Fail to understand burden of diseases, fail to understand healthcare reform (Part 1)

March 27, 2012
Singapore Democrats

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Ansari Abudeen



Following the launch of
The SDP National Healthcare Plan, many questions have been raised about the healthcare system in Singapore. I would like to discuss this subject by way of analysing the SDP’s plan.

This, however, cannot be done without a firm understanding of the burden of diseases. I will, therefore, begin the discussion with this first of a three-part series of articles by focusing on why managing and reducing the burden of diseases should be the purpose of government expenditure on healthcare.

While there is a larger than expected positive expression of support for the SDP’s plan, I had anticipated a much healthier debate from the traditional sceptics and cynics.

What is evident in their argument is the little understanding that they have about the purpose of government healthcare expenditure, which is to help the country to not only manage but also reduce the burden of disease in the population.

There were a few arguing that SDP’s plan must be rejected on the basis that the plan will lead to long waiting lines even though they have not provided any evidence to back up their claim.

The purpose of government spending on healthcare system should not just be about avoiding long waiting lists, which is just a single component of the burden that diseases can impose on a country.

Diseases impose various types of burden on a population. In order to properly understand them, they need to be measured using a variety of indicators.

The first, and main, indicator is the epidemiological burden which can be understood in terms of mortality (deaths) and morbidity. Morbidity can be defined as ill health in an individual and to levels of ill health in a population or group. This can be quantified in terms of how many people fall ill, by what condition and for how long.

Another indcator is loss of resources. This will be covered in the next part of this series.

Unfortunately, little effort has been spent to gather evidence on these indicators in Singapore.

Any new healthcare plan that is proposed needs to answer these questions: First, how many more lives can it save? This is obviously difficult to answer as public data is not yet available. Nevertheless, between a universal healthcare system and one that is not, the former has a greater chance of saving lives, provided it gives priority to evidence-based policies.

This is one of the reasons, along with the wide-ranging benefits, that inspired member states of the World Health Organisation (WHO) to adopt a resolution in 2005 that encourage countries to develop health financing systems aimed at providing universal coverage.

Incidentally, one of the objectives of universal healthcare, which is what SDP is proposing, is timeliness in access to care. Evidence suggests that healthcare systems that are universal and responsive do not lead to long waiting times for patients seeking treatment.

Second, how can morbidity in the patient population be better managed? In other words, how can the well-being, care provision and risks of deterioration of the health status of a patient population be improved even if the condition and the duration of the illnesses do not change? There are many proposals in the SDP’s plan to suggest that morbidity in the patient-population will be better managed.

Third, how can the morbidity level in a patient-population be reduced? In other words, how can the proposed healthcare system reduce the expected or current number of patients falling ill and/or the duration for which they typically fall ill? Though the details in SDP’s plan in this area is limited, there are a few indications that this is achievable in the SDP’s healthcare model. Fundamentally it is a patient-centric model rather than a bureaucrat-centric model and it has given some policy strategies such as giving importance to preventative medicine, improved screening programs, etc. which suggest a strategy to reduce morbidity levels.

The SDP model also gives priority to evidence-based prevention strategies instead of prevention strategies that are not proven but easy to implement.

Indeed SDP’s healthcare plan shows promise of better management and reduction of burdens that diseases impose on Singapore society.

When SDP was compiling this report, I did not get to see it until the day they made it available to the public. It has received the attention it deserves. It is a plan that charts a new direction for healthcare in Singapore, one that is benchmarked and consistent with the best in the Organisation for Economic and Co-operation and Development (OECD) healthcare systems.

This healthcare plan is also more consistent with the policy guidelines of the WHO than the current set of healthcare policies.

It has certainly achieved history by pushing dialogue and debate on healthcare in this country.

However, no healthcare plan guarantees slaying the dragon of disease burden – the SDP does not pretend that its plan will. But to slay that dragon requires, first and foremost, a plan that shows promise.

No political party holds any magical solution or monopoly of solutions. It is, therefore, important that there be a competition of ideas and debate as this will lead to pertinent areas being brought to the public’s attention that would otherwise remain hidden, and their solutions proposed.

Other players such as the public, researchers, healthcare providers, etc have as much a role to play as politicians in formulating healthcare policies due to the complex nature of healthcare today.

At every level, we must ask the central question: How do we manage and reduce the burden of diseases in the population?

Ansari Abudeen is a Singaporean working as a health economist in the National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales. He is also a PhD candidate. In 2011, one of his research projects won a national award for research excellence. Ansari has also provided consultancy on evaluating cost effectiveness of communtiy pharmacy service provisions and economic value of asthma research. Currently, he is providing consultancy to a state ministry of health, Indigenous community organisations and service providers in Australia on implementing frameworks to monitor and evaluate health outcomes.