School Dental Services
Dental hygiene in post-war Singapore was atrocious.
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The DMFT (Decayed, Missing and Filled Teeth) Index
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for Singapore is a healthy 0.42 today, but in 1949 it was 15, which meant the average man on the street had barely half a set of good teeth in his mouth.
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The best way to address this was to provide dental services and education to children so they could form good habits while young. The 1950s saw children being bussed to Singapore’s only dental clinic in Tan Tock Seng Hospital;
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later, mobile vans would bring services to schools in outlying areas. There was no electrical supply in the rural schools at the time; each mobile dental clinic towed its own generator.
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After Independence, “dental huts” were conceived as part of Singapore’s early school development programme in the 1970s.
Principal Dental Therapist, Ms Lim Kah Choo, who has been with SDS for 44 years, recalls:
So it’s literally a hut. The school that I was in, there were two primary schools and [a] secondary school within the same compound. A site was selected to build two dental huts.
One dental hut was manned by dental nurses while the other hut had a dental officer [a trained dentist] who also oversees the work of the dental nurses like me who had just graduated from training school.
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Apart from actual dental treatment, SDS was tasked with inculcating good dental habits among students. This included conducting tooth brushing drills for all students during recess – a major programme from the 1980s to the 1990s. SDS even invented tablets and toothpaste that would stain dental plaque on teeth and gums that were not properly brushed.
Today, a dental clinic is part of every primary school that is upgraded or built in Singapore. 16 SDS services have also been extended to secondary schools. 17 The dental clinics themselves are no longer the cold rooms of the early days. Instead, they have been upgraded with soft toys and colourful posters, to make it less intimidating for young children to visit them. According to Ms Lim, nowadays “children come in to the clinic for dental treatment on their own accord”. 18
Staying Healthy, Starting Young
Today, both SHS and SDS come under the Youth Preventive Services Division in the Health Promotion Board (HPB).
They play an important role in Singapore’s philosophy of encouraging preventive healthcare, anchoring annual screening programmes to detecting and managing health conditions among schoolchildren early, and helping our young people to cultivate healthy habits that will persist into adulthood.
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Other initiatives in the 1970s, such as the Clean Air Act of 1971, and the Environment Protection Act, helped to maintain the cleanliness and the quality of our lived environment. Numerous campaigns were also carried out in the name of bettering public health: including campaigns against littering and for eradicating mosquitoes. A decade-long effort was also made to clean up the Singapore River.
IMPROVING HEALTHCARE SERVICES: A NETWORK OF PRIMARY CARE PROVIDERS AND CORPORATISED HOSPITALS
As Singapore’s urban infrastructure was built up in the years following Independence, overall public health steadily improved. At the same time, efforts were also being devoted to make healthcare services better and more accessible to the public. In Singapore’s early years, the healthcare system was organised to deal with the acute medical problems common to a young population – either simpler conditions such as a mild influenza or emergency trauma care, which tend to require treatment over a brief period before the patient stabilises or recovers.
A number of public hospitals had already been established by the time Singapore achieved self-rule in 1959. These included the Singapore General Hospital (SGH), Alexandra Hospital (AH) and Kandang Kerbau Maternity Hospital (KKH). The Chinese migrant community had also set up a hospital, which came to be known as Tan Tock Seng Hospital (TTSH). Other than KKH, these hospitals were all geared towards acute care (such as general surgery and medicine, orthopaedic surgery and emergency medicine).
Over the years, Singapore’s hospitals have been rebuilt to expand and improve their facilities, capacity and services, beginning with SGH in the late 1970s and the other major hospitals, including TTSH and KKH, in the 1990s. In 1996, Toa Payoh Hospital and Changi Hospital merged to become the present-day Changi General Hospital, with new premises in Simei.
As of 2015, public sector hospitals remain the backbone of hospital care in Singapore, complemented by some private institutions such as Mount Elizabeth Hospital, Gleneagles Hospital and Raffles Hospital.
ENSURING HEALTHCARE IS AFFORDABLE AND SUSTAINABLE
Healthcare financing in Singapore adopts a hybrid approach. Most healthcare systems around the world are financed either by the state (through taxes) or by some form of social risk-pooling such as health insurance. Singapore balances both these approaches, along with some co-payment by individual consumers. This holds individuals responsible for their own medical expenses and encourages them to keep themselves healthy, while allowing government and society to help ensure that everyone has access to the healthcare services they need. This also helps to mitigate unnecessary demand for healthcare services, which can then be channelled to those who need them more.
To ensure that no Singaporeans will be denied access to care, healthcare is heavily subsidised by the state. Class B2 and C hospital wards are subsidised at up to 65% and 80% respectively; subsidies are also given for nursing homes and community hospital care. These subsidies depend on each patient’s means, with those of lower income receiving more help. Visits to the government-run polyclinics are also highly subsidised, so that all Singaporeans can afford good primary care. Certain types of treatment, such as cosmetic or experimental procedures, are not subsidised.Complementing government subsidies are Singapore’s 3Ms: Medisave, MediShield and Medifund. Medisave is a compulsory national medical savings scheme, introduced in 1984. Under the scheme, part of every working Singaporean’s earnings are put aside in their personal Medisave account to help meet future healthcare expenses. To account for large treatment bills that cannot be sufficiently covered by individual savings, MediShield was introduced in 1990 as a low-cost national health insurance scheme. To keep premiums affordable, MediShield has has deductibles and daily expense limits. Medifund was introduced in 1993 as an endowment fund to help needy Singaporeans – those who cannot pay for their bills, and who lack Medisave or MediShield coverage, or both. Together, government subsidies and the 3Ms form the basis of Singapore’s healthcare financing framework.
Towards Greater Collective Responsibility
While personal responsibility remains a central tenet of Singapore’s approach to healthcare, there have also been steps towards building a more inclusive and caring society, where resources are pooled together to help the sick among us and where those who are needy receive the help that they require. With the introduction of MediShield Life (to be effected by end 2015), lifetime coverage will be extended to all Singaporeans – even if they have preexisting conditions, or are too old to enjoy coverage under other insurance schemes. This has been made possible through premium subsidies, financial assistance and risk-pooling at the national level. At the same time, the Government is increasing its share of national healthcare expenditure. One example is the increase in subsidy at the subsidised specialist outpatient clinics and for standard drugs. These measures will reduce co-payment for lower-to-middle income households and help ensure healthcare remains affordable.