Sir, the WP MPs have raised points which cover the main prongs of the Healthier SG White Paper. These include concerns on capitation funding, manpower issues across the healthcare landscape and the future evolution of the family medicine ecosystem as envisaged, amongst others points.
The upcoming changes to the healthcare system underwritten by the White Paper are significant, and in the main, the Workers’ Party supports the strategic shift towards preventive healthcare – important aspects of which were pre-emptively raised by Workers’ Party MP Leon Perera in his Adjournment Motion on reviewing strategies towards preventive healthcare in February this year.
My contribution to this motion will be short, and it covers an important but sometimes understated stakeholder in the public healthcare ecosystem. And that stakeholder are the Traditional Chinese Medicine (TCM) practitioners and others who are practitioners of alternative or complementary medicine. In my speech today, I will make three suggestions to bridge TCM and complementary or alternative medicine as important community partners of a Healthier SG.
An overview of TCM in Singapore
In July this year, I asked the Minister for Health in a written parliamentary question how TCM practitioners would be integrated into the Ministry’s Healthier SG plans. Minister Ong replied and I quote “Traditional Chinese Medicine Practitioners (TCMPs) are important stakeholders, especially given their emphasis on holistic and long-term care. However, unlike western doctors, TCMPs are not tightly regulated by MOH, the standard of care delivery varies widely, and we will not be able to take the same approach as we have for western doctors.”
This reply is nonetheless not inconsistent with the Minister’s public comments in December 2021 where the Minister was quoted as recognising the benefits of TCM in fighting chronic diseases. In fact, successive Health Ministers have raised hopes of alternative approaches to healthcare like TCM which complement and integrate Western medicine.
Some almost 30 years ago in 1995, the Health Ministry accepted the recommendations of the Committee on Traditional Chinese Medicine, and moved to begin regulating TCM.
Globally, under the Beijing Declaration adopted by the World Health Organisation (WHO) in November 2008, traditional Chinese medicine was recognized as having an important role in the improvement of public health. Acupuncture has in fact been scientifically proven through trials recognized by the WHO, to be an effective treatment for more than 20 diseases and disorders.
Today, TCM practitioners in Singapore are governed by the Traditional Chinese Medicine Practitioners Act, and physicians are expected to abide by the Ethical Code and Ethical Guidelines for TCM practitioners issued by the TCM Practitioners Board – which also comes under the Ministry of Health. In 2019, new legislative changes were made to further professionalise the TCM industry.
These included the introduction of continuing professional education and raising the maximum fines on errant practitioners from $10,000 to $50,000. This hike in fines brought the TCM Practitioners Board’s disciplinary powers in line with those in the dental, pharmaceutical and allied healthcare boards.
Sir, TCM and other alternative treatments such as ayurveda and other alternative therapies have a long tradition of acceptance in various Asian cultures. Singapore is no different with non-Chinese Singaporeans resorting to TCM and alternative medicine as well. To this end, some TCM products have even been halal-certified.
In fact, as early as 2005, MOH allowed licensed hospitals and nursing homes to have full service TCM clinics – including acupuncture, tui-na and herbal medicine services to be co-located on their premises, on the condition that the TCM clinic was clearly distinct from conventional medical services. In 2018, an acupuncturist at Khoo Teck Puat Hospital was quoted as saying that around 40% of her patients who sought acupuncture were non-Chinese and under the age of 25.
The Government, for its part, has previously allocated $3m for the TCM Clinical Research Grant from the fiscal years 2013-2018 to support research into chronic diseases. A further $10m in research and development grants was also announced in 2017 as part of efforts to modernize the industry. Then Senior Minister for Health Mr Chee Hong Tat was quoted as saying, “after you come out of hospital, how do you help a person to get back, as quickly as possible, to good health…I think things like tui-na (therapeutic massage) actually play a very useful role.”
On 29 Dec 2020, in a significant move, the Ministry of Health announced that it was extending means-tested subsidies and Medisave coverage under a pilot arrangement to support acupuncture for lower back pain and neck pain at specialist outpatient clinics (SOCs) in public healthcare institutions. The pilot did not cover acupuncture used to treat other pain indications, and other forms of traditional, complementary and alternative medicine offered at public healthcare institutions. However, MOH stated that it would review the expansion of the pilot to other settings in the longer term, taking into account learnings and data from this pilot. Healthier SG may well provide the opportune platform and impetus to expand this pilot.
Suggestion 1: Extending use of Medisave to more procedures and allow TCM practitioners to offer them
To this end Sir, my first suggestion is for the Government to consider extending the use of Medisave for more TCM procedures and alternative therapies that have a proven role in the management of one’s general health and more pertinently, in the prevention of chronic diseases. This expansion should also see the inclusion of certified TCM practitioners who can be allowed to offer such approved procedures in their TCM clinics, outside public healthcare institutions. In order to prevent abuse, a fixed and audited list of procedures and caps to limit the fees that can be charged for such procedures ought to be considered. Additional subsidies can also be extended to Pioneer and Merdeka card holders for these procedures, many of whom resort to TCM as an important source of primary care.
Suggestion 2: Consider alternative and complementary medicine to lower costs
Secondly, the Ministry of Health should look into the costs of alternative medicine that substantively produce the same clinical outcomes as medicines and drugs disbursed by our public healthcare institutions.
For example, Fybogel, which is commonly dispensed for constipation can cost around $20 on the shelf, without subsidies, whereas Psyllium Husk which confers similar if not identical benefits and can be purchased from Little India and even NTUC supermarkets at under $3. In 2015, the then Head of the Traditional and Complementary Medicine Branch of the Primary and Community Care Division at Ministry of Health confirmed and I quote “that MOH constantly reviews the regulations and policies on TCM, taking into consideration the scientific advancements and rising standards of TCM.”
In similar vein and with a view to better manage costs, a review of commonly prescribed medicine which substantially produces the same clinical outcomes as complementary medicine should be undertaken on a longer-term basis. It would be useful to understand if the Ministry or a relevant body like the Health Sciences Authority (HSA) currently carries out such comparisons of clinical outcomes between Western and alternative medicine with a view to lower overall healthcare costs.
Separately, I suspect more than a few in this House would have encountered cervical episodes for which traction and other specific thoracic mobility stretches are commonly prescribed through physiotherapy. Similarly, TCM also advances traction and certain stretching and mobility exercises as rehabilitative procedures. In this light, would the Ministry consider whether there is scope for such rehabilitation or physiotherapy to be undertaken at TCM clinics by TCM practitioners?
Such rehabilitation is not usually just more affordable than physiotherapy sessions at many private and public healthcare facilities, but the convenience of having such options for Singaporeans within one’s neighbourhood and perhaps right under one’s block, can ensure that patients complete their rehabilitation and live healthier and more mobile lives.
Suggestion 3: Leverage on TCM practitioners to achieve a HealthierSG
Finally, Mr Speaker, late last year, a Straits Times article reported that the Government’s feedback channel REACH discovered that many seniors were reluctant to get their COVID-19 vaccines due to and I quote “advice from their doctors – mostly traditional Chinese medicine practitioners who were unsure of what advice to give.” unquote. In response to this, the Ministry of Health arranged to meet all TCM practitioners to explain why vaccination was critical.
Sir, while TCM and other alternative therapies have not been covered in any substantive detail in the White Paper, it is clear that TCM practitioners do not have a small footprint in the mindshare of Singaporeans when it comes to our health, particularly in the heartlands.
Like Healthier SG, prevention of long-term diseases is a core belief of TCM and complementary medicine. And this does not start in one’s senior years. Their treatment philosophy places an acute focus on prevention before a disease arises. They advance the view that one’s lifestyle is intimately related to health which can be improved through effective mental health management, rest, a good diet and interventions based on a person’s specific physical conditions, amongst others. By watching such indicators, one is well on his or her way to good health, regardless which economic strata of society one belongs to.
Indeed, the White Paper lists a number of community partners such as AIC, Sport Singapore, the People’s Association and the National Parks Board that will empower residents to chart their own journey towards healthy and active lives. In our journey to live more healthy lives, I would suggest that we should not underestimate the wide reach of the local sin-seh in our neighbourhoods.
MOH should tap on them to help share healthy living tips and preventive healthcare strategies, not just to our seniors. MOH should not rule out subsidizing TCM practitioners subject to their contributions towards the objective criteria under HealthierSG.
Such an approach would also be consistent with the aim of successive Ministers for Health who hoped to integrate Western medicine and TCM and alternative medicine as far as practicable, even as both branches of medicine operate in different cultural and professional milieus. While progress in this regard appears to be fitful so far, HeathierSG provides a new-found opportunity for TCM and alternative medicine to play a more active role in the primary care healthcare space.
In conclusion Sir, just like family doctors, many Singaporeans have been going to the same TCM practitioners for decades. For some, the reasons behind this may well be behavioural – peace of mind and more comfort dealing with a TCM practitioner. The Government is on record to say that TCM practitioners are an important stakeholder in HealthierSG. The Ministry should consider concrete plans and strategies to include them in the country’s strategic shift towards preventive healthcare as HealthierSG is fleshed out and operationalized in the months and years ahead. The Ministry will not be starting from ground zero. With decades of regulatory experience and periodic reviews of the TCM landscape undertaken by the TCM Practitioners Board, a dedicated effort must be undertaken, driven by the Ministry to draw on the treasure trove of alternative and complementary medicine that has been relied upon by generations of Singaporeans for their well-being.
This is an opportunity that should not be missed. Thank you.
国会反对党领袖演讲：《健康SG白皮书》 – 传统中医和替代医疗能扮演的角色
我对这项动议的发言将很短，但是它将涵盖一个公共医疗系统中重要却有时被忽略的利益相关者。他们就是传统中医治疗（TCM）的中医师和替代或补充医疗 （alternative or complementary medicine） 的从业者。在今天的演讲中，我将提出三点建议，将传统中医和替代或补充医疗包含在 “健康SG计划” ，让他们成为重要的社区合作伙伴。
今年7月，我以书面形式向卫生部长提出国会质询，问如何将中医师纳入卫生部的 “健康SG计划” 。王部长回答说：“中医师是重要的利益相关者，特别是考虑到中医的强项在于整体和长期护理。然而，与西医不同的是，中医师不受卫生部的严格监管约束，提供的护理标准差异很大，因此我们无法采取与西医相同的方法处理。”
尽管如此，这个答复与部长在 2021 年 12 月的公开评论中并没有产生矛盾。部长肯定了传统中医在对抗慢性病方面的优势。事实上，历任卫生部长都提出了替代医疗保健，例如中医，能补充和整合西式医疗。
在全球，根据世界卫生组织（WHO）于 2008 年 11 月通过的《北京宣言》，传统中医被认为在改善公共卫生方面具有重要作用。事实上，针灸已获得世界卫生组织认可，可有效治疗 20 多种疾病和病症。
今天，新加坡的中医师受中医师法令（Traditional Chinese Medicine Practitioners Act）监管，中医师必须遵守由卫生部属下的中医管理委员会指定的《道德准则与道德指导原则》（Ethical Code and Ethical Guidelines）。 2019年，为了进一步让中医师更加专业化，再进行更新准则规定。
其中包括规定所有执业中医师和针灸师须通过强制的中医继续教育计划，并将不当行为或专业疏失的执业中医师的最高罚款从1万元调高到5万元。最高罚款额调高后，中医管理委员会的纪律权力将与牙医、药剂师，以及综合医疗保健人员（Allied Health Professionals）纪律委员会的一致。
事实上，早在 2005 年，卫生部就允许医院和疗养院在其场所内开设全方位服务的传统中医诊所——包括针灸、推拿和中草药服务，条件是传统中医诊所提供的服务必须与常规的医疗服务明显区分开来。 2018 年，邱德拔医院的一位针灸师说，向她寻求针灸服务的病患中约有 40% 是 25 岁以下的非华族。
就其本身而言，政府此前已从 2013 至 2018 财政年度拨出 300万元 用于传统中医临床研究补助金，以支持对慢性病的研究。为了致力于使这个行业更加现代化，政府在2017 年还宣布了另外 1000 万元的研究与发展拨款。我引述时任卫生部高级政务部长徐芳达先生的话：“出院后，如何帮助你尽快恢复健康……我认为像推拿（按摩治疗）实际上是非常有用。”
2020 年 12 月 29 日，卫生部作了一项重大的宣布：在试点计划下，扩大根据经济状况提供的补贴和保健储蓄覆盖范围，以支持在公共医疗保健的专科门诊（Specialist Outpatient Clinics，简称SOC）进行针灸治疗腰痛和颈部疼痛。这项试点计划不涵盖用于治疗其他痛症的针灸疗程 ，以及公共医疗机构所提供的其他形式的传统、补充及替代医疗服务。然而，卫生部表示，将先从这项试点计划中吸取经验和收集数据，再考虑是否扩大试点计划的适用范围。也许 “健康SG计划” 可为扩大这一试点提供适时的平台和动力。
例如，通常用于便秘的 Fybogel 在没有津贴的情况下价格约为20元，而具有相似功效的Psyllium Husk，可以低于3元的价格在小印度或职总超市购买到。2015 年，时任卫生部基础医疗与社区保健司传统和补充医学科主任证实了这点。我引述他的话：“卫生部不断检讨与传统中医相关的法规和政策，同时考虑到科学的进展和不断提高的执业标准。”
建议 3：借助中医师实现 “健康SG” 目标
与 “健康SG” 一样，预防长期疾病是传统中医和补充医疗的核心信念。这不是从一个人的年龄趋高时才开始的。他们的治疗理念将重点放在疾病出现之前的预防。他们提出这样的观点：即一个人的生活方式与健康密切相关，可以通过有效的心理健康管理、充足的休息、良好的饮食和基于个人特定身体状况的预防措施等来改善。通过观察这些指标，无论一个人属于社会的哪个经济阶层，他都在迈向健康的大道。
卫生部应该利用他们来传达健康生活技巧和预防保健策略，不仅仅是给我们的老年人。卫生部不应排除根据中医师对 “健康SG” 客观标准的贡献来津贴他们。
这种方法也与历任卫生部长的目标符合，他们都希望尽可能将西医和中医和替代医疗结合起来，即使这两者在不同的文化和专业环境中独立运作。虽然到目前为止这方面的进展似乎断断续续，但 “健康SG” 为中医和替代医疗在基础保健医疗领域发挥更积极的作用提供了一个新的机会。
总之，议长先生，就像家庭医生一样，许多新加坡人几十年来都拥有相同的中医师来照料。对于一些人来说，背后的原因很可能是寻求一个安心，与中医师打交道更加自在。政府公开表示，中医师是 “健康SG” 的重要利益相关者。卫生部应考虑具体计划和策略，将它们纳入国家的 “健康SG计划” 朝向预防性医疗保健进行变革，在未来的几个月和几年中充分并投入发挥作用。卫生部不会从零开始。我们对传统中医业的监管有几十年的经验，并且定期由中医管理委员会检讨。替代和补充医疗好比一个深受几代新加坡人依赖的宝库。应该由卫生部积极带头推动，让它继续发扬，照顾国人的健康。