Ong Ye Kung on AI, genetic screening and preparing for a super-aged Singapore

Health Minister Ong Ye Kung confirmed Singapore is now a super-aged society, with the over-65 share crossing 21%. The transition has been steady, not sudden. Government health spending is set to rise from S$22.5 billion this year to S$30 billion by 2030 — from 2.7% to 3.5% of GDP. Singapore still spends under 5% of GDP on healthcare, far below the 9–12% typical of developed economies, thanks to the S+3M system anchored by Medisave co-payments.

The system is shifting from episodic hospital care suited to younger populations toward continuous, multi-setting care for older ones. Acute hospital spending fell from three-quarters of the operational health budget in 2021 to nearly two-thirds in 2024. Aged care rose from 11% to 13%, and population health from 14% to 19%. Preventive and community care now anchor the strategy.

Three new measures support this shift. First, an AI risk-prediction tool — trained on anonymised local patient data — will reach all Healthier SG doctors in early 2027, identifying patients with a 75%-plus chance of developing diabetes or high cholesterol over the next three years; 60 Singaporeans suffer a heart attack or stroke each day. Second, subsidised genetic testing for HBOC begins in December for an estimated 2,000+ people a year, with cascade testing for relatives of BRCA1/BRCA2 carriers and Medishield Life and Medisave extended to cover HBOC preventive surgeries. Third, the Medisave 500/700 scheme will be renamed the Medisave Chronic and Preventive Care Programme, with the limit raised from S$5,700 to S$7,100 and hyperthyroidism and hypothyroidism added to the CDMP — effective January 2027.

Caption language: en · Fetched: 2026-05-02

Three years ago in April 2023, I informed the house that Singapore will become a super age society in 2026 this year. This is when 21% or more of our population will be 65 and above. So you consider in June 2025 last year already 20. 7% of our population was 65 and above and that percentage has been going up by about 1 percentage point every year. So we should have crossed 21% by now. So as I speak Singapore is a super age society. So welcome to super age Singapore. When was the exact point of transition? Actually I don't think anybody knows. We can do a estimation. What happened at the exact moment? Nothing dramatic. There wasn't a SD, SEDDF siren or anything. It came and gone. Aging does not arrive with a bang. Neither is it a whimper. It progresses quietly with a real and profound impact.

And at MO we feels we feel it very strongly in the hospitals in the emergency department in nursing homes and we are doing our best to manage the workload and care for all our patients. More importantly we foraw this demographic transition years ago and took as many early action as we can. This includes raising the GST to strengthen our fiscal position, increase the retirement and reemployment ages, build many more age friendly streets and two room flexi and senior apartments, bolstered financial security for seniors through silver support, CPF life, medicial life. And these policies are long in the making. They have helped cushion the impact of this very profound demographic transition. But arguably the most complex task is to prepare to prepare for an older population is to sustain and to transform the health care system.

These are the two topics I want to talk about today. Sustain and transform. Let me first touch on sustaining the health care system. Rising demand and care means the health care system must expand. It will become bigger, which we are doing. At the opening of this term of parliament, the MO addendum set out the target of adding 2,800 more public acute and community hospital beds between 2025 and 2030. We are on track. However, meeting rising demand and running a larger system will cost more. And if we do not manage this carefully, rising health care spending can strain public finances and household budgets alike. In fact, if we are really extravagant, we're not careful about it, it can even our system. How do we ensure health care remains affordable?

I think we need to start at the very top to ensure that the national health care bill is under control. Otherwise, it's like the Titanic sinking and you are pouring water out of the deck. It must be floating. National healthcare expenditure. And that is the hospital bill of the nation. And that bill, remember this, is always and is ultimately paid by the people. Whether through health care charges, through taxes, through insurance premiums, through medical security contributions, ultimately is always paid by the people. So a government can claim we provide cheap or even free health care. It's actually not very true. The truth is healthcare is never really free. Even if patients do not pay anything at the point of delivery, they will just pay in some other ways.

A sick nation that consumes health care indiscriminately will incur a large and wasteful bill and it will be very costly to the population to the households to the patients to the people. So with your permission Mr. Chairman may I display a couple of slides on screens please go ahead. Thank you. This is a scatter chart different countries and you can see Singapore is an outlier in the bottom right corner. Let me interpret this chart. The vertical axis measures how much the population spends on health care. Developed economies shown by the different dots on screen typically spend about 9 to 12% of GDP on health care with the US outlier in the other direction spending 17%. Singapore spends below 5%. The horizontal axis is average lifespan. This is a internationally accepted and generic measure of health outcomes.

And Singapore has one of the highest lifespans in the world. But of course, beyond lifespan, there are many other measures of health outcomes. And across all these measures, Singapore are comparable or even better than many developed economies. So how did we become an outlier like this? I think it has a lot to do with our S plus 3M healthcare financing system that members are familiar with and Medisafe is the lynchpin of that system. Singaporeans and our employers set aside part of our monthly income into Medisafe. The government also provides topups from time to time to for various segments of the population and we did that again this budget and we then use Medisafe to co-pay directly for a small part for the cost of health care.

So even a modest co-ayment it goes a long way to instill discipline and reduce unnecessary consumption on both the supply as well as the demand sides. And we do not have to look very far to imagine what happened when that discipline is eroded. You just look at private healthcare in Singapore. The discipline of co-ayment was weakened because of overly generous insurance including the IP riders and as a result private hospital bill sizes have been rising rapidly. Private insurance premiums have been escalating very quickly. So once that genie is out of the bottle, it is difficult to put it back. But we will try. You will not stop us from trying. In our S plus3M system, multiple payers, they pull their weight to pay for this national health care bill. Apart from co-ayment, you have we have insurance schemes like Medishu Life.

It plays a sizable role. A big part of it is also paid by charity dollars. We thank all the donors and philanthropic organizations. But the biggest proportion about half of the national health care bill is paid through tax revenues. redistributed as government healthcare subsidies. The government health budget today is about two 2. 7% of GDP this year and it is expected to rise to about 3. 5% GDP by 2030. This 0. 8 percentage point increase is actually very significant. It means increasing government health budget from about 22. 5 billion this year to about 30 billion by 2030 or in 2030. And beyond 2030, the government health budget will likely continue to grow and we must we must ensure that the increase can be supported by economic growth and by rising tax revenues.

And at the same time we must continue to maintain that discipline and avoid unsustainable level of healthcare spending that we see elsewhere. So the next topic I want to talk about is to transform the health care system. A health care system for a young population is very different from one for an older population for a super aged society because you imagine for a young person sickness tend to be episodic. You are admitted to hospital, you got treatment, you get discharged and then you recover. Good health is the default. On the other hand, an older person's care journey is complicated and continuous. When well, they need preventive care. When sick, they need coordinated care because they tend to have multiple conditions. Post discharge they need rehabilitative care and follow-up care in a community. Good health is not a default.

It's a continuous quest for an old person. So from episodic hospital care, we now need continuous multidisciplinary care across settings. And this shift is reflected in how we have allocated healthcare funding over time. Let me show another chart on screen. Left chart is at the height of the chart is our government healthcare budget 2021. Right bar is 2024. You can see that overall um budget has increased by 1. 5 times. But I want to point members uh draw members attention to the composition. At the start of this decade 2021, about three quarters of our operational funding for the healthcare sector went towards acute hospital care. That's the white portion of the bar. The remaining one quarter was spent on aged care and population health including preventive and primary care. Today we move to the right 2024 the budget is 1.

5 times higher but the share of acute hospital care has fallen from three quarters to almost 2/3 and the remaining one-third goes to agent care and population health. Specifically, the share of funding for agent care rose from 11% to 13%. That's the green portion between 2021 and 2024. And over the same period, the share of population health grow from 14% to 19%. And these shifts are largely driven by our national programs healthier SG and HSG. And looking ahead, how would this chart go? I think almost certainly the share of spending on aged care will grow further because we need more nursing homes, senior care centers, rehab services, hospice care. As for population health, we do our best to maintain this share at around 19%.

With total spending rising, maintaining the share alone requires a strong commitment to continue to invest in population health. Mr. Chairman, today my MOH colleagues and I will be speaking on further steps to transform healthcare and get ready for the future. SMS core will speak about manpower is it uh it is a key agenda including how we will significantly shorten the time to train clinical psychologists. We are taking seven to eight years currently. We will reduce it to about to about five years. SMS Tan will speak about anchoring care in a community through technology and you heard MOS Roayu speaking about population health and preventive care including what we are doing in the north where prevalence of chronic diseases are higher. There was a question by Miss Mariam Jaffa. You missed that part of the speech. Yeah.

I should emphasize this is in case she asks many PQ uh clarifications later. I should emphasize preventive care and population health remain the overarching strategic trust of what we are doing anchored by healthier SG and HSG. I thank Miss Mariam Jaffa Dr. Hares uh for speaking about this. This is at the core of healthcare transformation and MO agrees with many of the points you have raised. I will now speak about three new initiatives to support healthcare transformation. The first common topic this whole COS and budget debate AI once again Miss Mariam Jaffa and Dr. Chup Paling spoke about how AI can strengthen healthcare delivery and we agree. So when it comes to AI in healthcare we are guided by two principles. Number one care should be AI enhanced not AI decided.

Clinicians remain in the loop and health care remains a profoundly human endeavor. Number two, we take a practical use case approach. AI should not be a hammer looking for a nail, a solution looking for a problem. We deploy AI where we know it will improve patient outcomes or the delivery of care and it can do so cost effectively. And what such one such use case is in health screening around the world. Many AI models have been trained to predict if a well person is likely to develop severe diseases in the near future. And if you use it appropriately and responsibly. Such tools are very useful. It helps the clinicians intervene early. It can delay or even prevent the onset of serious diseases. Mo has developed such a model for our local context using anonymized patient data.

By with this model by reviewing an individual's current health status, it can identify if he has a high risk high risk defined by 75% or above developing chronic diseases such as diabetes or high cholesterol within the next three years. We chose diabetes and high cholesterol because they are the key drivers of strokes and heart attacks which affect 60 Singaporeans every day. Every day 60 Singaporeans either have a heart attack or stroke. Many of these cases can be prevented if early actions were taken such as through lifestyle adjustments and medication. This AI risk assessment tool will be rolled out to doctors for all healthier SG enrolles from early 2027.

If the two flexs a patient as high risk, the doctors may recommend more significant lifestyle adjustments and instead of three yearly annual check uh three-ear checkups, maybe annual checkups and these additional screenings will continue to be subsidized under healthy SG. The second initiative I think is an exciting and significant one and a breakthrough which is to use genomics to strengthen preventive care. Dr. Hammed Razat asked about this. We are born with our genes. They shape our biological blueprint. And indeed, many diseases are linked to our genetic characteristics. But we need not be fatalistic about it. Genes are not our destiny. How we live, how we manage risk matters a lot. So we do not go fumbling through our genetic blueprint hunting for blemishes and possible mutations that we know little about.

It will create a lot of anxiety and all of us will become a nation of hypocchondrics. So instead of shooting in the dark, instead of shooting in the dark, we should focus on the parts of the blueprints that are illuminated by science. This means taking a disease-specific approach, identifying genetic characteristics that we know drives certain diseases and for which we know there are established preventive interventions and treatment pathways. And this is what we did for FH, a familiar hypo cholesterolmia. And that we did that last year. And FH is a genetic condition that increases the risk of heart attacks even amongst young people.

The FH genetic testing program offers subsidized genetic testing for individuals with abnormally high cholesterol levels and if they are tested positive, we will offer the same test to their immediate family members. This is what we call cascade testing. And by doing so, we try to identify as many individuals as we can in Singapore with the FH genetic mutation. And then we take steps to reduce their risk of future heart attacks and strokes. And we will now move on to our next genetic condition which is HBOC, hereditary breast and ovarian cancer. In Singapore, it is estimated that one in 150 individuals carry a mutation in genes such as the BRAA 1 or BRAA 2 that are associated with HBOC. Such a mutation substantially increases a woman's lifetime risk of developing breast and ovarian cancer.

From December this year, we will offer subsidized genetic testing to at risk individuals for HBOC, such as individuals with a family history of HBOC or breast and ovarian cancer. They will undergo genetic counseling before and after the test. And if they test positive, we will also offer the test to their immediate immediate family members. Cascade testing. We expect over 2,000 individuals to be eligible for the tests annually. We will make the test affordable. In addition to subsidies, the cost of the test can also be offset using Medisafe. For those found to have the mutation, they will be offered suitable preventive interventions. Typically, this means more frequent breast MRIs or mamograms or oral medication. Patients will ultimately decide in consultation with their doctors which intervention is appropriate.

A minority may opt for surgical interventions. Members may recall celebrity actress Angelina Jolie after she discovered she have the BRAA one gene mutation she underwent a double preventive mastctomy. I came across women in Singapore who chose to undergo preventive mastctomy to reduce their risk of breast cancer such as MissWendelinto and these women have demonstrated great courage. Unfortunately, they lament that they cannot claim insurance for such surgeries because medic generally does not cover prevention and it is designed to be so for a good reason. is it is to keep coverage focused and premiums affordable. Then private insurance take dressing from medical life. Dr. Hamemed Razat and Miss Sylvia Lim asked about this.

In fact, Miss Stephanie Theo, she's the founder of the nonprofit organization she s her empowerment has raised this issue with me several times. I share your concerns with advances in medical science. The boundary between preventive and curative care is increasingly blurred. If a high-risisk individual is unable to undergo preventive mastctomy, she has a high chance of eventually needing cancer treatments including a curative mastctomy to remove cancerous cells in her breast or cancerous tissue in her breast. There is hence a case for Medishield life to be judiciously extended to cover certain selected preventive surgeries. We are prepared to do so when there's a clear clinical need, minimal risk of abuse. The procedure is suitable for risk pooling through insurance and it does not financially burden the medical life scheme.

risk reducing mastctomies for breast cancer prevention and the removal of both fallopian tubes and ovaries for ovarian cancer prevention fall within these criteria. We will therefore extend medic and medisafe to cover preventive surgeries for HBO later this year. I should add that breast reconstruction is also covered no different from today. This will better support women to harness genomics to better take care of their health. I think this is a meaningful policy change ahead of International Women's Day on the 8th of March. The third initiative is to inject more flexibility in the use of medicave to encourage early intervention and reduce downstream complications. Associate Professor Jameus Lim was right to describe medical expenses as lumpy.

Indeed, it is very well documented that hospital expenses escalate almost like a vertical war towards the end of life. And so even after accounting for inflation, the average Singaporean living up to their mid 80s spends almost four times as much on hospital expenses in the last 10 years of their life compared to the previous 10 years. But that explains the existing design of the Medisafe withdrawal system and why the system is designed like that, why the scheme is designed like that. It has higher limits for more complex treatments and longer hospital stays and you can draw on it as and when you need it. This means the original this meets the original objective of medicave which is to co-pay for major impatient episodes whether they happen unexpectedly or in old age.

With this design, after subsidies, Medish shoe life and Medisafe, nine in 10 Singaporeans pay less than $500 out of pocket for their subsidized impatient bills. However, it is human nature to worry about present medical expenses rather than lumpy potential unexpected or future hospital bills. Hence as a relief valve we have schemes like flexi medicafe and medicafe 500700 to provide flexibility for chronic disease management for scans for dentist visits etc without overly diluting medicave's original objective of catering for this big lumpy hospital bills in O during emergencies but the situation has changed since medicave was implemented in 1984 four. At that time, people in Singapore lived to about 73 on average. Today, we live to 85 and beyond. On one hand, it continues to be important to preserve medicine for big hospital bills.

On the other hand, as people live longer, the need to spend on preventive care and chronic disease management also go up. Hence, I can appreciate the repeated and various calls by members to allow medicave to be used more flexibly to cover more chronic diseases or as Mr. Pam Singh suggested to pay for higher private insurance premiums. But I also hold the realistic view that no matter how frequently Mo reviews the medicave scheme, how much we liberalize and expand its usage, the public and members of this house will continue to press me and Mo to liberalize the scheme every year during the COS and probably outside of the COS. It is the karma of this scheme because it is designed to be the lynch pin of the healthcare financing system.

It must always navigate between present and future health care needs between recurring disease management and the major hospitalization episodes. Tradeoffs are inherent in the medicafe scheme. It is zero sum. Using more balances for recurring recurrent medical expenses means having less in the future when we are hospitalized and vice versa. And when the tension becomes too severe, we will have to consider raising contribution rates so that you have a bigger pot to spend. The tension is therefore deliberate and a design feature. It is a balance we must constantly and carefully manage to ensure the system of co-ayment is held together while ensuring affordability and keeping CPF contribution rates reasonable for everybody.

Hence we continue to have ongoing regular reviews to study where we can expand the use of medicafe and provide more flexible withdrawals. For example, we recently increased the flexi medicafe limit for seniors and we doubled the annual limit for diagnostic scans. This time we will make further changes to the medicine 500700 scheme. This scheme helps patient pay for the recurring cost of managing conditions on the chronic disease management program or CDMP. Mr. Chai, Mr. Jerroam asked about this. So today, individuals with a simple chronic condition can use up to $500 a year, while those are with complex chronic conditions can withdraw up to $700 per year to provide more support for preventive and chronic care in the community. We will raise Medisafe limits from $5700 to $71,000.

This will benefit over 910,000 patients who currently tap on the scheme, roughly 20% of whom have annual bills exceeding the withdrawal limit. We will also expand the list of conditions covered under the CDMP to include hyperthyroid hyperthyroidism and hypothyroidism. In addition, we are studying whether we can include other chronic conditions such as eczema in the CDMP. With the above enhancements, we will rename Medisafe 500700. It's actually a cumbersome name. Every time you change the limit, you change the name. Uh we will rename it to Medisafe chronic and preventive care scheme to reflect the scope of coverage. The changes will be effective January 2027. Before I end this section, let me address the question posed by Miss Suvelim. Miss Lim, I thank her for watching my Tik Tok videos.

She mentioned the role of riders in providing additional coverage for cancer patients not on the cancer drug list. The objective of the recent changes to the IP riders is to prevent the over erosion of co-ayment because that sets off a buffet syndrome and then that leads to rapid escalation of private hospital bills. IP riders covering nonCDL drugs for outpatient treatment do not contribute to this erosion and therefore this feature will not be affected by the changes. I should also point out that the changes to IP riders affect only new policy holders but not existing policy holders. We will always watch out for the case cancer patient when we make changes to IP writers. Mr. Chairman, when I informed the house three years ago that we'll be a super age society this year, it was not to instill fear but to prepare ourselves.

Our transition to a super aged society has been steady rather than dramatic. It reflects deliberate long-term planning, including transforming the healthcare system. Indeed, healthcare transformation is fundamentally a long-term endeavor, not one sweeping reform. It is the accumulation of numerous small steps, each taken with judgment and purpose, each carefully planned and executed. And today today we announced further deliberate steps. Mr. Chairman, it is my hope that this house continues to support our approach of long-term planning, long-term governance to anticipate future challenges early and act before they overwhelm us. If we do so, we need not fear being a super aged society. We can embrace it and we can make the best of it. Ultimately, it is not the percentage of Singaporeans above 65 that defines us.

We can exercise our wiser minds to mourn less for what age takes away from us than what it leaves behind. What matters is that Singaporeans are not just living for longer. We are living healthier for longer. We are not just a super age society but we are striving to be a super healthy one as