It may be just under three months before the Ministry of Health (MOH) lays out to Parliament its plans for the next five years, but already, Health Minister Gan Kim Yong finds himself in the hot seat with an urgent issue to address - the outbreak of hepatitis C at the Singapore General Hospital (SGH).

Twenty-three patients who had been warded at SGH between April and June this year have been diagnosed with the same family of hepatitis C virus. Two more patients have tested positive for hepatitis C, and SGH is studying if they are part of the same cluster. If so, the number infected would be 25.

Eight patients have since died, with five of the deaths linked to the virus. The ministry has set up an independent review committee to look into not just how the infection occurred, but also the actions of the hospital and the ministry following its discovery. The committee includes international experts.

SGH has also filed a police report so that the police can ascertain whether there was any foul play involved in the spread of the virus in the hospital.

Less pressing, but still requiring addressing over the longer term, are the growing healthcare demands of the population.

This was seen earlier in a shortage of hospital beds that resulted in patients being housed in tents, three to a cubicle meant for one, and along corridors. With the opening of the 700-bed Ng Teng Fong General Hospital, that problem has eased somewhat. More community, as well as general, hospitals are being built and set to open this year and next, which should address the immediate problem.

But building more hospitals is not the only solution, given Singapore's rapidly ageing population and the demands that will place on the healthcare system.

Greater emphasis needs to be placed on care within the community and, even more importantly, on preventing and managing chronic ailments so the population can age healthily, remain independent and not become a drain on healthcare financing.

Singaporeans' life expectancy has been going up by roughly three years every decade.

MOH's $3 billion Action Plan for Successful Ageing could go some way in this direction - if it is properly implemented and gets buy-in from seniors.

Mr Gan is right when he said: "We need to plan ahead to ensure that Singaporeans need not worry about getting old, but instead embrace new opportunities that come with longevity."

Another area that could be addressed is the provision of free, or at least subsidised, vaccines for adults and seniors.

Most developed countries recommend, or even provide, vaccinations against pneumococcal diseases, shingles and influenza.

Although they tend to be less effective in older people, studies have shown that there are still cost benefits to the nation, aside from reducing pain and death among those affected.

THE CHALLENGE OF RISING COSTS

The other major piece on Mr Gan's plate is healthcare financing, amid higher demands from an ageing population.

MediShield Life will be launched next month, and lays a good foundation to ensure people can afford basic medical care.

However, two in three people today are on medical insurance that offers them coverage at private - rather than subsidised - levels.

The MediShield Life Review Committee has asked the ministry to work on a standard B1 medical insurance plan, given the grave concerns many people expressed about soaring private premiums and differing coverage by the five private insurers that offer MediShield top-up coverage.

This will hopefully materialise soon, as many are eagerly awaiting some control over a market that few understand, or are able to navigate.

The more important job for the minister, however, is keeping a lid on rising costs.

Medical insurance claims have been going up at double-digit rates every year for the past several years.

MOH has promised to keep premiums for Medi- Shield Life unchanged for the first five years. But this does not change the fact that healthcare costs will continue to rise in those five years.

If left unchecked, such spiralling premium increases could easily bankrupt the national health insurance, since total claims paid out could double every eight to 10 years.

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