Archive for March 12, 2013
血清素被喻為快樂荷爾蒙，適量的血清素，會讓人較易獲得滿足感，同時降低食慾並改善睡眠。其實血清素是一種大腦神經傳遞物質，與情緒調節有關，血清素功能不足、分泌量不夠或作用不良會造成憂鬱症。一項來自卡迪夫大學（Cardiff University）的研究顯示，經常在早餐時食用麥片，有助於降低唾液皮質醇（壓力荷爾蒙）。這很有可能是麥片內的碳水化合物促進了血清素的分泌，繼而鎮定大腦。本地飲食治療師阿琳娜（Alina Azhar）披露，除了碳水化合物，蛋白質、維生素B及Omega-3脂肪酸也有助於打造好情緒。
A patient rests on a hospital bed
SINGAPORE: Singapore’s Health Minister Gan Kim Yong said the review of the country’s healthcare financing system will be extensive, involve fundamental shifts, and will take more than a year to complete.
Speaking in Parliament during the Health Ministry’s Budget debate on Tuesday, he said while managing costs and ensuring that Singapore is effective in the way it delivers care, there is also the need to enable patients to pay for their portion of the cost.
Thus, the first major shift is to increase the government’s share of national spending — so as to provide Singaporeans with greater assurance that care will remain affordable and accessible.
The government will take on a greater share of national spending, from the current one-third to about 40 per cent and possibly even further, depending on various factors such as demographics, and the ability to manage healthcare costs and target the subsidies, Mr Gan said.
He believes this will help to reduce the impact of rising healthcare costs on Singaporeans, especially for those in the lower- and middle-income bracket.
During the review, the ministry will explore how it can provide more financial support in a targeted way for specialist outpatient care, primary care, preventive healthcare, dialysis and long-term care, so as to reduce the share that patients have to pay.
Mr Gan said: “How we spend the additional money is crucial. Today, the bulk of our subsidies go towards hospitals, where the cost per episode is high. As our population ages, delivery of healthcare will increasingly extend beyond hospitals.”
The second major shift is on Medisave. Mr Gan said the ministry has been expanding Medisave use progressively since 2006, so as to include outpatient treatments for chronic diseases, as well as selected vaccinations and medical screenings.
Now Singaporeans can use up to S$400 per Medisave account to pay for these treatments each year.
“Medisave has been sized primarily to pay for subsidised care in the inpatient setting. As we grow old, we are more likely to require hospitalisation, and each hospital stay is longer,” said Mr Gan.
“If we allow unrestricted use of Medisave, many of our elderly may not have sufficient Medisave for their needs in the future. However, we do exercise flexibility for cases with exceptional circumstances,” he added.
Mr Gan is confident that if the government calibrates carefully and puts in place some safeguards, a greater flexibility can be allowed in the use of Medisave to reduce out-of-pocket costs without jeopardising the future.
So the ministry will review Medisave policies to see how to have greater flexibility in its use.
Mr Gan said: “We raised the cap on the use of Medisave for chronic diseases from S$300 to S$400 last year. Can we raise it further? Should we expand the Chronic Disease Management Programme (CDMP) to include more diseases? Should we allow Medisave to be used for outpatient treatments beyond the CDMP?
“How do we prioritise the different needs, to ensure that Medisave will not be depleted? How do we ensure that providers focus on necessary and cost-effective treatments, so that each Medisave dollar is well spent? These are issues that need to be addressed in the review.”
Mr Gan said the third shift is on the role of insurance. He explained that to stretch the health dollar and to give Singaporeans greater peace of mind, there is a need to enhance the role of insurance schemes like MediShield and ElderShield.
But there is a need to do this carefully to guard against over-servicing and over-consumption, both of which will lead to rising costs and higher premiums for all.
So the ministry will study how it can shift the balance towards greater insurance coverage, without driving up demand and consumption, and allow insurance to carry a larger share of healthcare funding.
Mr Gan said: “MediShield is designed to be a catastrophic insurance primarily for larger inpatient bills. As we review how we can strengthen insurance coverage, we will also examine whether it should remain so, or if we can expand it so that it can offset a higher proportion of costs while keeping premiums affordable.
“We will also have to address Singaporeans’ concerns about exceptionally large bills that go beyond the current cap on MediShield claims.”
He stressed that the subsidy and 3M framework — involving Medisave, MediShield and Medifund — has served the people well so far. But there is a need to further strengthen this as the healthcare needs of the population evolve over time.
Mr Gan said the major review of the health financing framework, which was initiated in 2012, will take some time.
However, a few immediate changes to keep healthcare affordable will be made. Mr Gan said the Ministry of Finance will be topping up the Medifund capital sum by S$1 billion.
This will increase the annual Medifund assistance by at least 20 per cent to S$120 million, to help more needy patients with their healthcare bills.
Mr Gan said: “From April 1, 2013, we will extend Medifund assistance to patients at the National Dental Centre. In addition, Singaporean mothers who face difficulty paying for their antenatal care and delivery can also be assisted by Medifund.
“By June 2013, we will also extend Medifund to the polyclinics, including dental services there. This will provide some relief for needy patients with recurring bills for their chronic conditions.”
From April 1, the ministry will add 17 new drugs onto the Standard Drug List and the Medication Assistance Fund. These drugs include second generation insulin products and insulin penfills to help lower the cost for diabetic patients. This is expected to cost the government S$5 million a year.
The Health Ministry said it will also absorb the fee of about S$3 that is charged to institutions for each Medisave claim that patients make.
Healthcare costs a concern among Singaporeans: MOH
The Health Ministry held two sessions of the “Our Singapore Conversation”, engaging many Singaporeans — including patients — to hear their views. From this, four main concerns emerged.
Firstly, Singaporeans are concerned over rising healthcare costs, said Mr Gan.
Currently, the country spends about four per cent of the GDP on healthcare — around US$1,700 per person — which is similar to what Hong Kong spends. Over time, Singaporeans can expect national healthcare spending to continue to rise as the country’s population ages.
“So what drives healthcare costs? First, cost of the same treatment goes up over time, due to rising cost of manpower, supplies, and so on. This is the usual inflation,” said Mr Gan.
“Next, as we age and our health deteriorates, we will spend more on healthcare. On average, annual expenditure on hospitalisation, after subsidy, for a 65-year-old is three times that of a 45-year-old.
“The third reason — and a key one — is that healthcare is getting significantly better and more accessible. We have adopted more advanced medical treatments and technologies that achieve better outcomes for patients, and these have become more common over time.”
The second concern of Singaporeans is how much out-of-pocket cash they have to pay. Thirdly, the concern of incurring exceptionally large healthcare bills.
Thus, Mr Gan said the ministry will carefully explore how it can provide Singaporeans with greater assurance against very large out-of-pocket payments.
The fourth feedback received was that many Singaporeans have said that while there are many help schemes, they do not know how to get the help they need.
Mr Gan said that the starting point is for every Singaporean to take ownership of his health, to live healthily, seek treatment early, and make informed choices in seeking treatment. For this reason, it is important to preserve the principle of co-payment, but at the same time ensuring that it remains affordable.
Government to ramp up infrastructure on healthcare
By 2020, there will be 4,100 more acute and community hospital beds, 400 more than what was announced in 2012.
Beyond 2020, the ministry is also planning to build four new acute hospitals in areas where demand is likely to grow.
Mr Gan said: “We are currently studying regional demographic profiles to identify the likely locations of these new hospitals, and we will reveal our infrastructure plans closer to 2020.”
There are currently seven public acute hospitals in Singapore. They include Singapore General Hospital, Tan Tock Seng Hospital and KK Women’s & Children’s Hospital.
In the short-term, two new facilities will open this year. One of them is the new Medical Centre at the National University Hospital (NUH), which will open by July 2013.
Mr Gan said this will allow NUH to expand its specialist outpatient clinics and day surgery operating theatres. The building will also house the National University Cancer Institute.
The other new facility is the National Heart Centre, which will allow for expansion in cardiac services.
In the medium-term, several hospitals will start operations. The Ng Teng Fong General Hospital will begin to serve patients from end-2014, while community hospitals in areas like Jurong and Sengkang will also be ready between 2015 and 2020.
Mr Gan also announced plans for new polyclinics. By 2017, polyclinics will be opened in two new towns — Jurong West and Punggol.
He added that there will be four new polyclinics by 2020, and another six to eight more by 2030.
To provide more patients with convenient access to support services, the government will set up three more Community Health Centres this year. They will be located in Bedok, Jurong East and Tiong Bahru.
As for the healthcare workforce, the ministry is increasing the training capacity of health institutions with a S$50 million boost this year.
It has also launched a new branding campaign for nursing and allied health jobs.
Mr Gan said: “In the past year, our healthcare professional workforce grew by 3,700, or about eight per cent. We are on track to growing our professional workforce to meet the healthcare needs of our population, as outlined in Healthcare 2020. Our priority continues to be to grow our local healthcare manpower supply.”
He added that the workforce will also be supplemented with training by overseas professionals.
A nursing home in Singapore (file photo)
SINGAPORE: An enhanced set of nursing home licensing standards will be introduced by 2015.
Speaking in Parliament on Tuesday, Minister of State for Health Dr Amy Khor said an industry-led committee will be reviewing standards and identifying areas that can be enhanced.
There will be more specific standards set in various aspects of clinical care — such as oral hygiene, continence management and falls prevention. The social aspects of nursing home care will also be looked into. These include respecting residents’ dignity and caring for their emotional well-being.
The committee will also add new standards on organisational excellence, covering areas of human resource and financial management.
The Health Ministry is also engaging Singaporeans to remake nursing homes. The ministry is tapping on architects’ creativity to build nursing homes that are not just clinical care facilities, but modern homes for seniors to recuperate.
For new nursing homes, the government is planning to design them to be aesthetically pleasing, yet functional.
Dr Khor said: “An example is the future nursing home in Jurong East. Instead of a squarish residential block, the architect ‘breaks up’ the mass to create a more interesting form.
“Green balconies are injected in between the towers, making the whole development more visually pleasing to the surrounding community. This will not look out of place within a residential area.”
“Beyond the hardware, we are evolving our nursing homes to be eldercare hubs that can benefit a wider community of seniors and their caregivers. Where space allows, we will expand their suite of services beyond nursing home care to include day care and other services for caregivers.”
However, Dr Khor acknowledged that some seniors prefer to be cared for outside of the nursing home. Thus, the Health Ministry will step up its efforts to develop home-care services to support caregivers.
It will be convening an industry-led committee to review and chart new standards and strategies for home care development.
The committee will recommend a common system to assess the care needs of home care patients, set common standards for home care and identify new home care services that can be developed.
The government also recognises that looking after a family member can be stressful and tiring. Thus, the Health Ministry is working to make respite services more accessible and affordable, said Dr Khor.
The ministry is starting a pilot project, by working with a few nursing homes to set aside some beds for caregivers who need temporary reprieve.
Dr Khor also revealed that the Senior’s Mobility and Enabling Fund, which was announced in Budget 2013, supports seniors who want to live independently in the community.
The application process for subsidies under the fund will be simplified. Any senior living in a three-room flat or smaller will automatically qualify for a 90 per cent subsidy for devices that cost less than S$350.
Dr Khor said: “We will expand subsidies beyond mobility devices to cover other assistive devices. Seniors can receive subsidies for more items such as motorised wheelchairs, commodes, geriatric chairs and pressure-relief mattresses. The fund will also cover spectacles and hearing aids.”
The enhanced fund can also be used to subsidise transport costs for more seniors who are community-ambulant.
Activists fault WHO report on Fukushima radiation
Activist physicians on Monday accused the World Health Organization of downplaying the health impact of nuclear fallout from the Fukushima nuclear disaster.
In a New York symposium marking the two-year anniversary of the Fukushima nuclear plant meltdown in Japan, the physicians took issue with WHO’s conclusion in a recent report that it did not expect a significant surge in cancer in Japan or elsewhere due to radiation leaks.
“It’s a report that was meant to reassure people who, almost certainly, many will develop leukemia and cancer,” said Helen Caldicott, a prominent anti-nuclear activist whose foundation, the Helen Caldicott Foundation, co-sponsored the symposium, along with Physicians for Social Responsibility.
“What is going to happen is there will be a high incidence of cancer and leukemia and genetic disease,” due to the leaks, she said.
The WHO report drew criticism from Japanese government officials because it projected an increase in some cancers among those living near the plant.
Japanese officials said the report was based on faulty assumptions and would unnecessarily upset residents.
But Caldicott said the report, released Feb 28, understated the problem because of key issues it either “ignored” or “glossed over.”
For one, she said, WHO did not take actual radioactive emissions into account, relying on estimates.
The UN health body also did not examine the effects on children comprehensively, including what the impact would be of eating radiation-contaminated food over a lifetime.
The agency also did not closely examine the impact on workers at the Fukushima plant or on people from the area who evacuated through the plume of radiation that came from the plant, she said.
“As a physician, I abhor what they’ve done,” Caldicott said.
The two-day conference at the New York Academy of Medicine marked the anniversary of the 9.0-magnitude subsea earthquake and tsunami which rocked Japan on March 11, 2011, leaving nearly 15,881 people dead and 2,668 others still unaccounted for.
The quake and tsunami deeply damaged the cooling systems of the Fukushima nuclear plant, causing partial meltdowns in several units and spilling radioctive particles into the air and sea nearby.
Monday’s symposium featured presentations from biologists, epidemiologists and other scientists on the health effects of nuclear accidents.
Caldicott cited one survey done by a Fukushima medical organization that showed 42% of 100,000 children sustained thyroid abnormalities, such as a cyst or a nodule. The survey showed three children with thyroid cancer and seven additional cases of suspected cancer.
She said data showed that three times as much radioactive xenon, and possibly three times as much cesium, escaped at Fukushima as at Chernobyl, the nuclear plant in the Ukraine that released huge amounts of radioactive particles into the atmosphere after an explosion and fire in 1986.
The WHO report did conclude that the cancer risk was higher for certain groups of local people in Fukushima.
That includes a projected 7% increase in leukemia among males exposed as infants, over what would have normally been, and a 6% higher occurrence of breast cancer among women exposed as infants.
The occurrence of thyroid cancer in females over a lifetime could rise by as much as 70% over the normal rate.
But for the general population inside and outside of Japan, the WHO said, “the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.”
Steven Starr, a program director at the University of Missouri, presented data from Chernobyl that showed, 14 years later, that 40 percent of high school graduates suffered chronic blood disorders and malfunctioning thyroids.
Starr predicted similar problems in Fukushima.
Maurice Enis and Jaime Plym, two U.S. Navy quartermasters, told the symposium that they experienced the effects of radiation poisoning after servingon a search and rescue mission near Fukushima after the disaster.
Enis complained of loss of energy, hair loss and the appearance of some lumps on his body.
Plym said her menstrual cycle has been thrown off due to exposure to radioactive materials. They said troops were kept in the dark about the severity of the nuclear incident at Fukushima.
The two have joined a lawsuit with 115 current and former U.S. military personnel against the nuclear plant’s owner, Tokyo Electric Power Company, that alleges TEPCO misrepresented the depth of problems at the plant.