Building adequate buffers for future pandemics and right-siting resources are essential for making good investments in public healthcare, Finance Minister Lawrence Wong said.

At the multilateral and regional level, this means building better mechanisms to prepare for future health crises similar to the Covid-19 pandemic, including risk pooling and the sharing of information, he added.

He was speaking at a panel discussion on the second day of the Special Ministerial Conference for Asean Digital Public Health. The event was held virtually on Wednesday and yesterday.

Mr Wong noted that after the 1997 Asian financial crisis, the region emerged stronger and more resilient through multilateral currency swap arrangements, such as the Chiang Mai Initiative Multilateralisation.

"In the same way, we have to build better mechanisms to prepare for public health crises and emergencies. That can include, at a very simple level, better exchange of information... (and) initiatives like risk pooling and sharing of resources," he said.

Countries should not swing to the extreme and think that because the pandemic led to supply chain dislocations, they must do everything within their borders, he said.

"We still need to work colla-boratively with different stakeholders, all of whom are important - including philanthropic and non-profit organisations. That is the kind of collective response that will best enable us to prepare for the next pandemic."

Mr Wong acknowledged that healthcare costs continue to escalate and healthcare financing is a concern for finance ministers everywhere.

The healthcare trilemma, he said, involves a difficult balance among universal access, high quality and low cost.

This is why Singapore nationalised its hospital insurance system and now has a mandatory universal risk pool, he said, adding that this has to be balanced against over-consumption by users and over-servicing by healthcare providers.

"We have evolved a hybrid system in Singapore where we continue to emphasise the importance of individual and collective responsibility in healthcare," he said.

He outlined three key lessons from Covid-19: First, build buffers in the healthcare system to scale up during a public health emergency.

Second, right-site scarce medical resources and boost primary care. This means that not everyone has to be treated in an acute setting.

Third, improve outcomes such as quality of life and ensure good returns from investments in healthcare spending, not just by spending more or increasing output.

"Something that we are trying to do is shift more spending and interventions upstream," he said, citing lifestyle and diet as some reasons for common diseases today.

"If we can have investments upstream, they will provide better bang for the buck for the tax-payer dollars."

Another panellist, Dato Dr Mohd Amin Liew Abdullah, Minister at the Brunei Prime Minister's Office and Minister of Finance and Economy II, said Brunei has increased its investments in public healthcare specialist centres, and is looking to maximise "every dollar spent" on better quality healthcare services and preventive treatment.

Under Brunei's Asean chairmanship this year, the Asean Comprehensive Recovery Framework will oversee the implementation of initiatives to ensure a sustainable recovery. As at August, 40 out of 185 initiatives have been implemented.

Adviser to the Thailand Ministry of Public Health Phusit Prakongsai cited the Thai Health Promotion Foundation, which is financed by tobacco and alcohol consumption taxes, as an example of social returns on healthcare investment.

The foundation carries out various public health programmes, such as campaigns to promote physical activity and to get people to cut down on drinking.

Asian Development Bank (ADB) vice-president Ahmed M. Saeed stressed the need for timely state support. The ADB, he said, is working with governments to design risk financing instruments that provide quicker disbursement in the aftermath of a pandemic.

Asian Infrastructure Investment Bank director-general for social infrastructure Hun Kim noted the World Health Organisation's recommendation that countries spend at least 5 per cent of their gross domestic product on health, and that most developing nations in Asia are "far from meeting" these low benchmarks.

He said multilateral development banks have a role to play in localising healthcare manufacturing - in other words, boosting domestic production of pharmaceuticals which are currently dominated by a few multinational companies.

Mr Wong observed that the global public health system is fragmented, inadequate and under-funded.

Noting the recommendations of the Group of 20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response - which Senior Minister Tharman Shanmugaratnam co-chairs - he said countries need better early warning systems and systems for vaccine manufacturing and distribution, all of which require double the current level of spending, a premium "well worth paying".

Initiatives started by the Brunei government as Asean chair, such as regional reserves of medical supplies and strengthening regional capabilities, will also complement these multilateral initiatives, he said, adding that public-private partnerships have proven to be important in fighting the virus.

"Indeed, vaccine development is the ultimate success story of public-private partnerships."