Singapore leads the way for ASEAN in healthier ageing, with its move towards preventive healthcare
In 2010, about 1 in 10 Singaporeans (9%) were aged 65 years and above, rising to about 1 in 6 individuals (15.2%) in 2020. In 2030, almost 1 in 4 Singaporeans are expected to be over 65 years of age. By 2050, the elderly population in Singapore is forecast to make up one-third of its total population.
As lifespans increase, elderly individuals are more likely to be living with one or more chronic diseases in their silver years. In an Asia-wide survey conducted by Economist Impact, only 59% of respondents expressed confidence they would be healthy enough to live well into the age 80 or longer.
Increase in chronic diseases and healthcare costs
From 2009 to 2017 alone, the proportion of older adults with three or more chronic diseases has nearly doubled, from 19.8% to 37%. The top five chronic health conditions reported in older adults are hypertension (high blood pressure); hyperlipidaemia (high blood cholesterol); cataract; joint pain; arthritis, rheumatism or nerve pain; and diabetes.
The prevalence of chronic diseases such as hypertension and hyperlipidaemia has also risen to worryingly high levels, at 32% and 37% of the population respectively. If this situation continues to escalate, the higher disease burden would translate into greater healthcare needs and eventually, higher healthcare expenditure. The Singapore government’s healthcare expenditure has tripled over the past 10 years from about $3 billion to $10 billion and may almost triple again to $27 billion by 2030.
Singapore is also facing a surge in cancer diagnoses. According to Singapore Cancer Registry’s 2020 report, 16.3% of cancer diagnoses were among individuals 70 and older between 1968 to 1972. From 2016 to 2022, that number had risen sharply to 38.2%. The median age at diagnosis has also increased, from 58.7 years to 66 years over the same periods.
As a result, cancer drug spending has more than doubled from $110 million to $275 million between 2017 and 2021; three times the rate of non-cancer drugs. If left unchecked, by 2030, Singapore is projected to spend about $2 billion on cancer treatments – a whopping seven times its expenditure in 2017!
The shifting focus to primary care services in Singapore
Healthier SG is an initiative that is expected to manage healthcare costs in the face of the rising incidence of chronic diseases.
Established with the objective of shifting the healthcare delivery strategy from that of reactive curative care to preventive care, Healthier SG will enable the government to decentralise healthcare from government polyclinics to private general practitioners (GPs) while empowering patients to care for their own health.
Healthier SG enables more individuals to access and establish a long-term relationship with a qualified GP, who will be able to provide more customised healthcare plans or treatments based on the individual’s medical history and health conditions.
“The Healthier SG reform highlights the crucial role of GPs in delivering life-course and whole-person preventive care to the public. Channelling patients, particularly the elderly from government polyclinics to private GPs will help reduce the waiting time for clinic consultation at the polyclinics and enable senior citizens to access treatments more easily. Government subsidies also enable seniors to receive up to 90% waivers on the overall consultation charges,” explains Dr Benedick Lau, General Practitioner, Martin Medical Centre.
While decentralising delivery of healthcare to patients, Healthier SG consolidates health and medical records such as screenings and lab test results from public health institutions such as polyclinics and public restructured hospitals through the HealthHub app, which can be accessed with SingPass.
Through HealthHub, patients can not only access health records for themselves but also their loved ones and perform transactions across public healthcare clusters such as appointments, bill payments and replenishing of medication.
The impact of telemedicine and Healthier SG on how GPs practice
The COVID-19 pandemic has led to the explosion and accelerated uptake of private telemedicine platforms by GPs and patients.
"Telemedicine and Healthier SG have led to the rise of two types of GPs - the dedicated family physicians, and GPs who prioritise quick consultations over comprehensive care," says Dr Alexander Wong, General Practitioner, and Contract Resident Physician at the Ling Kwang Home for Senior Citizens.
"A patient who is genuinely seeking medical advice would be more prepared to wait for their appointment to receive a complete examination and the necessary care. By contrast, if a patient’s desire is to excuse himself for work or school at short notice, he would visit a physician who is prepared to provide a quick consultation and issue a Medical Certificate (MC). Ultimately, it is the patients who select the type of physicians that they prefer."
He adds, “Either way, telemedicine and Healthier SG have in their own ways made GPs more accessible to the general public than before the pandemic. Healthier SG can also potentially encourage people to see their GPs when their conditions are still manageable, rather than wait for them to worsen to the point where they would need to see a specialist. In the long run, this would lower healthcare costs while simultaneously improving patient outcomes."
The pain of ageing
Healthier SG has also shed a spotlight on other chronic conditions such as pain, which is expected to increase in incidence in a rapidly ageing population.
“Most visits to the GP are due to pain. Pain prevalence increases with increasing age among older adults," says Dr James Lee, General Practitioner and Medical Director of DR + Medical Paincare Clinic (Kovan). DR+ Medical & Paincare clinics are GP clinics that offer primary healthcare services with a focus on pain care. GPs practicing at these clinics undergo rigorous training and continuous education on pain management, family medicine, nursing, and clinical service standards by the Singapore Paincare Academy.
Chronic pain is often associated with worse health due to greater functional impairment, disability, depression, dementia, impaired sleep, and social isolation. The increasing prevalence of obesity among the elderly has also contributed to the rise in chronic pain during their golden years. From 2017 to 2020, increases in obesity prevalence were observed across all age groups in Singapore, most notably among older adults aged 50-74 years.
"Accumulating evidence strongly suggests pain and obesity are significantly related to each other. We are increasingly seeing more patients presenting with pain due to their body weight, some of whom are only in their 40s. Many elderly are suffering from osteoarthritis in the knee due to their excess body weight," says Dr Lee.
"The focus of Healthier SG has mostly been on chronic disease management, especially dyslipidaemia, diabetes, and high blood cholesterol. There is some funding through Healthier SG for the management of more recognised pain conditions such as osteoarthritis of the knee, for example, which has enabled physicians to better manage the condition. But we hope that in the future, more pain conditions will be recognised and more funding directed to their treatment," adds Dr Wong.