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S'pore's next challenge: A pandemic of chronic illnesses like diabetes

When the pandemic is over, Singapore's most important national healthcare agenda will be a major shift away from hospital-centric care and toward a more patient-centered preventive model, according to Health Minister Ong Ye Kung.

Singapore is the world leader in diabetes-induced kidney failure, with approximately 5.7 new cases diagnosed each day. There are currently over 8,500 dialysis patients here.

Dubbed Healthier SG and announced last month during the Ministry of Health's (MOH) budget debate, the initiative aims to get general practitioners, family physicians and the community to play a larger role in spotting diseases earlier and keeping people out of hospital as much as possible.

This focus is necessary because after Covid-19 has passed, Singapore needs to tackle a far more challenging pandemic of longer-term, chronic illnesses - of which diabetes is a significant one, said Mr Ong.

He was speaking at the official opening of a National Kidney Foundation (NKF) dialysis centre at Yishun Community Hospital (YCH) - the first to be located within a hospital compound.

Mr Ong began his statement by commending NKF for saving lives every day throughout the epidemic, noting that despite a major relaxing of Covid-19 measures since March 29, the number of infections has been reducing - from more than 13,000 in March to roughly 4,000 in recent days.

"So far, my prediction has been wrong, because I expected that once we ease up, cases will have an uptick but it continues to go down," he added. "So I'm very glad to say that I was wrong. But we still have to watch next week."

He emphasized that for illnesses such as diabetes, where individual dietary habits and preferences are involved, a movement mobilizing 2,000 trustworthy GPs could be more effective in changing mindsets.

In a private setting, where the doctor advises the patient and says, "These are your readings, you need to do something about it for your family, for your children, for your parents, for your loved ones," and after the patient sees the doctor several times, "then there may be enough trust" for the person to change his mind, according to Mr Ong.

MOH will begin encouraging residents aged 40 and up to enroll in a national program to commit to visiting one GP of their choosing in the middle of next year, he added.

Much of the GPs' advise would be lifestyle-based, including recommendations that would necessitate community support, such as brisk walking or other forms of exercise.

Mr Ong suggested that the government consider "positive nudges" to encourage the patient along, citing potential incentives such as decreased healthcare insurance rates and vouchers for eating well.

A complete plan for Healthier SG will be issued in the fourth quarter of this year in the form of a White Paper, and the strategy will be thoroughly debated in Parliament, he added.

According to NKF chairman Arthur Lang, the foundation's larger objective - to prevent or delay kidney failure, especially by collaborating with GPs to focus on early intervention - is very much linked with the Healthier SG agenda.

NKF's long-term goal is to close all dialysis centers within the next two decades, he says.

There are 40 such centres islandwide, including the one officially launched on Sunday at YCH, though it started operations in December 2020. It was established with the help of a $2 million donation from the philanthropic arm of Singapore conglomerate Keppel Corporation.

In contrast to YCH's emphasis on recovery, the dialysis center is located to Khoo Teck Puat Hospital (KTPH), an acute hospital for short-term treatments and procedures.

"This enables patients to be transferred in a fast and smooth manner," Mr Lang explained. "Patients are not required to travel to different dialysis centers. Patients who have been discharged from KTPH can come to YCH for dialysis... Patients will benefit from seamless continuity of care provided by interconnected networks of healthcare teams, information flow, and therapeutic care plans."

NKF's YCH centre is also the first to offer peritoneal dialysis, a typically home-based treatment where a cleansing fluid is introduced into the abdomen through a tube. The centre also conducts training, troubleshooting and counselling for patients, among other services.

NKF's other centres concentrate on haemodialysis, which involves inserting two needles - one to remove blood and the other to return cleansed blood to the body - during treatment sessions that take place thrice a week for about four hours each time.


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