Historians will record 2020 as the year Singapore healthcare truly came of age.

For too long, especially in the early years of Singapore’s nation-building, healthcare was deemed as a form of consumption, a necessary draw on the country’s fiscal resources.

With the Government’s push for biomedical research and innovation two decades ago, green shoots started to emerge that health was also an investment.

In 2020, these shoots grew into mighty trees, holding up the hopes for economic recovery and a return to some semblance of normalcy.

Singapore’s biggest crisis saw 3,000 additional staff deployed in healthcare operations and 18,000 temporary healthcare beds mobilised at short notice.

Additionally, 23,000 beds were added to the pipeline.

Our nation’s researchers, working tirelessly to identify insights to support the battle against the virus, published 42 papers in Lancet and the New England Journal of Medicine, two top medical journals.

This was a more than four-fold increase compared to 10 in 2019.

Beyond Covid-19 patients, the health system also pivoted, embracing tele-consultations. One primary care group reported an almost 50-fold increase in virtual consultations in the first 10 weeks of the outbreak.

Credit to regulators and funders which also reacted quickly, enabling appropriate rules and reimbursement to follow necessary clinical practice changes.

What will 2021 and beyond look like given these seminal forces that have so shaped the landscape?

The tea leaves are still settling but I would suggest that there are five fundamental and enduring paradigm shifts.

Firstly, health is well and truly existential and now in the same league as national defence and water.

Public health needs just have to be met.

“Lives or livelihoods” is a false dichotomy, especially in Singapore where trade and connectivity are our lifeblood.

Lives are livelihoods and livelihoods are lives.

If we cannot assure public health and safety, our economy is doomed. If our economy continues to sputter, we will not have the resources needed for successful public health control.

Secondly, Singapore will see increasing universalism in healthcare, with service coverage for all residents and all citizens included into national funding schemes.

Even before Covid-19, Singapore was on this path with MediShield Life and CareShield Life but the pandemic has accelerated expansion of the concept of universalism tremendously.

The World Health Organization exhorts national leaders that no country is safe until all countries are safe.

Mutations can emerge anywhere in the world and ravage an economy through no fault of the country or its leaders. Likewise, we as Singaporeans are all in this together.

Viruses do not discriminate and the scythe of economic carnage can cut through any sector.

Health needs to be protected and healthcare access assured, no matter one’s employment status or wallet thickness.

Thirdly, healthcare will have to look more like defence in terms of emergency mobilisation and surge capacity.

Singapore’s military has a substantial reserve of operationally ready NSMen, about six times the size of the full-time force which she can call upon in times of crisis.

As Covid-19 has shown, healthcare needs the same.

Moving forward, what should be our plan to raise, train and sustain a healthcare corps which can augment our doctors and nurses?

Do we need an ongoing national ability to open and staff in days additional thousands of hospital beds?

Fourthly, the hitherto dominant healthcare model of in-person consultations needs to be blended much more substantially with remote monitoring, virtual consultations and other innovative technology-enabled ways to deliver care to patients anywhere, anytime, at the lowest resource use possible and in the safest ways for both patients and providers. 

Perhaps these hybrid models would be an area Singapore the Smart Nation can aspire to lead the world in. 

Imagine a virtual consultation with a doctor, then a robot delivering a kit to your doorstep including a wearable monitoring device for your healthcare team to track your vital signs for the next 24 hours to ensure you remain well.

Finally, all these are going to cost money.

We have prided ourselves on spending much less on healthcare as a percentage of gross domestic product than other developed countries.

But with ageing, the explosion of chronic diseases, and the new imperatives forced by Covid-19 and future pandemics, we must be ready to spend what we need and whatever it takes. 

If taxes have to increase, if more of the national budget is channeled to healthcare and less to other sectors, then so be it. That’s what being existential is about.

I refer to not just dollars and cents but also human capital.

More of our best and brightest must come into healthcare, not just in patient care but also in system planning and policy formulation.

In 2021, let us recognise that the world has changed fundamentally and the health system needs to change fundamentally too. 

We need more universalism, surge capacity and to leverage technology much more. Singapore needs and deserves these changes.

ABOUT THE AUTHOR:

Associate Professor Jeremy Lim is director of global health at the National University of Singapore's Saw Swee Hock School of Public Health.