic management 211 00:10:21,280 --> 00:10:24,620 Speaker 2: systems or the electronic medical records are supposed to communicate. 212 00:10:24,620 --> 00:10:25,600 Speaker 2: The course set there. 213 00:10:26,050 --> 00:10:29,340 Speaker 2: Before today's discussion. I was actually seeing a clinic and 214 00:10:29,350 --> 00:10:31,640 Speaker 2: it was quite interesting because I was looking at records 215 00:10:31,640 --> 00:10:34,360 Speaker 2: from patients who were seen 216 00:10:34,980 --> 00:10:38,579 Speaker 2: in the polyclinic at the other end of Singapore as well. 217 00:10:38,590 --> 00:10:41,199 Speaker 2: And it was quite straightforward because I could actually see 218 00:10:41,200 --> 00:10:44,320 Speaker 2: the records, the key summaries of what was going on. 219 00:10:44,330 --> 00:10:47,730 Speaker 2: And increasingly, the number of my family physician colleagues are 220 00:10:47,730 --> 00:10:50,910 Speaker 2: also coming from what we are now in a position 221 00:10:50,910 --> 00:10:52,480 Speaker 2: where we can try to build on top of it. 222 00:10:52,480 --> 00:10:53,870 Speaker 2: But of course you are right to call up the 223 00:10:53,870 --> 00:10:57,360 Speaker 2: fact that it's still the journey we've embarked on it 224 00:10:57,370 --> 00:11:00,010 Speaker 2: and we do have to keep our noses to the 225 00:11:00,010 --> 00:11:02,719 Speaker 2: grindstone to make sure that it actually comes to be, 226 00:11:03,130 --> 00:11:04,480 Speaker 1: I'm going to give it to you guys that in 227 00:11:04,480 --> 00:11:06,720 Speaker 1: a few years this will be ironed out. I imagine 228 00:11:06,720 --> 00:11:09,230 Speaker 1: the day I go in and its facial recognition team 229 00:11:09,230 --> 00:11:10,929 Speaker 1: and then all my data pulls up on the screen 230 00:11:10,929 --> 00:11:11,760 Speaker 1: for the doctor 231 00:11:11,910 --> 00:11:14,219 Speaker 1: who can even just tap certain parts of my body 232 00:11:14,220 --> 00:11:17,540 Speaker 1: to see what the diagnosis. I'm sure that will happen eventually. 233 00:11:17,550 --> 00:11:22,670 Speaker 1: Will this all also add on to increasing burdens for GPS? 234 00:11:22,670 --> 00:11:25,740 Speaker 1: We already see quite long queues at clinics, especially during 235 00:11:25,740 --> 00:11:28,429 Speaker 1: peak hours. So now people are coming in not just 236 00:11:28,429 --> 00:11:30,750 Speaker 1: for your regular coffin code, they're coming in because they 237 00:11:30,750 --> 00:11:34,220 Speaker 1: want to have extra screening extra checks. Is that going 238 00:11:34,220 --> 00:11:36,420 Speaker 1: to make things worse for you guys? Especially since we 239 00:11:36,420 --> 00:11:40,230 Speaker 1: know manpower is lacking as well. There's a shortage. 240 00:11:40,242 --> 00:11:42,342 Speaker 1: You have to run longer clinic hours. What would this 241 00:11:42,342 --> 00:11:45,362 Speaker 1: mean for you guys as GPS? I'll be honest and 242 00:11:45,362 --> 00:11:48,032 Speaker 1: say that it is going to be certainly challenging for 243 00:11:48,032 --> 00:11:50,772 Speaker 1: us on the ground where we actually have to face 244 00:11:50,782 --> 00:11:55,511 Speaker 1: a potentially patients coming in from the politics system who 245 00:11:55,511 --> 00:12:00,462 Speaker 1: were previously seeing politics because of the subsidized care that 246 00:12:00,462 --> 00:12:03,992 Speaker 1: was available to them only in the politics. Healthier energy 247 00:12:03,992 --> 00:12:06,492 Speaker 1: is supposed to level the playing field in some way 248 00:12:06,502 --> 00:12:08,562 Speaker 1: to allow some right, citing where 249 00:12:08,574 --> 00:12:11,984 Speaker 1: some of our community patients will be able to choose 250 00:12:11,994 --> 00:12:14,984 Speaker 1: a family physician and stick to the family physician and 251 00:12:14,994 --> 00:12:18,854 Speaker 1: hence therefore shift their care out of the politics system. 252 00:12:18,854 --> 00:12:22,204 Speaker 1: Or perhaps even the outpatient specialist care if their conditions 253 00:12:22,214 --> 00:12:25,223 Speaker 1: allow them to do so. One of the challenges for 254 00:12:25,234 --> 00:12:28,224 Speaker 1: perhaps maybe the mom and pop gps who have been 255 00:12:28,234 --> 00:12:31,614 Speaker 1: operating in a style, you know, over the last 234 256 00:12:31,614 --> 00:12:36,634 Speaker 1: decades will find challenging finding the skilled manpower to help 257 00:12:36,644 --> 00:12:36,894 Speaker 1: them 258 00:12:36,905 --> 00:12:41,175 Speaker 1: out in the administrative Taskings. And indeed that is one 259 00:12:41,176 --> 00:12:43,896 Speaker 1: of my concerns. You know, when I look forward to 260 00:12:43,896 --> 00:12:46,506 Speaker 1: the healthier S. G. Scheme, I certainly feel that it 261 00:12:46,506 --> 00:12:49,636 Speaker 1: is beneficial for the patients, but we can only benefit 262 00:12:49,636 --> 00:12:53,986 Speaker 1: the patients if we have the requisite human resource as 263 00:12:53,986 --> 00:12:57,576 Speaker 1: well as the ability to pull off all these changes 264 00:12:57,576 --> 00:12:59,566 Speaker 1: that are going to be coming along. Because that's the 265 00:12:59,566 --> 00:13:01,646 Speaker 1: other thing. Right? I'm your patient. I only want to 266 00:13:01,646 --> 00:13:04,116 Speaker 1: see you don't want to see any other doctor that 267 00:13:04,116 --> 00:13:05,226 Speaker 1: is in your clinic. 268 00:13:05,480 --> 00:13:08,170 Speaker 1: So likewise for you, Raymond, does that mean you may 269 00:13:08,170 --> 00:13:10,720 Speaker 1: have a bunch of patients, but your other doctor only 270 00:13:10,720 --> 00:13:14,510 Speaker 1: has 10% of that load. The healthy concept of one 271 00:13:14,510 --> 00:13:17,590 Speaker 1: family doctor, one family when we actually do in practice 272 00:13:17,590 --> 00:13:21,000 Speaker 1: is one family clinic not a doctor per se because 273 00:13:21,010 --> 00:13:23,370 Speaker 1: it is a fact that the private market, a lot 274 00:13:23,370 --> 00:13:25,370 Speaker 1: of clinics are meant by low comms, there's a lot 275 00:13:25,370 --> 00:13:28,760 Speaker 1: of movement around clinics of the doctors themselves. That's why 276 00:13:28,770 --> 00:13:31,820 Speaker 1: it falls back to the system itself. System is very important. 277 00:13:32,070 --> 00:13:35,620 Speaker 1: The ability to have the case notes being saved being 278 00:13:35,620 --> 00:13:39,810 Speaker 1: documented very clearly allows for transference of care within a 279 00:13:39,809 --> 00:13:42,829 Speaker 1: clinic group between clinic groups as well. So that's how 280 00:13:42,830 --> 00:13:45,819 Speaker 1: you are able to maintain that continuity of care. And 281 00:13:45,820 --> 00:13:47,900 Speaker 1: I think the government's going further than that 282 00:13:48,120 --> 00:13:50,720 Speaker 1: into maintaining the standard of care. It is a fact 283 00:13:50,720 --> 00:13:53,910 Speaker 1: that in the clinical practice in the private setting GPS 284 00:13:53,920 --> 00:13:57,510 Speaker 1: might treat things differently. The same condition, the same kind 285 00:13:57,510 --> 00:14:00,000 Speaker 1: of parameters. You might have a different kind of operating 286 00:14:00,010 --> 00:14:03,640 Speaker 1: or treatment style. But the government's coming very detailed guidelines 287 00:14:03,650 --> 00:14:08,429 Speaker 1: on exactly how do you tackle chronic disease in each stage. 288 00:14:08,440 --> 00:14:11,600 Speaker 1: And with that standardization of care, patient can rest a shirt, 289 00:14:11,610 --> 00:14:14,180 Speaker 1: you say standardization of care. But Raymond if it's a 290 00:14:14,179 --> 00:14:16,390 Speaker 1: locum at your place and it's not my doctor, I 291 00:14:16,390 --> 00:14:18,090 Speaker 1: don't want to see him. I want to see the 292 00:14:18,090 --> 00:14:20,780 Speaker 1: doctor that I recognize that has known me for the 293 00:14:20,780 --> 00:14:23,710 Speaker 1: last five years, not just some other guy who has 294 00:14:23,710 --> 00:14:25,790 Speaker 1: come into your clinic for the night. What would you 295 00:14:25,790 --> 00:14:28,110 Speaker 1: say to that? It is impossible to have the same 296 00:14:28,110 --> 00:14:31,400 Speaker 1: doctor see the same patient all the time. Doctors need 297 00:14:31,400 --> 00:14:33,590 Speaker 1: to go and leave. We need to get married and 298 00:14:33,590 --> 00:14:35,100 Speaker 1: have kids and stuff. And like, so 299 00:14:35,260 --> 00:14:38,290 Speaker 1: I think steve is absolutely right. Steve was my patient 300 00:14:38,290 --> 00:14:40,800 Speaker 1: for example, he certainly would want to see me. However 301 00:14:40,800 --> 00:14:43,710 Speaker 1: you see being his family physician would allow me to 302 00:14:43,710 --> 00:14:46,640 Speaker 1: then educate him because I have got a long, long runway. 303 00:14:46,640 --> 00:14:48,900 Speaker 1: You know, I've seen him for five years, he's probably 304 00:14:48,900 --> 00:14:51,360 Speaker 1: trusting me now, right? I don't have to worry that 305 00:14:51,360 --> 00:14:54,020 Speaker 1: he is still second guessing my own 306 00:14:54,075 --> 00:14:56,825 Speaker 1: opinion because I believe that he will have already decided 307 00:14:56,835 --> 00:14:59,535 Speaker 1: that culture is a pretty decent gpu No, what if 308 00:14:59,535 --> 00:15:01,965 Speaker 1: he says something, I'm going to just take that as 309 00:15:01,965 --> 00:15:04,715 Speaker 1: probably the truth, you know, unless I'm really, really skeptical 310 00:15:04,715 --> 00:15:08,265 Speaker 1: about that diagnosis at that point that he's put across now. 311 00:15:08,265 --> 00:15:10,445 Speaker 1: So this is exactly what Raymond is trying to say. 312 00:15:10,445 --> 00:15:12,885 Speaker 1: So at this point, I would say, hey, look steven, 313 00:15:13,060 --> 00:15:15,200 Speaker 1: you know, if you've got major problems, if you've got 314 00:15:15,210 --> 00:15:17,870 Speaker 1: anything that's deferring or if you've got anything that you 315 00:15:17,870 --> 00:15:21,210 Speaker 1: have a question about come to me. However, if it's 316 00:15:21,210 --> 00:15:24,180 Speaker 1: routine stuff, you need a vaccination without already told you 317 00:15:24,180 --> 00:15:27,090 Speaker 1: about if you just need to refill a prescription or 318 00:15:27,090 --> 00:15:28,820 Speaker 1: if you just need to have something check up. That's 319 00:15:28,820 --> 00:15:30,830 Speaker 1: a minor thing and you know, it's minor because I've 320 00:15:30,830 --> 00:15:33,090 Speaker 1: told you about it or that perhaps you might be 321 00:15:33,090 --> 00:15:33,370 Speaker 1: willing 322 00:15:33,386 --> 00:15:36,076 Speaker 1: to see someone within my clinic group itself, you know, 323 00:15:36,076 --> 00:15:39,286 Speaker 1: be that a locum or a standing doctor or my 324 00:15:39,286 --> 00:15:41,986 Speaker 1: other doctors who are running my group because I trust 325 00:15:41,986 --> 00:15:44,006 Speaker 1: them as well. And hence that's why they're in my 326 00:15:44,006 --> 00:15:47,456 Speaker 1: group healthier as as I said, it goes beyond just myself, 327 00:15:47,466 --> 00:15:51,956 Speaker 1: but also to the community. Yeah, so it goes both ways. So, 328 00:15:51,956 --> 00:15:53,696 Speaker 1: so I would put the onus on you guys 329 00:15:53,712 --> 00:15:55,662 Speaker 1: for this because I think people will come in with 330 00:15:55,662 --> 00:15:58,122 Speaker 1: the expectation. So if you've known me for five years, 331 00:15:58,132 --> 00:16:00,382 Speaker 1: during those five years, you should have introduced me to 332 00:16:00,382 --> 00:16:02,832 Speaker 1: your other doctors as well. So that in a way 333 00:16:02,832 --> 00:16:05,691 Speaker 1: I have more than one regular doctor to see at 334 00:16:05,692 --> 00:16:09,292 Speaker 1: your clinic because if you are really a one man show, 335 00:16:09,302 --> 00:16:11,962 Speaker 1: it's a relationship as well and that trust that is 336 00:16:11,962 --> 00:16:14,040 Speaker 1: something that we have to clarify for people. 337 00:16:17,750 --> 00:16:20,400 Speaker 1: Hi, my name is steve Lie and I'm Teresa Tang, 338 00:16:20,620 --> 00:16:22,989 Speaker 1: and we are the hosts of the new podcast, CNN 339 00:16:22,990 --> 00:16:26,580 Speaker 1: correspondent from new york to Bangkok join us as we 340 00:16:26,580 --> 00:16:29,610 Speaker 1: kick back and chat with our colleagues across the globe 341 00:16:29,620 --> 00:16:32,670 Speaker 1: about the latest news developments, look out for our weekly 342 00:16:32,670 --> 00:16:34,930 Speaker 1: episodes wherever you get your podcasts. 343 00:16:37,930 --> 00:16:40,120 Speaker 1: Okay, let's move on and talk about some other stuff 344 00:16:40,120 --> 00:16:42,720 Speaker 1: because one of the other bugbears is the cost of drugs. 345 00:16:42,730 --> 00:16:45,370 Speaker 1: This was debated a little bit in parliament saying how 346 00:16:45,370 --> 00:16:49,060 Speaker 1: GPS are worried of losing their profit margin through dispensing 347 00:16:49,060 --> 00:16:52,920 Speaker 1: medication when drug prices are made comparable to those at 348 00:16:52,920 --> 00:16:55,490 Speaker 1: poly clinics. I don't know how you guys feel about 349 00:16:55,490 --> 00:16:58,120 Speaker 1: this because there have been many debates about whether even 350 00:16:58,130 --> 00:17:00,900 Speaker 1: our G. P. Should be dispensing medication to begin with 351 00:17:00,910 --> 00:17:02,770 Speaker 1: because in some other parts of the world they don't 352 00:17:02,770 --> 00:17:06,129 Speaker 1: write your reaction because with healthier S. G. They're saying 353 00:17:06,130 --> 00:17:07,900 Speaker 1: everything should be more transparent 354 00:17:08,400 --> 00:17:11,190 Speaker 1: which means you can't now charge me double the price 355 00:17:11,190 --> 00:17:13,880 Speaker 1: of what a polyclinic does in that respect. How will 356 00:17:13,880 --> 00:17:15,590 Speaker 1: this affect your operations? 357 00:17:15,740 --> 00:17:19,109 Speaker 1: It will be a potential problem if the plans are 358 00:17:19,109 --> 00:17:22,110 Speaker 1: not thought up properly because I think what will probably 359 00:17:22,109 --> 00:17:24,230 Speaker 1: happen is that the polyclinic list of what we call 360 00:17:24,230 --> 00:17:28,700 Speaker 1: the Standard Drug List will not have all the drugs 361 00:17:28,710 --> 00:17:31,680 Speaker 1: within the drug list itself. So I feel that there 362 00:17:31,680 --> 00:17:34,060 Speaker 1: might be a little bit of confusion if certain drugs 363 00:17:34,060 --> 00:17:37,550 Speaker 1: don't fall in the parameters of a standard drug list, 364 00:17:37,560 --> 00:17:40,540 Speaker 1: that will be number one, number two as you have 365 00:17:40,550 --> 00:17:43,670 Speaker 1: alluded to, many, doctors actually do have a profit margin 366 00:17:43,670 --> 00:17:44,030 Speaker 1: built 367 00:17:44,040 --> 00:17:46,630 Speaker 1: into the drugs that they sell as part of the 368 00:17:46,630 --> 00:17:49,590 Speaker 1: running cost of keeping the clinic afloat. So that is 369 00:17:49,590 --> 00:17:52,850 Speaker 1: a genuine issue that we will actually have to look into. 370 00:17:52,859 --> 00:17:56,280 Speaker 1: Ultimately cost will have to be covered. So in some 371 00:17:56,280 --> 00:17:58,650 Speaker 1: way it will have to be recovered in the form 372 00:17:58,650 --> 00:18:03,080 Speaker 1: of either increasing consultation fees or perhaps maybe the ministry 373 00:18:03,080 --> 00:18:08,060 Speaker 1: will come in to assist in the forms of subsidies etcetera. 374 00:18:08,070 --> 00:18:11,220 Speaker 1: But I believe that this has to be discussed before. 375 00:18:11,220 --> 00:18:12,330 Speaker 1: It is rolled out. 376 00:18:12,680 --> 00:18:16,740 Speaker 2: I think that the current business model that my colleagues 377 00:18:16,740 --> 00:18:20,760 Speaker 2: in G. P. Land essentially have is essentially sort of 378 00:18:20,770 --> 00:18:21,530 Speaker 2: piece rate. 379 00:18:22,180 --> 00:18:26,260 Speaker 2: They see individual cases and the charges then flow based 380 00:18:26,260 --> 00:18:28,580 Speaker 2: on that episode. If I were to put it in 381 00:18:28,580 --> 00:18:32,270 Speaker 2: another perspective it's almost like gig work that one does. 382 00:18:32,280 --> 00:18:35,530 Speaker 2: It's actually a singular sort of episode that you work on. 383 00:18:36,090 --> 00:18:38,980 Speaker 2: There are different ways to monetize that you could pay 384 00:18:38,980 --> 00:18:42,890 Speaker 2: for outcomes over a year if the individual that is 385 00:18:42,890 --> 00:18:46,180 Speaker 2: registered to you does well or you've done the required 386 00:18:46,180 --> 00:18:48,700 Speaker 2: sort of management steps that are required. So there are 387 00:18:48,700 --> 00:18:51,070 Speaker 2: different models that we can explore. But what my two 388 00:18:51,070 --> 00:18:54,950 Speaker 2: colleagues have said is actually important overall they must get 389 00:18:54,950 --> 00:18:58,460 Speaker 2: a fair remuneration for the effort in time. If I 390 00:18:58,460 --> 00:19:00,360 Speaker 2: were to back check a little bit about your interesting 391 00:19:00,359 --> 00:19:02,729 Speaker 2: question essentially about you just want to see Raymond and 392 00:19:02,730 --> 00:19:04,919 Speaker 2: you want to see Shannon and no one else 393 00:19:05,350 --> 00:19:08,750 Speaker 2: I've always thought that personally in the longer term when 394 00:19:08,750 --> 00:19:11,030 Speaker 2: we talk about community care you actually have to wrap 395 00:19:11,030 --> 00:19:14,270 Speaker 2: services around the G. P. So that they can optimize 396 00:19:14,270 --> 00:19:16,960 Speaker 2: care for the increasing number of cases that they have 397 00:19:16,960 --> 00:19:20,420 Speaker 2: to care for. Or they have to advise, it starts 398 00:19:20,420 --> 00:19:22,690 Speaker 2: with the trusted family physician 399 00:19:23,300 --> 00:19:25,859 Speaker 2: but the family physician can work in the team and 400 00:19:25,859 --> 00:19:28,480 Speaker 2: just like we do in the poly clinics and even 401 00:19:28,480 --> 00:19:31,380 Speaker 2: in the hospitals I think over time that will happen. 402 00:19:31,390 --> 00:19:33,369 Speaker 2: But this is the first step because you want a 403 00:19:33,369 --> 00:19:37,760 Speaker 2: trusted face. And therefore it becomes important for the establishment 404 00:19:37,760 --> 00:19:40,419 Speaker 2: of a relationship with either a particular clinic or a 405 00:19:40,420 --> 00:19:42,350 Speaker 2: particular doctor. That becomes key. 406 00:19:42,880 --> 00:19:45,129 Speaker 2: The movement from piece rate 407 00:19:45,810 --> 00:19:49,380 Speaker 2: to a different way of monetizing care is workable. 408 00:19:49,790 --> 00:19:52,790 Speaker 2: But we must be fair here in the way we 409 00:19:52,800 --> 00:19:56,010 Speaker 2: look at how our G. P. Colleagues then come out 410 00:19:56,020 --> 00:19:58,379 Speaker 2: financially for the effort that they put in to help 411 00:19:58,380 --> 00:20:00,560 Speaker 2: us create a healthy society. 412 00:20:00,570 --> 00:20:03,300 Speaker 1: Right? Of course we want a situation where which is 413 00:20:03,300 --> 00:20:05,880 Speaker 1: win win for both sides. One of the things M. O. H. 414 00:20:05,880 --> 00:20:08,169 Speaker 1: Has said is that fees will be paid to GPS 415 00:20:08,170 --> 00:20:12,200 Speaker 1: based on the health risk profiles of patients and depending 416 00:20:12,200 --> 00:20:15,830 Speaker 1: on the outcomes. Now to me that already sounds a 417 00:20:15,830 --> 00:20:16,460 Speaker 1: bit calm 418 00:20:16,470 --> 00:20:20,920 Speaker 1: implicated because we're human beings very complicated. Which means my 419 00:20:20,920 --> 00:20:23,740 Speaker 1: outcome could be entirely different from another guy's outcome. And 420 00:20:23,740 --> 00:20:26,180 Speaker 1: for the same procedure we know a lot of patients 421 00:20:26,180 --> 00:20:29,040 Speaker 1: don't always listen to doctors and do what we should 422 00:20:29,040 --> 00:20:31,190 Speaker 1: be doing. So how again are you going to measure 423 00:20:31,190 --> 00:20:33,200 Speaker 1: this when it's going to be so varied and so 424 00:20:33,200 --> 00:20:34,760 Speaker 1: different for everyone. I'll 425 00:20:34,760 --> 00:20:37,050 Speaker 2: start first, what I used to hear a lot of 426 00:20:37,050 --> 00:20:39,600 Speaker 2: is that when the individual case that they look after 427 00:20:39,600 --> 00:20:42,360 Speaker 2: has one chronic condition let's say have attention right? It's 428 00:20:42,359 --> 00:20:43,159 Speaker 2: not too difficult 429 00:20:43,640 --> 00:20:48,109 Speaker 2: once the person acquires diabetes and high cholesterol then the 430 00:20:48,109 --> 00:20:51,100 Speaker 2: medications become more complex. It becomes a lot more challenging 431 00:20:51,100 --> 00:20:53,160 Speaker 2: for them to hold the case. That's what they mean 432 00:20:53,160 --> 00:20:55,850 Speaker 2: by the case. Getting more complex. And the issue is 433 00:20:55,850 --> 00:20:58,040 Speaker 2: how do we then make it easier for them to 434 00:20:58,040 --> 00:21:01,750 Speaker 2: manage cases who have more than one chronic condition? 435 00:21:01,950 --> 00:21:04,919 Speaker 1: Part of the healthy STD program is that we are 436 00:21:04,930 --> 00:21:09,290 Speaker 1: to prescribe a stipulated set of treatments and diagnostics on 437 00:21:09,300 --> 00:21:12,270 Speaker 1: a certain profile patient. As long as we can demonstrate 438 00:21:12,270 --> 00:21:16,210 Speaker 1: that we have done our due diligence, then we will 439 00:21:16,210 --> 00:21:19,560 Speaker 1: get amply compensated in that sense so that we may. 440 00:21:19,570 --> 00:21:21,350 Speaker 1: It was a bit of the burden and the risk 441 00:21:21,359 --> 00:21:25,780 Speaker 1: of the patient just being completely noncompliant despite our best efforts. 442 00:21:25,790 --> 00:21:28,140 Speaker 1: Then the other part about it is that on very 443 00:21:28,140 --> 00:21:32,040 Speaker 1: large scale kind of concept. The evidence from other countries 444 00:21:32,040 --> 00:21:34,820 Speaker 1: have shown that on a white population basis. If you 445 00:21:34,820 --> 00:21:37,180 Speaker 1: apply all these methodology of care, 446 00:21:37,460 --> 00:21:41,800 Speaker 1: most patients will have biometric improvements there. Hb one c 447 00:21:41,800 --> 00:21:46,270 Speaker 1: withdraw their blood pressure readings will be better from that basis. Right. 448 00:21:46,280 --> 00:21:49,750 Speaker 1: If I manage a pool of say 5000 patients, I 449 00:21:49,750 --> 00:21:53,230 Speaker 1: can maybe have 100 200 ERIN people and overall I 450 00:21:53,230 --> 00:21:55,980 Speaker 1: should see the same outcomes as demonstrated in large scale 451 00:21:55,980 --> 00:21:58,680 Speaker 1: studies from other countries. Okay, let me play a little 452 00:21:58,680 --> 00:22:02,800 Speaker 1: bit of devil's advocate here while it sounds workable on 453 00:22:02,810 --> 00:22:06,490 Speaker 1: paper on the ground. This is actually what my feelings 454 00:22:06,490 --> 00:22:06,980 Speaker 1: are 455 00:22:07,470 --> 00:22:12,040 Speaker 1: if we actually base remuneration based on outcome or disease 456 00:22:12,050 --> 00:22:15,790 Speaker 1: outcome or improvement in health. what will end up happening 457 00:22:15,800 --> 00:22:17,790 Speaker 1: over a period of time, if you ask me 458 00:22:17,980 --> 00:22:21,450 Speaker 1: is that they may potentially be a bias towards keeping 459 00:22:21,450 --> 00:22:26,070 Speaker 1: the healthier patients and shunting away the more difficult cases 460 00:22:26,080 --> 00:22:29,260 Speaker 1: which then creates a negative cycle and defeats the whole 461 00:22:29,260 --> 00:22:32,840 Speaker 1: purpose of healthier S. G. Hence I am a little 462 00:22:32,840 --> 00:22:36,760 Speaker 1: reserved when I say that remuneration or compensation should be 463 00:22:36,760 --> 00:22:39,040 Speaker 1: based upon results or outcomes. 464 00:22:39,440 --> 00:22:44,190 Speaker 1: Now as for whether running the appropriate laps, the diagnostics 465 00:22:44,200 --> 00:22:47,340 Speaker 1: are sufficient. Again, I would challenge you that there will 466 00:22:47,340 --> 00:22:52,129 Speaker 1: be different areas in Singapore with different socio economic levels 467 00:22:52,130 --> 00:22:54,170 Speaker 1: of information knowledge 468 00:22:54,369 --> 00:22:58,300 Speaker 1: which may make it more difficult for certain segments of 469 00:22:58,300 --> 00:23:02,919 Speaker 1: population to come regularly for their checks, not because they 470 00:23:02,920 --> 00:23:07,810 Speaker 1: are intentionally defaulting therapy but because their home and their 471 00:23:07,820 --> 00:23:11,250 Speaker 1: community circumstances do not allow them to come at that 472 00:23:11,260 --> 00:23:14,530 Speaker 1: very kind of frequency. Now let's say I was a G. P. 473 00:23:14,540 --> 00:23:14,730 Speaker 1: In 474 00:23:14,740 --> 00:23:18,140 Speaker 1: one of the older estates in Singapore. I believe that 475 00:23:18,140 --> 00:23:21,690 Speaker 1: my outcomes is measured in this kind of international yardsticks 476 00:23:21,690 --> 00:23:27,010 Speaker 1: will differ very much from say corporate clinic or young G. P. 477 00:23:27,010 --> 00:23:32,820 Speaker 1: Clinic in say perhaps a little bit more young estates etcetera. 478 00:23:32,830 --> 00:23:35,109 Speaker 1: So I would say that we need to be really 479 00:23:35,119 --> 00:23:37,629 Speaker 1: careful, you know and ministry probably needs to be a 480 00:23:37,630 --> 00:23:41,730 Speaker 1: bit aware that there will be some differences out there 481 00:23:41,740 --> 00:23:45,570 Speaker 1: when we have to set in place a fixed target 482 00:23:45,580 --> 00:23:49,080 Speaker 1: for enumeration and also because not just a fixed target 483 00:23:49,080 --> 00:23:51,790 Speaker 1: for the prices but also because some of the checks 484 00:23:51,790 --> 00:23:55,080 Speaker 1: require equipment? It means the GPS have to invest in it. 485 00:23:55,080 --> 00:23:57,550 Speaker 1: So I guess one of the big questions people are 486 00:23:57,550 --> 00:24:00,109 Speaker 1: concerned about is will this then at the end of 487 00:24:00,109 --> 00:24:03,179 Speaker 1: the day result in higher costs for me as a 488 00:24:03,180 --> 00:24:03,790 Speaker 1: patient 489 00:24:04,040 --> 00:24:06,590 Speaker 1: because you now had to buy an x ray machine 490 00:24:06,820 --> 00:24:09,800 Speaker 1: even though it's not directly related to me, but it 491 00:24:09,800 --> 00:24:12,540 Speaker 1: means your overall costs have gone up and therefore my 492 00:24:12,550 --> 00:24:16,430 Speaker 1: consultation fees are now more expensive. Is this something patients 493 00:24:16,430 --> 00:24:19,260 Speaker 1: should be concerned about? It's not just the fact about 494 00:24:19,270 --> 00:24:21,090 Speaker 1: the G. P. Is going to be the one doing 495 00:24:21,090 --> 00:24:24,290 Speaker 1: all the screenings because this is where we need to 496 00:24:24,290 --> 00:24:28,409 Speaker 1: form the whole PCM concept of shared resources and having 497 00:24:28,410 --> 00:24:33,150 Speaker 1: teams of nurses, of healthcare phlebotomist who can actually make 498 00:24:33,150 --> 00:24:36,400 Speaker 1: trips down to patients houses to perform such checks as well. 499 00:24:36,570 --> 00:24:39,300 Speaker 1: Our company's experience that we have done chronic disease management 500 00:24:39,300 --> 00:24:42,300 Speaker 1: programs where we deploy our staff nurses of the bottom 501 00:24:42,300 --> 00:24:45,240 Speaker 1: is to perform both the digital I check as well 502 00:24:45,250 --> 00:24:47,780 Speaker 1: as blood drawing for patients in the comfort of their 503 00:24:47,780 --> 00:24:51,250 Speaker 1: own homes and that still allows patients to then follow 504 00:24:51,250 --> 00:24:54,949 Speaker 1: up on the necessary checks. But Raymond, surely that's going 505 00:24:54,950 --> 00:24:57,730 Speaker 1: to cost even more. Right. And is this going to 506 00:24:57,730 --> 00:24:59,790 Speaker 1: be covered by the government? Is healthier? Is she going 507 00:24:59,790 --> 00:25:03,150 Speaker 1: to be giving the mobile option to me as well? 508 00:25:03,359 --> 00:25:07,490 Speaker 1: I doubt that. I would say that because again, really 509 00:25:07,490 --> 00:25:10,690 Speaker 1: depends on which views are we taking. You know? Are 510 00:25:10,690 --> 00:25:14,200 Speaker 1: we looking at it from a national perspective, do we 511 00:25:14,200 --> 00:25:18,000 Speaker 1: have cost savings from a national perspective if we do it, 512 00:25:18,010 --> 00:25:21,300 Speaker 1: you know, and we organize our care in this manner. Okay, 513 00:25:21,300 --> 00:25:23,020 Speaker 1: help me out then. Let's talk about it both ways. 514 00:25:23,020 --> 00:25:25,300 Speaker 1: So as a national savings for the health care system, 515 00:25:25,300 --> 00:25:25,949 Speaker 1: will we see 516 00:25:25,960 --> 00:25:30,290 Speaker 1: Save money if this is running correctly and we get 517 00:25:30,300 --> 00:25:32,830 Speaker 1: buy in from the populace, I would say in the 518 00:25:32,830 --> 00:25:35,770 Speaker 1: long run, we will see benefits, you know, the decade, 519 00:25:35,780 --> 00:25:38,860 Speaker 1: two decades down the road for sure, two decades down 520 00:25:38,859 --> 00:25:41,060 Speaker 1: the road, 20 years from now. I feel that it 521 00:25:41,060 --> 00:25:44,190 Speaker 1: takes a generation. That's the time it takes for chronic 522 00:25:44,200 --> 00:25:48,080 Speaker 1: diseases to actually set in and you know, perhaps develop 523 00:25:48,080 --> 00:25:48,550 Speaker 1: complicate 524 00:25:48,560 --> 00:25:52,910 Speaker 1: Raymond generally, I think for complications 10 to 15 years 525 00:25:52,910 --> 00:25:57,439 Speaker 1: you should already see microvascular complications. Maybe about 5 to 526 00:25:57,440 --> 00:26:00,590 Speaker 1: 10 years. Micro maybe about 10, 15 then. But 20 527 00:26:00,590 --> 00:26:03,690 Speaker 1: years if you can set the attitude changes as well 528 00:26:03,690 --> 00:26:07,639 Speaker 1: as the whole concept of regular screening, regular prevention. I 529 00:26:07,640 --> 00:26:11,090 Speaker 1: think you see outcomes much earlier, especially when community cares 530 00:26:11,170 --> 00:26:14,800 Speaker 1: involved when you have all your fitness, your dietetics, all 531 00:26:14,800 --> 00:26:18,960 Speaker 1: this coming in together. You should see much earlier results. 532 00:26:18,960 --> 00:26:21,940 Speaker 1: I don't think we're looking at 20 years investment here. 533 00:26:21,950 --> 00:26:24,179 Speaker 1: I think the ministry look at a much earlier ri 534 00:26:24,180 --> 00:26:27,119 Speaker 1: on the returns actually profound maybe let me ask you, 535 00:26:27,130 --> 00:26:29,340 Speaker 1: I imagine in the short term will have to spend 536 00:26:29,340 --> 00:26:31,630 Speaker 1: a lot more to beef up the infrastructure to get 537 00:26:31,630 --> 00:26:34,399 Speaker 1: things ready to take on this new approach. But in 538 00:26:34,400 --> 00:26:36,220 Speaker 1: the long term we can see some of the rewards. 539 00:26:36,220 --> 00:26:39,330 Speaker 1: So is it short term pain for long term gain? 540 00:26:39,600 --> 00:26:41,550 Speaker 1: And what kind of duration are we talking about? 541 00:26:41,560 --> 00:26:43,790 Speaker 2: We should be seeing some of that. But I think 542 00:26:43,800 --> 00:26:47,070 Speaker 2: Raymond has probably mentioned some of that. The point essentially 543 00:26:47,070 --> 00:26:49,550 Speaker 2: that for certain things, if you can catch the condition 544 00:26:49,550 --> 00:26:51,700 Speaker 2: a little bit earlier, you can already make a difference 545 00:26:51,700 --> 00:26:55,660 Speaker 2: to the outcome. And many people don't proceed to do 546 00:26:55,660 --> 00:26:59,030 Speaker 2: necessary screening end up with the condition fairly late where 547 00:26:59,030 --> 00:27:02,550 Speaker 2: the cost of rescue is much, much higher. So while 548 00:27:02,560 --> 00:27:06,140 Speaker 2: it's correct that one should be cautious about over promising 549 00:27:06,500 --> 00:27:08,750 Speaker 2: it is this is a journey that I think we really, 550 00:27:08,750 --> 00:27:11,330 Speaker 2: really need to take because if we don't, we are 551 00:27:11,330 --> 00:27:15,310 Speaker 2: staring down the gun of extremely high cost, extremely high 552 00:27:15,310 --> 00:27:18,420 Speaker 2: demand of manpower, all of which we can't afford as 553 00:27:18,420 --> 00:27:21,410 Speaker 2: a nation in the very long term. So, it has 554 00:27:21,410 --> 00:27:25,060 Speaker 2: to be the situation where not only the health care professionals, 555 00:27:25,060 --> 00:27:28,430 Speaker 2: you know, but the Singapore population comes alongside and works 556 00:27:28,430 --> 00:27:31,910 Speaker 2: on this grand challenge together to try to achieve that 557 00:27:31,920 --> 00:27:33,010 Speaker 2: particular endpoint 558 00:27:33,470 --> 00:27:36,490 Speaker 2: at the very start. I spoke about this being right 559 00:27:36,490 --> 00:27:39,490 Speaker 2: from the beginning of life and I didn't allude to 560 00:27:39,490 --> 00:27:41,360 Speaker 2: the fact that we had to start with the ones 561 00:27:41,359 --> 00:27:44,830 Speaker 2: that are greater risk. So when the minister talked essentially 562 00:27:44,830 --> 00:27:48,280 Speaker 2: about people signing on to this family physician, they started 563 00:27:48,280 --> 00:27:51,350 Speaker 2: with the older age group first. But in essence we 564 00:27:51,350 --> 00:27:54,480 Speaker 2: hope that by signing on mom and dad or grandpa 565 00:27:54,480 --> 00:27:57,260 Speaker 2: and grandma that over time even the kids will end 566 00:27:57,260 --> 00:28:01,550 Speaker 2: up seeing this particular family doctor, a family doctor group. 567 00:28:02,150 --> 00:28:05,820 Speaker 2: And we hope to start that practice earlier on in life. 568 00:28:05,830 --> 00:28:08,290 Speaker 2: Get all the pickups done, do all the preventive measures 569 00:28:08,290 --> 00:28:10,730 Speaker 2: including the necessary vaccinations done early on. 570 00:28:11,310 --> 00:28:14,600 Speaker 2: So I think steve is a journey and yes we 571 00:28:14,600 --> 00:28:17,140 Speaker 2: have to climb that slope because we've spent a lot 572 00:28:17,140 --> 00:28:20,400 Speaker 2: of time developing the rescue care. Now we really need 573 00:28:20,400 --> 00:28:24,530 Speaker 2: to work essentially on prevention and promotion of health in 574 00:28:24,530 --> 00:28:26,399 Speaker 2: a very serious and very concerted way. 575 00:28:27,050 --> 00:28:31,510 Speaker 1: And for the typical patient should they be concerned about 576 00:28:31,510 --> 00:28:34,890 Speaker 1: rising costs When they go see the doctor. World prices 577 00:28:34,890 --> 00:28:35,510 Speaker 1: increase 578 00:28:35,520 --> 00:28:39,080 Speaker 2: over time we will see a general increase in cost 579 00:28:39,090 --> 00:28:41,960 Speaker 2: for the whole system. But if you ask me and 580 00:28:41,960 --> 00:28:44,220 Speaker 2: I've actually looked at the system costs it costs a 581 00:28:44,220 --> 00:28:46,610 Speaker 2: heck of a lot more for an individual to get 582 00:28:46,620 --> 00:28:49,370 Speaker 2: his hypertension treated in a government hospital, 583 00:28:49,600 --> 00:28:51,640 Speaker 2: then it cost for them to go and see a 584 00:28:51,640 --> 00:28:54,120 Speaker 2: doctor in primary care. All things being equal. If they 585 00:28:54,120 --> 00:28:56,970 Speaker 2: could get access to the same drop and the same 586 00:28:56,970 --> 00:29:00,230 Speaker 2: decisions were made and the degree of control. I do 587 00:29:00,230 --> 00:29:03,240 Speaker 2: know that there are certain G. P. Groups that have 588 00:29:03,240 --> 00:29:06,810 Speaker 2: done an extremely good job. Even earlier on when we 589 00:29:06,810 --> 00:29:10,140 Speaker 2: were actually working on war and diabetes in managing diabetes 590 00:29:10,150 --> 00:29:13,160 Speaker 2: with outcomes comparable if not as good as what you 591 00:29:13,160 --> 00:29:15,010 Speaker 2: would get in a good hospital clinic. 592 00:29:15,660 --> 00:29:17,960 Speaker 2: So I have actually a lot of faith that it's 593 00:29:17,960 --> 00:29:20,520 Speaker 2: possible for us to move in that direction. If we 594 00:29:20,530 --> 00:29:23,990 Speaker 2: give them the tools and we can actually make our 595 00:29:24,000 --> 00:29:27,010 Speaker 2: population see the value in doing this. Just 596 00:29:27,010 --> 00:29:29,310 Speaker 1: one more question related to that. This is a grand 597 00:29:29,310 --> 00:29:31,040 Speaker 1: plan but it's going to take years for it to 598 00:29:31,040 --> 00:29:32,610 Speaker 1: really have any effect, 599 00:29:32,910 --> 00:29:36,820 Speaker 1: any concerns that if things change in the world, perhaps 600 00:29:36,830 --> 00:29:41,770 Speaker 1: governments change. Minister of Health changes, some guy comes and says, 601 00:29:41,770 --> 00:29:44,700 Speaker 1: let's try a different policy. Will it mess things up? 602 00:29:44,710 --> 00:29:47,860 Speaker 1: Will we then have wasted these 3 to 5 years 603 00:29:47,870 --> 00:29:49,760 Speaker 1: building up what we're doing now. 604 00:29:49,770 --> 00:29:53,320 Speaker 2: There's always a worry, There's always a risk. We change that. 605 00:29:53,320 --> 00:29:57,540 Speaker 2: There will be some adjustments to direction sometimes because a 606 00:29:57,540 --> 00:30:00,150 Speaker 2: particular direction taken didn't quite work. 607 00:30:00,470 --> 00:30:02,540 Speaker 2: It is a journey that we have to take and 608 00:30:02,540 --> 00:30:05,640 Speaker 2: it's a journey that we have to take together with 609 00:30:05,650 --> 00:30:07,230 Speaker 2: the population, that's my field. 610 00:30:07,240 --> 00:30:10,180 Speaker 1: I completely agree that I don't believe that there will 611 00:30:10,180 --> 00:30:12,640 Speaker 1: be a waste to this because even if it's short 612 00:30:12,640 --> 00:30:15,380 Speaker 1: term or runs for a few years and then the 613 00:30:15,380 --> 00:30:19,920 Speaker 1: direction turns a little bit. I think the key message 614 00:30:19,930 --> 00:30:22,460 Speaker 1: and the key information that goes up there would be 615 00:30:22,470 --> 00:30:24,680 Speaker 1: primary prevention is important. 616 00:30:24,930 --> 00:30:29,110 Speaker 1: Health screenings are important. Health care must be seen as 617 00:30:29,110 --> 00:30:33,270 Speaker 1: something that comes into play even before you are safe. 618 00:30:33,280 --> 00:30:36,740 Speaker 1: Informing the relationship as you mentioned earlier on is really, 619 00:30:36,740 --> 00:30:37,800 Speaker 1: really important 620 00:30:38,090 --> 00:30:40,870 Speaker 1: to echo my colleagues. I think fundamentally when you talk 621 00:30:40,870 --> 00:30:44,250 Speaker 1: about the whole scientific basis of medical care is always 622 00:30:44,260 --> 00:30:47,720 Speaker 1: evidential that prevention is always going to be more cost 623 00:30:47,720 --> 00:30:51,820 Speaker 1: effective than anything else. So regardless of any policy direction change, 624 00:30:51,830 --> 00:30:53,310 Speaker 1: it will still have to be other point on the 625 00:30:53,310 --> 00:30:56,520 Speaker 1: scientific principle. I feel that this current direction we are 626 00:30:56,530 --> 00:31:00,070 Speaker 1: on right will definitely come to fruition in some way 627 00:31:00,070 --> 00:31:03,469 Speaker 1: or another in time to come. Okay very quickly. Perhaps 628 00:31:03,470 --> 00:31:05,540 Speaker 1: each of you can share with me if there's one 629 00:31:05,540 --> 00:31:06,320 Speaker 1: thing that you could 630 00:31:06,610 --> 00:31:08,660 Speaker 1: you know, change right now fixed right now with regards 631 00:31:08,660 --> 00:31:10,850 Speaker 1: to our health care system, what would it be if 632 00:31:11,030 --> 00:31:13,410 Speaker 1: you want to go first? So for me, I think 633 00:31:13,420 --> 00:31:17,120 Speaker 1: information to unify all the information in the health care 634 00:31:17,120 --> 00:31:20,460 Speaker 1: system such that all records are transferable. One of the 635 00:31:20,460 --> 00:31:23,100 Speaker 1: things that I've seen during the covid situation when we 636 00:31:23,110 --> 00:31:26,450 Speaker 1: launch H. R. P. The home recovery program to have 637 00:31:26,450 --> 00:31:28,720 Speaker 1: a national program on telemedicine 638 00:31:29,060 --> 00:31:31,630 Speaker 1: That make a huge impact. I think some of my 639 00:31:31,730 --> 00:31:35,770 Speaker 1: colleagues wrote a paper about it where our telemedicine system, 640 00:31:35,780 --> 00:31:39,790 Speaker 1: the government once saw about 200,300,000 patients and we had 641 00:31:39,790 --> 00:31:43,969 Speaker 1: an amazing outcome in mortality and mobility through our safety 642 00:31:43,970 --> 00:31:47,959 Speaker 1: blanket shows the importance of a unified health, care system. 643 00:31:48,210 --> 00:31:52,110 Speaker 1: a unified record system in being able to be a 644 00:31:52,110 --> 00:31:54,910 Speaker 1: very good safety blanket for our entire health care system. 645 00:31:54,920 --> 00:31:57,640 Speaker 1: I feel that systems is the most important part of this. Sean. 646 00:31:57,650 --> 00:32:01,420 Speaker 1: Actually I will say vaccinations, you know, the accessibility to vaccinations. 647 00:32:01,420 --> 00:32:03,830 Speaker 1: I think we've got lots of good vaccines out there 648 00:32:03,830 --> 00:32:07,580 Speaker 1: and unfortunately a huge proportion of the population who actually 649 00:32:07,580 --> 00:32:10,060 Speaker 1: should get it whole shot of getting it, you know. 650 00:32:10,060 --> 00:32:13,209 Speaker 1: So I think right now ministry also pushing some of 651 00:32:13,210 --> 00:32:15,760 Speaker 1: our elderly and higher risk patients as an example for 652 00:32:15,760 --> 00:32:17,370 Speaker 1: the pneumococcal vaccine 653 00:32:17,530 --> 00:32:21,430 Speaker 1: And I think it's short of 10% of the population 654 00:32:21,430 --> 00:32:24,610 Speaker 1: who requires or should go on it, not even getting 655 00:32:24,610 --> 00:32:29,510 Speaker 1: it because of ignorance and inaccessibility. So if I could 656 00:32:29,510 --> 00:32:33,140 Speaker 1: change it, if they could be equal and good access 657 00:32:33,140 --> 00:32:35,760 Speaker 1: to vaccines, how like how the COVID vaccines will roll up, 658 00:32:35,770 --> 00:32:38,840 Speaker 1: that would be what I want to change immediately. Your 659 00:32:39,630 --> 00:32:42,120 Speaker 1: and everyone is tomorrow somehow. 660 00:32:43,590 --> 00:32:45,040 Speaker 1: Well, 661 00:32:45,050 --> 00:32:47,130 Speaker 2: I wish we had done all of this five or 662 00:32:47,130 --> 00:32:50,120 Speaker 2: six years ago that if you asked me in a sense, 663 00:32:50,130 --> 00:32:53,400 Speaker 2: I know we've had challenges because we've had to deal 664 00:32:53,400 --> 00:32:55,720 Speaker 2: with Covid and everything else and we've had other things 665 00:32:55,720 --> 00:32:57,840 Speaker 2: to do to try to build the ecosystem. But if 666 00:32:57,840 --> 00:33:00,150 Speaker 2: we had done much of this about five or six 667 00:33:00,150 --> 00:33:02,730 Speaker 2: years ago, I think we'd be in a happier place. 668 00:33:02,740 --> 00:33:05,030 Speaker 2: We might have less challenges with regard to trying to 669 00:33:05,030 --> 00:33:08,240 Speaker 2: find staff. But I recognize that life is a journey 670 00:33:08,240 --> 00:33:10,100 Speaker 2: and this whole thing is a journey as well. I 671 00:33:10,100 --> 00:33:11,900 Speaker 2: wish we had done this earlier. 672 00:33:12,440 --> 00:33:16,170 Speaker 1: Well better late than never and here we are. Well. 673 00:33:16,170 --> 00:33:17,820 Speaker 1: One thing is certain in life we can all say 674 00:33:17,820 --> 00:33:19,980 Speaker 1: that we will die and we all have to pay taxes. 675 00:33:19,990 --> 00:33:23,320 Speaker 1: Okay that's maybe two things. But in between we all 676 00:33:23,320 --> 00:33:25,020 Speaker 1: want to live a life that's free of pain and 677 00:33:25,020 --> 00:33:28,130 Speaker 1: illness and it doesn't have to be too expensive. So 678 00:33:28,130 --> 00:33:31,080 Speaker 1: can this new healthier S. G. Model work? Will it 679 00:33:31,090 --> 00:33:33,180 Speaker 1: work out for the patients? Will it also work out 680 00:33:33,180 --> 00:33:36,890 Speaker 1: for our very talented healthcare workers who support it? I 681 00:33:36,890 --> 00:33:38,300 Speaker 1: guess only time will tell 682 00:33:39,960 --> 00:33:42,320 Speaker 1: a big thank you to my guests who have come 683 00:33:42,320 --> 00:33:44,390 Speaker 1: in to discuss this topic and to all of you 684 00:33:44,390 --> 00:33:47,520 Speaker 1: who have listened in as well. The team behind this 685 00:33:47,520 --> 00:33:51,140 Speaker 1: podcast is Jacqueline, chan, Joanne, chan, daniel lee and chris 686 00:33:51,140 --> 00:33:54,500 Speaker 1: pena robert. And I'm Stephen chan signing off, I'll see 687 00:33:54,500 --> 00:33:55,170 Speaker 1: you next week