新加坡卫生部长王乙康国会发言：新加坡评为世界上最佳的医疗系统
2024年3月6日，新加坡卫生部长王乙康在国会发言，“健康SG”计划在实施中，越来越多人已经加入。通过建立健康SG计划，要实现医疗的三大目标。
以下内容为新加坡眼根据国会英文资料翻译整理：主席先生，陈有明医生强调，医疗需要跨越时间和空间进行，我们同意这一观点。事实上，这是我们正在努力实现的转型的一个关键方向。有疾病需要在诊所和医院进行治疗，但医疗需要在社区和家中建立起来。卫生部一直在推动这一转型，过去几年我们已经进行了一些战略性的政策调整。
患者数据需要在医疗系统中流动，从医院到诊所，再到老年护理和康复中心。这项工作几乎已经完成，尚待完成的是一项新法律，我希望能在今年晚些时候提交到这个议会。监管需要从以医疗场所为中心转变为以服务为中心，因此，我们不再对医院或诊所进行监管，而是对提供的服务进行监管，无论其环境如何。因此我们修改了法律，颁布新的《医疗服务法案》（Healthcare Services Act ）。
财政支持必须是中立的。但我们不能简单地基于这个原则去规划，因为这很可能导致滥用和意外行为。相反，我们逐步识中立性应该适用的情况和环境，然后进行调整。去年，我们对保健基金计划的相互承认和通过远程医疗延伸保健储蓄支持以管理慢性疾病做出了一些改变。今年，我刚刚宣布了进一步的措施，包括社区医院、居家病房和远程医疗的保健储蓄支援。
最重要的是，在预防保健和保障人口健康方面，我们需要做出果断和审慎的投资。我们经常听到要增加医院能力和医疗人力资源的呼声。这是合理的。但更重要的是从长远来看，社区和社会的能力扩展，以预防疾病并建立健康。我们通过“健康SG”计划正在做到这一点。我们开始看到变化，更多的居民开始参加锻炼、骑自行车、跑步或快走，大家正在关注糖摄入量。
钠的改变需要更长一段时间。食品饮料（F&B）从业者正在改用低钠盐。克里斯汀·洛克（Christine Lock）在武吉坎贝拉小贩中心是第一个这样做的人，她卖的是咖喱饭。她是自愿这样做的，因为她的爱人曾经患过心脏病。她说：“我想照顾好我的顾客。”
梁智强导演在疫情期间发起了一个为老年人举办的快步走团体，名为“趴趴走”。这个名字的英文意思是为了乐趣四处走走。这个活动每周举行一次，吸引了近1000名来自新加坡各地的参与者，包括年轻人和老年人。如果他们聚集在社区的某个地方，你会立即注意到。对于他们来说，快步走已经成为了一种新习惯，而且还可以结识新朋友。导演和他的团队甚至为“趴趴走”创作了一首歌，并将更健康的新加坡的信息融入其中。他们没有征求我的意见。所以，两周前我加入了他们，每个人都唱了那首歌。除了我，每个人都知道这首歌。
我也想分享一下 Cynthia Phua女士的故事。许多议员都认识她，她曾是一名前国会议员。她同意我今天与大家分享她的故事。去年底，她加入了健康SG计划，选择了一个离家近的家庭医疗诊所。这位医生注意到她已经三年没有做乳腺X光检查了，并提醒她去做检查。最后，她在去年底做了乳腺X光检查，发现自己可能患有乳腺癌，后来通过活检确诊了。幸运的是发现得很早，她后来接受了手术切除肿瘤，而且她的身体中没有发现新的肿瘤。
Cynthia Phua女士现在正在休养并接受治疗。她精神状态良好，我们祝愿她一切顺利。她想让我告诉大家：请参与社区推动的健康SG计划。她坚持不懈的呼吁大家参加，因为这可以改变生活，也可以挽救生命。
英国乐格塔姆研究对世界上的医疗系统进行了全面的排名。他们不仅考虑到医生与人口比例或医疗保健能力，或者使用的先进设备的种类，而且还评估人口健康和预防保健系统。他们在2023年将新加坡评为世界上最佳的医疗系统，这个评选结果非常宝贵，它鼓励我们做得更好。
据说在医疗领域存在一个不可打破的铁三角。医疗的三大目标是：医疗准入、成本控制和医疗质量。它们之间相互权衡的，其中一方面的改善总是以牺牲其他两个方面为代价的。
我已经概述了通过使用“居家病房“和正确安置的方法，我们可以增加病床的容量，而不一定需要建造更多的医院床位。换句话说，在不影响医疗质量的前提下，降低医疗准入门槛。通过将保险和自付相结合，我们降低了患者的医疗成本，同时抑制了对医疗的过度需求。因此，在不影响医疗准入的情况下，提高了负担能力。更重要的是，通过建立健康SG计划，我们同时实现了这三个目标，使人们能够过上更长、更健康和更有意义的生活。
健康SG计划不是一个政府计划或融资方案。它是一个针对新加坡人的运动，一种新的生活方式，国民、社区和政府之间的新协议。我们还没有打破铁三角，去往医疗健康更简单的道路。但我们已经取得了良好的开端，并开辟了自己的道路，为我们自己、我们的家庭和我们的国家实现更大的幸福和可能的繁荣。
以下是英文质询内容：
Mr Chairman, Dr Tan Wu Meng urged that healthcare needs to be delivered across time and space, which we agree. This is, in fact, a key aspect of the transformation we are striving for. Whereas sickness often needs to be treated in clinics and hospitals, health almost exclusively has to be built up in communities and in our homes. MOH has been working on this transformation and we have made a few strategic policy changes over the last couple of years.
Patient data needs to flow across care delivering settings, from hospitals to clinics, to senior care and rehabilitation centres. This piece of work is almost done. What remains is a new law, which I hope to table in this House in the later part of this year. Regulation needs to move from being premises centric to services centric. So, we do not regulate hospitals or clinics, but the services delivered, regardless of settings. That is why we revamped our legislation to enact the new Healthcare Services Act (HCSA).
Financial support needs to be settings and premises neutral. But we cannot simply apply this based on first principles, as it is bound to lead to abuse and unintended behaviour. Instead, we progressively identify the situations and circumstances where premises-neutrality should apply, and then make deliberate rule changes. We made a few changes last year on the mutual recognition of MediFund and extension of MediSave support to manage chronic illnesses via telehealth. This year, I just announced further moves on community hospitals, MIC@Home and MediSave support for telehealth.
Most importantly, we need to be decisive and deliberate in making investments in preventive care and health of our population. We often hear calls for investment in hospital capacity, in our medical manpower. This is valid. But what is more important for the long term is capacity expansion in communities and society, in its ability to prevent sickness and build health. We are doing so via Healthier SG, and we are starting to see a change. More residents are coming forward to exercise, cycle, run or brisk walk. People are watching their sugar intake.
Sodium takes a while more. Food and beverage (F&B) players are switching to lower-sodium salt. Christine Lock, who sells Nasi Lemak, she was the first to do so at Bukit Canberra Hawker Centre. She did so voluntarily, because she had a loved one who suffered a heart attack. She said, “I want to take care of my customers.”
Film Director Jack Neo has started a brisk walking group for seniors, started during the pandemic. It is called “趴趴走”. In English, it means walking around for fun. His event is every week, and it will attract almost 1,000 participants, young and old, from all over Singapore. If they descend on one of your communities, you will immediately notice. A thousand people gathering somewhere. For them, brisk walking has become a new habit, and they made new friends. Jack and his team even composed a song about “趴趴走” and incorporated messages of Healthier SG. They did not consult me. So, when I joined them two weeks ago, everyone sang the song. Everyone knew the song except me.
Let me also share the story of Ms Cynthia Phua. Many Members will know her, she was a former Member of Parliament. She agreed to let me share her story with you today. She enrolled into Healthier SG late last year, with a GP clinic near her home. The GP noticed that she had not done a mammogram for three years. So, repeatedly reminded her to do. Eventually she did, late last year. That was when Cynthia found out that she might have breast cancer, and it was later confirmed through a biopsy. Fortunately, it was discovered early. She has since gone through an operation to remove the tumour, and no further tumors were discovered in her body.
