SINGAPORE - Building adequate buffers for future pandemics, right-siting resources, and ensuring good outcomes are essential to making good investments in, and financing public healthcare, said Finance Minister Lawrence Wong.
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 (Oct 6) and Thursday.
Mr Wong noted that after the 1997 Asian financial crisis, the region emerged stronger and more resilient by implementing stronger surveillance systems and multilateral currency swap arrangements such as the Chiang Mai Initiative Multilateralization.
"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 dislocation and lower trust in the global marketplace, they must do everything within their borders, he said.
"I don't think it will be a better world... Ultimately, we still need to go back to public- private partnerships. We still need to work collaboratively 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.
In the early years of Singapore, privatised insurance risk pools were fragmented and insurance companies tended to cherry pick "good" risks, which was not ideal as this left certain people without coverage, he said.
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. It's not just the state's responsibility," he said.
He outlined three key lessons from Covid-19: First, reduce wastage and costs, and build buffers in the healthcare system to scale up during a public health emergency.
Second, right-site and conserve scarce medical resources and boost primary care. This means that not everyone has to be treated in an acute setting.
Third, look at outcomes and ensure good returns from investments in healthcare spending - not just by spending more or increasing output, but by improving outcomes such as quality of life.
"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 taxpayer dollars."
Another panellist, Dato Dr Mohd Amin Liew Abdullah, Minister at the Brunei Prime Minister's Office and Minister of Finance and Economy II, touched on a similar point, saying that Brunei has increased its investments in public healthcare specialist centres and is looking to maximise "every dollar spent" to provide better quality healthcare services and carry out 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 of August, 40 out of 185 initiatives have been implemented, and 60 are in the process of completion.
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, noting that studies have shown that a dollar of aid delivered immediately after a crisis is worth as much as five dollars when delivered later.
The ADB, he said, is working with governments to design risk financing instruments that provide much quicker disbursement in the aftermath of a pandemic.
Asian Infrastructure Investment Bank director-general for social infrastructure Hun Kim said that emergency support during the crisis was a quick fix and, now, countries need sustained and commensurate funding for the health sector.
He noted the World Health Organisation's recommendation that countries spend at least 5 per cent of their GDP on health, and that most developing countries in Asia are "far from meeting" these low benchmarks.
He said that multilateral development banks have a role to play in facilitating the localisation of healthcare manufacturing - in other words, boosting the domestic production of pharmaceuticals which are currently dominated by a few multinational companies.
Political will is also needed to build social protection systems including health insurance, he said. But there is a risk that short-sighted governments and politicians, with competing needs for investment spending today, may not want to wait to reap the benefits during the next pandemic, which might be 10 to 20 years away, he said.
"Already, I believe there is a sizeable risk that the lessons from Covid-19 will not be learnt. And this a pity," he added.
Mr Wong observed that the global public health system is fragmented, inadequate, and under-funded.
Noting the recommendations of the Group of 20 (G-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, an insurance 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."