Health & Life Sciences Update: Upcoming Changes to Singapore’s Healthcare Act

Health & Life Sciences Update | January 18, 2018
Authors: Shay Wester, Hai Pham, Ying Hui Tng, and Natalie McDaniel
 
LOOKING AHEAD
 
 

January 30-31: 2018 Health & Life Sciences Industry Mission to the Philippines

The Council is now registering executives for our Health & Life Sciences Industry Mission to the Philippines on January 30-31. The mission aims to support the national health agenda and identify opportunities for collaboration with the Department of Health and its new Secretary, Dr. Francisco Duque III. Deadline to register for the mission is Tuesday, January 23, 2018. Please contact Ying Hui Tng at yhtng@usasean.org and Hai Pham at hpham@usasean.org with any questions or to express interest.

March 30: 2018 Health & Life Sciences Industry Mission to Vietnam

This year, the Health & Life Sciences Industry Mission to Vietnam will be held on the margins of the Council's annual Vietnam Business Mission on March 30, 2018. This mission will be focused on continuing our strong engagement with the Ministry of Health (MOH), including our regular Joint Working Group Meeting as part of the Council's MOU with the MOH. For questions, please contact Hai Pham at hpham@usasean.org.

 
THE COUNCIL'S TAKE
 
 

Upcoming Changes to Singapore’s Healthcare Act

The Healthcare Regulation Group (HRG) of the Ministry of Health (MOH) is reviewing the current Private Hospitals and Medical Clinics Act (PHMCA) and to modernize it with the new Healthcare Services Act (HCSA). Healthcare providers will now be licensed based on the types of services they provide, rather than on physical premises. Telemedicine and app-based services will be licensed under the Bill and regulated accordingly. Licensees will be required to contribute to the National Electronic Health Record (NEHR), which aims to improve coordination and continuity of care and patient safety nation-wide. Patients who do not wish for their records to be accessible via the NEHR may opt-out, (but their information will still be uploaded to it) with disputes being assessed on a case-by-case basis. The NEHR will only be accessible for patient care, and not other purposes such as assessment for employment or insurance. All patients will have their health data contributed to the NEHR by default.

The HCSA will also increase the scope of information the MOH is able to gather for the purposes of using big data applications to promote patient safety and public health interests, including national surveillance for prevention of public health emergencies. MOH will also be able to publish information about non-compliant licensees and unlicensed providers. The draft Bill adds various penalties such as furnishing false or misleading statements to the MOH and will amend existing naming restrictions and prohibit licensees from using names of services they are not licensed to minimize public misperception. It will also tighten publicity controls, and only licensees and their appointed agents will be permitted to advertise healthcare claims. The draft Bill is expected go before Parliament in 2018, with implementation planned for the end of 2019 until December 2020.

The Ministry of Health is inviting its licensees and the general public to provide feedback on the draft HCSA Bill until February 15, 2018. The draft Bill is available here.
 

Philippines to Receive Refund for Unused Dengvaxia Doses

On January 4, the Philippine government suspended the product registration for Sanofi’s dengue vaccine Dengvaxia and symbolically fined the company $2,000 after the Food and Drug Administration of the Philippines found Sanofi violating its post-marketing surveillance requirements. President Duterte previously stated that the Philippines would demand a refund of 3 billion pesos paid for the vaccine. On January 15, Sanofi agreed to refund the Philippine government for unused Dengvaxia doses, worth about 1.4 billion Philippine pesos ($28 million). Sanofi released a statement that the reimbursement decision is “not related to any safety or quality issue” with the vaccine and that it has requested a meeting with the Department of Health (DOH) to “contribute to their efforts to restore public trust” in vaccination. The Public Attorney’s Office recently performed autopsies on children who died after receiving the dengue vaccine. Initial findings found common causes of death among some of the children to be characteristics of severe dengue, including bleeding in vital organs compatible with hemorrhagic shock. The DOH is waiting for conclusive results from a separate examination conducted by experts at the Philippine General Hospital. However, Secretary of Health Francisco Duque III has stated that Dengvaxia cannot be directly linked with the deaths under investigation unless the experts reach such a conclusion. As vaccine-preventable diseases are making a recurrence in Southeast Asia in part due to reduced immunization rates from consumer doubts over vaccine safety, the Philippines must allay the public’s fears over vaccination to ensure immunization rates remain high to prevent future disease outbreaks. The Council has been monitoring the situation (please click here for previous update) and will continue to do so.


Drug Bidding Saves $10 Million in Vietnam

The national centralized bidding process for 20 types of essential drugs covered by health insurance has helped Vietnam save $10.9 million on drugs. The centralized drug bidding was organized by the Vietnam Social Security agency (VSS) in cooperation with the Ministries of Planning & Investment, Health, Finance, and local health departments and facilities covered by health insurance. The total price of the 20 bid-winning drugs was 21.2% lower than the average drug bidding price of the previous year. Further, the cost of generic drugs was reduced by 33.8%, while the cost of patented medications was reduced 13.8%. As a result of the process, VSS was able to identify and remove abnormally high drug prices, differences in content, and variation of price of drug groups. Bidders were required to show documentation for proof of their drug supply commitment, and VSS will supervise drug supply and use in healthcare facilities using its health insurance supervision information system. While some experts and officials believe that this bidding process has achieved its goals to ensure a supply of high quality drugs and reduce drug prices, others have expressed concerns that the process lacked sufficient quality requirements and did not focus on the total social costs for patients.

 
ADVOCACY UPDATE
 
 

Knowledge-Sharing Workshop with Indonesia MOH and LKPP

Following on to the Council's advocacy effort in 2017 on Indonesia's e-catalogue issue, the Council is sending a letter to the Indonesia Ministry of Health (MOH) and National Public Procurement Agency (LKPP) to propose a knowledge-sharing or capacity-building workshop in Q1 2018 before the next re-opening of the e-catalogue. The workshop will support the POKJA team in MOH and LKPP in understanding the varying technological differences in medical devices and how they may benefit users. For more information, please contact Ying Hui Tng at yhtng@usasean.org.

 
IN THIS UPDATE
 
 
Cambodia
Cancer facility inaugurated
Cambodia Issues Health Warning Over Bird Flu Outbreak in Phnom Penh

Indonesia
Measles Kills Dozens of Children in Indonesia's Papua
Indonesia sends military to help fight health crisis in Papua

Malaysia
Tackling nutrition issues in Malaysia
Health Ministry says losing more medical specialists each year
Malaysia's Healthcare System Is At A Crossroads

Myanmar
ART centre opens in Yangon Central Women’s Hospital
K2bn earmarked for health research in coming year
Vaccination ramps up in diphtheria-hit Rohingya refugee camps

Philippines
DOH demands P1.4-B refund from Sanofi over ‘defective’ Dengvaxia
The Philippines is a diabetes ‘hotspot’
PAO insists on examining Dengvaxia deaths without UP-PGH experts
Sanofi to pay back Philippines after Dengue vaccine problems

Singapore
Shaping future of healthcare
Draft Bill eases privacy fears over electronic health records
Speeding up patient visits at NUH
New guidelines to help diagnose, treat gestational diabetes
Two schemes to help more seniors stay out of hospital
Govt assistance schemes helped halve healthcare inflation rates: Chee Hong Tat
'Much needed update' to healthcare law

Thailand
Thai Law About to Make Medical Marijuana Legal
Public health budget hike of 13% sought
Ministry gives in on charging ban

Vietnam
New criteria classify private hospitals
Drug bidding saves $10 million
Vietnam to release anti-dengue mosquitoes
Opposition to tax on sweet drinks
 
ARTICLE CLIPS
 
 
Cambodia

Cancer facility inaugurated Phnom Penh Post 16th Jan 2018
Cambodia's National Cancer Center – a more than $23 million modern teaching facility – was inaugurated at Calmette Hospital yesterday, though the centre’s director and experts acknowledged that oncology services still fall well below the country’s demand. During an interview yesterday, Dr Eav Sokha, director of the new centre, said there are only 26 oncologists for the more than 15 million people in the country. Of those, 20 will be working at the centre, with the other six working at the Khmer-Soviet Friendship Hospital’s Oncology Department – the only two public locations in the country providing such services. The majority of the funding for the new centre came from the government, with contributions from France and the International Atomic Energy Agency (IAEA), among others. The centre will offer cutting-edge treatment, such as nuclear medicine, hematopoietic stem cell transplantations, radiation, chemotherapy and paediatric oncology. The centre will start seeing patients in the next two weeks.

Cambodia Issues Health Warning Over Bird Flu Outbreak in Phnom Penh VOA 16th Jan 2018
Health officials in Cambodia have urged calm after an outbreak of avian influenza, or bird flu, in poultry in Phnom Penh last week. Hundreds of birds were taken in for testing by health officers in the capital’s Sen Sok district. Officials were quick to clarify that no humans had been found to have been infected by the H1N1 virus. Ly Sovann, a health ministry spokesman, said an outbreak was also discovered late last year in Kampong Thom province.

Indonesia

Measles Kills Dozens of Children in Indonesia's Papua US News 16th Jan 2018
Indonesian authorities are struggling to contain a months-long outbreak of measles in easternmost Papua province that has killed dozens of children. Stefanus Lange, a doctor at a state-run hospital in Papua's Asmat district, said Tuesday that cases were first detected in September, but a lack of access to remote areas, insufficient personnel and the high mobility of villagers hampered treatment and vaccination efforts. Lange said 36 victims died in Pulau Tiga sub-district and 22 died in Agats, the main town and capital of Asmat district. He did not rule out the possibility of a higher number of victims since reports have not been received from some sub-districts.

Indonesia sends military to help fight health crisis in Papua Reuters 17th Jan 2018
Indonesia is deploying military paramedics to carry food and vaccines to a remote part of its easternmost province of Papua, where reports say at least 61 infants died from malnutrition and diseases such as measles. Papua is one of Indonesia’s poorest provinces despite being rich in resources and President Joko Widodo pledged to speed its development when he came to power in 2014. The situation in the remote Asmat regency was an “extraordinary incident”, the health ministry said in a statement, adding that it was sending 39 health workers there.

Malaysia

Tackling nutrition issues in Malaysia Star2.com 16th Jan 2018
Rapid urbanisation and dramatic socio-economic advances in Malaysia since Independence has brought about marked changes to the lifestyle of the population. This has resulted in significant changes in the nutrition scene, with the existence of the paradoxical double burden of malnutrition. Various strategies and action plans have been put in place to promote healthy nutrition and active lifestyles for the prevention of these diet-related nutrition problems. Dr Tee E Siong, president of the Nutrition Society of Malaysia (NSM), shares his views on effective and practical ways of curbing these nutritional problems in the country and how the community itself can play a role in preventing these diseases.

Health Ministry says losing more medical specialists each year Malay Mail Online 10th Jan 2018
Subramaniam said 170 government medical specialists resigned last year, an increase from 158 the previous year. ― Picture by Yusof Mat IsaPUTRAJAYA, January 10 — The number of medical specialists resigning from the government hospitals has increased annually due to the public-private sector income disparity. Health Minister Datuk Seri Dr S. Subramaniam said 170 government medical specialists resigned last year, an increase from 158 the previous year. “Most of those who resigned were medical specialists of Grade UD54 and above, who have a lot of experience and are highly skilled. It is a big loss for us,” he told a press conference, here, today.

Malaysia's Healthcare System Is At A Crossroads Star2.com 9th Jan 2018
The Malaysian health system faces new challenges in the face of rapidly evolving demographic and epidemiological transitions. — AFP Malaysia subscribes to the World Health Organization’s priority objective of universal health coverage (UHC), which has been defined as “ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services”. Malaysia has UHC. However, some of the recent studies of the healthcare system’s performance raises concerns.

Myanmar

ART centre opens in Yangon Central Women’s Hospital The Myanmar Times 12th Jan 2018
An anti-retroviral treatment Centre (ART Centre) opened in Yangon Central Women’s Hospital on January 11. The centre will provide testing, screening, counseling and treatment for pregnant women and women with HIV. The centre opens Wednesday, Thursday and Friday from 9am  to 4pm. The hospital has been providing patients with HIV/AIDS, hepatitis B and C tests free of charge since the opening ceremony of the ART centre, said Dr Pa Pa, Senior Medical Superintendent of the hospital.

K2bn earmarked for health research in coming year Eleven Myanmar 8th Jan 2018
The Ministry of Health and Sports will allot 2 billion kyat of its budget for 2018-2019 financial year for health research work. For this fiscal year, only 1 billion kyat was earmarked for health research. The ministry will put an emphasis on research into public health, treatment, traditional medicine and sport activities. There will be less emphasis on basic research that costs more but yields fewer immediate benefits.

Vaccination ramps up in diphtheria-hit Rohingya refugee camps Reuters 15th Jan 2018
Aid workers are ramping up efforts to vaccinate half a million children against diphtheria in and around Rohingya refugee camps in Bangladesh, said the World Health Organisation (WHO). The respiratory disease has killed as many as 31 people and infected about 4,000 since it broke out in November in the camps, which house more than 655,000 Rohingya Muslims who fled Myanmar military operations that began in August. About 316,000 Rohingya children were vaccinated last month, according to a Sunday statement by the WHO, the United Nations’ health agency. They will need two more doses, spaced a month apart.

Philippines

DOH demands P1.4-B refund from Sanofi over ‘defective’ Dengvaxia Inquirer 12th Jan 2018
The Department of Health (DOH) has demanded P1.4 billion in refunds from pharmaceutical firm Sanofi Pasteur for its “defective” anti-dengue Dengvaxia vaccine. DOH Secretary Francisco Duque III on Friday said they sent a letter to Sanofi Pasteur Asia Pacific chief Thomas Triomphe asking for a refund of P1.4 billion for the remaining unused anti-dengue vaccines.

The Philippines is a diabetes ‘hotspot’ Inquirer 9th Jan 2018
The Philippines is considered one of the diabetes “hot spots” in the Western Pacific region, where the disease is already reaching epidemic proportions. Our government knows this too well, and the increased taxes on sugary drinks is just one of the steps being taken to stem the tide. Sufficient public education is needed to make everyone aware of the lifestyle changes needed to prevent diabetes, or to detect it earlier, so it can be controlled before there is serious damage to vital organs like the heart, kidneys, brain, eyes, nerves, liver—since practically all organs and tissues of the body are affected.

PAO insists on examining Dengvaxia deaths without UP-PGH experts Rappler 8th Jan 2018
The Public Attorney's Office (PAO) will continue conducting forensic examinations on vaccinated children without the participation of experts from the University of the Philippines-Philippine General Hospital (UP-PGH), PAO chief Persida Acosta said on Monday, January 8. PAO is set to open a new investigation into a child who died in Malolos, after getting vaccinated with dengue vaccine Dengvaxia, now recalled after manufacturer Sanofi Pasteur disclosed it could lead to severe dengue symptoms for children who have not had dengue before but got the vaccine.

Sanofi to pay back Philippines after Dengue vaccine problems Pharmaphorum 16th Jan 2018
Sanofi’s is to pay back money to the Philippines government for unused doses of its Dengue fever vaccine, after serious safety concerns halted its use. Dengvaxia is the first vaccine of its kind, and analysts had tipped it to generate blockbuster revenues for Sanofi. Concerns arose when an analysis of trial data showed that although the vaccine produces an overall reduced risk of infection, it significantly increases risk of severe infection and hospitalisation among those who have not had a prior infection.

Singapore

Shaping future of healthcare The Straits Times 9th Jan 2018
The Ministry of Health has asked for feedback over the next six weeks on the proposed changes to laws governing the provision of healthcare in Singapore. Among other things, the proposed Healthcare Services Act broadens the ministry's oversight to include treatments and services carried out online or via mobile apps. It also delimits the use of the National Electronic Health Record once it becomes mandatory for all healthcare providers to input patient information. The proposed rules on this have already undergone changes, given the reaction to the decision. An example is to refuse employers and insurers access to people's medical history through their medical staff.

Draft Bill eases privacy fears over electronic health records The Straits Times 6th Jan 2018
Many Singaporeans have been worrying that employers and insurers can obtain their medical history without their consent when it becomes compulsory for such information to be stored in a national health databank. Yesterday, their fears were allayed when a proposed piece of legislation was unveiled. The draft Healthcare Services Bill made it plain that employers and insurers will be barred from accessing the information. Also, people can choose between two options should they want to shield their medical history even from doctors.

Speeding up patient visits at NUH The Straits Times 16th Jan 2018
A faster method to treat serious infections and partnerships with community clinics are among the ways National University Hospital (NUH) is trying to make visits for its patients more fuss-free. The hospital has started giving patients rapid infusions for five commonly used drugs, meaning that they can be done in less than a quarter of the time taken previously. In the past, some patients with serious infections used to have to go in for antibiotic infusions almost every day for weeks, with each session lasting up to 45 minutes.

New guidelines to help diagnose, treat gestational diabetes The Straits Times 13th Jan 2018
A new set of guidelines has been drawn up to help doctors here better diagnose and treat women with gestational diabetes, it was announced yesterday. These are based on the latest international standards and will help deal with a problem that affects thousands of pregnant women here every year and can cause health problems that last for life. In Singapore, one in five pregnancies - or more than 6,000 women each year - is affected by gestational diabetes.

Two schemes to help more seniors stay out of hospital The Straits Times 11th Jan 2018
Thousands more elderly patients will soon benefit from out-of-hospital care thanks to the expansion of two health programmes. A scheme that provides elderly people with post-discharge care to reduce their chances of being hospitalised again will be scaled up from the current base of 3,000 patients to 5,000 by the end of the year. Another initiative, under which trained volunteers in 18 neighbourhoods keep an eye on elderly residents living near them, will be expanded to 30 districts.

Govt assistance schemes helped halve healthcare inflation rates: Chee Hong Tat TODAYonline 9th Jan 2018
Recent initiatives such as the Pioneer Generation Package, the Community Health Assistance Scheme, and subsidies for MediShield Life have halved Singapore’s healthcare inflation rate down to about 1.2 per cent, bringing it below the OECD (Organisation for Economic Co-operation and Development) average of 1.6 per cent, Senior Minister of State for Health Chee Hong Tat said in Parliament on Tuesday (Jan 9). Prior to these government assistance schemes, annual healthcare inflation — which measures the growth rate of prices for healthcare related goods and services paid by patients, after government subsidies — stood at about 2.4 per cent between 2011 and 2016.

'Much needed update' to healthcare law The Straits Times 6th Jan 2018
Sweeping healthcare regulations that include banning the hire of specified people to prevent abuse of the elderly are in the pipeline as the Health Ministry undertakes a major update of the law for the first time in 18 years. With the increasing use of virtual care such as telemedicine and with a rapidly ageing population, the move is a much needed update, said Dr Tan Tze Lee, president of the College of Family Physicians. Beside covering a wide range of medical treatments and services, the Healthcare Services Bill will also give the authorities more powers, such as higher penalties for infringements.

Thailand

Thai Law About to Make Medical Marijuana Legal Khaosod English 17th Jan 2018
The announcement of the nation’s first legal marijuana cultivation facility presages changes to the nation’s drug laws that will soon allow medical use of cannabis, Thailand’s top drug enforcement agent said Tuesday. A recent rewrite of the nation’s strict narcotics laws will allow marijuana to be sold legally over-the-counter with a doctors’ prescription, Narcotics Control Board director Sirinya Sitdhichai said Tuesday. “For medical purposes, they will be able to get the marijuana, but only on a doctor’s orders. They can’t grow it on their own,” Sirinya said. “This is what we have put in the draft.”

Public health budget hike of 13% sought Bangkok Post 9th Jan 2018
The rising cost of medicine and hospital visits has prompted the Ministry of Public Health to propose a public health-care budget of 193 billion baht, up 13% from its present level. Piyasakol Sakolsatayadorn, the public health minister, said the budget has not increased in two years, causing it to fall out of synch with the costs faced by taxpayers. With the ministry's budget constrained by its current cap, the price of medicine and the cost of visits to hospitals or clinics has spiked while the number of patients is also on the rise, he said.

Ministry gives in on charging ban Bangkok Post 8th Jan 2018
The Public Health Ministry has decided not to prohibit staff from using office supplies and assets, or ban the charging of mobile phones. It has pulled its announcement of the bans, which was signed by permanent secretary for public health Jessada Chokdamrongsuk. The announcement, which Dr Jessada signed on Dec 29, prohibited 400,000 ministry staff from charging personal mobile devices at the office, citing the need to set clear boundaries to prevent conflicts of interest.

Vietnam

New criteria classify private hospitals Vietnam News 12th Jan 2018
The Ministry of Health has issued a set of criteria to classify the quality of private hospitals and healthcare clinics across the country. The move came after the Việt Nam Social Insurance Agency decided that in 2018, private hospitals and healthcare clinics that wanted to sign a contract with the agency to examine people with health insurance cards, would have to show a legal document proving their quality under the ministry’s standards. Lê Văn Phúc, deputy head of the agency’s department for health insurance implementation, said that based on the classification, the agency could exactly calculate the rate of health insurance fees it had to cover for a patient treated at a private hospital or healthcare clinic instead of a public hospital or healthcare clinic.

Drug bidding saves $10 million Vietnam News 6th Jan 2018
The national centralised bidding for 20 types of drugs covered by health insurance has helped save VNĐ251.13 billion (US$10.9 million) on drugs, said Dương Tuấn Đức, director of the Centre for Health Insurance Appraisal and Multi-level Payments in the North under Việt Nam Social Security. The total price of 20 bid-winning drugs was VNĐ935.99 billion ($40.7 million), down 21.12 per cent compared to the average drug bidding price of last year.

Vietnam to release anti-dengue mosquitoes Northbound Philippines News Online 16th Jan 2018
Vietnam will start releasing next month mosquitoes laced with Wolbachia — natural bacteria present in many insects — which is capable of preventing Aedes aegypti mosquitoes from becoming infected with dengue virus, meaning the mosquitoes cannot transmit the virus to humans. Wolbachia-laced mosquitoes will be released in Vinh Luong commune, Nha Trang city, central Khanh Hoa province in 12-18 weeks starting in March, according to Vietnam’s Health Ministry on Monday.

Opposition to tax on sweet drinks vietnamnews.vn 10th Jan 2018
The Ministry of Finance is proposing to levy a special consumption tax of 10 per cent on sweet drinks to combat child - and adult - obesity rates, a problem worrying Government and health experts. However, many business people disagree with the proposal. The special consumption tax proposal for sweet drinks is a part of a ministry proposal to revise five tax laws, including a value-added tax (VAT), special consumption tax, corporate income tax, personal income tax, and natural resources protection tax.