Quality of Death Index: Singapore ranked 2nd in Asia, 12th globally

SINGAPORE has emerged second in Asia - and 12th globally - in the 2015 Quality of Death Index, behind Taiwan which was in top spot for the region.

The report by the Economist Intelligence Unit surveyed and ranked 80 countries in five categories, including palliative care and healthcare environment; the affordability of care and quality of care.

Singapore has moved up the rankings since the 2010 Quality of Death Index, where it was ranked 18th as it lacked a national palliative care strategy then. The attention and resources that the government has devoted to palliative care since has paid off.

In affordability of care and quality of care, Singapore was ranked sixth and eight respectively.

For instance, the daily withdrawal limits for Medisave usage for palliative care has been raised and there is no longer a cap on Medisave usage for patients with terminal illnesses. There are also 51 registered palliative care specialists today, up from 33 in 2011.

Dr Angel Lee, chairman of Singapore Hospice Council and senior consultant Tan Tock Seng Hospital, said: "Palliative care is now part of the healthcare language in Singapore. It is the result of the close partnership between policymakers, hospice activists and palliative care providers working together towards better solutions to improve care for the dying. This has brought about positive changes in funding, new services and in-patient facilities, guidelines and new training programmes."

However, where Singapore needs to improve is community engagement as there is a lack of awareness of hospice palliative care.

"While there has been recent efforts to promote advance care planning in the healthcare system, Singapore can do more to encourage candid discussions on palliative care and end-of-life matters; and to enforce the idea that such discussions do not only have to take place when illness strikes," the report suggested. The government too can play a lead role in pushing for community engagement in palliative care.

Capacity is also another issue, especially given Singapore's greying population. Singapore was ranked 20th in terms of capacity for delivering palliative care.

The number of inpatient hospice beds grew from 137 beds in 2011 to only 147 in 2014. Based on Singapore's ageing trend, the government's plans for 360 inpatient beds by 2020 would need twice the current manpower and expertise, the report noted.

Another area of concern is the current financing model for palliative care services as such services are often funded by charities, raising the question of sustainability since charities rely on donations.

Palliative care services at present are means-tested and funded by a mix of government subvention, Medisave and Medifund - but there is a bias towards acute care, the report pointed out.

The report also highlighted the need for doctors and nurses to be better equipped with basic and better palliative care knowledge.

A Lien Foundation survey in 2014 found that only 44 per cent of doctors and 59 per cent of nurses with frequent contact with terminally ill patients in Singapore said they were familiar with hospice palliative care.