The impact of stress-related conditions on Singapore’s health system conservatively equates to US$2.3 billion of spend (approx. S$3.18 billion) or 18% of health expenditure according to a new report published today by Cigna and Asia Care Group.

The in-depth research study, which examined nine key markets worldwide, found that between 4% and 18.8% of health spending is attributable to stress-related illness.  Of the markets covered, Singapore has the second-highest costs, at 18%, just behind Australia’s 18.8%.

The report, titled Chronic Stress: Are we reaching health system burn out?, examined the impact of stress-related illness in Singapore, Australia, Hong Kong, South Korea, Taiwan, Thailand, United Arab Emirates, United Kingdom, and the United States. The findings demonstrate that stress translates as one of the largest single areas of spend facing Singapore’s health system today.

These costs are most keenly felt in Singapore’s primary care, where just over 35% of all attendances relate to stress-related conditions. For emergency department attendances, just over 19% relate to stress-related illness and a cost of US$16.7 million (S$22.68 million) and US$4.4 million (S$5.98 million) of cost to government and private sector respectively. 

Stress-related conditions are less obvious in outpatient settings, accounting for only 12% of total outpatient service spend. This may be due to an effective system of referral which ensures that access to outpatient care is controlled via triaging and redirecting patients back to primary care where necessary. However, stress-related illness represents a significant burden on all parts of health systems, and costs are expected to continue to rise.

Chronic stress is a widespread issue affecting people’s physical and mental health globally. It increases the risk of various health disorders, such as depression and anxiety, and is commonly associated with physical illnesses, such as irritable bowel syndrome or lower-back pain.

As well as analysing the health service usage by people suffering from stress-related conditions, the research analysed the usage by people with mental health issues who sought medical help for unexplained physical issues or physical symptoms that are commonly associated with stress.

April Chang, Chief Executive Officer of Singapore for Cigna International Markets, said: “Despite experiencing signs of mental illness caused by chronic stress, many people do not seek medical help straight away, waiting until they experience physical symptoms. This could be partly due to the fact that in some countries mental health is still considered a taboo subject, and seeking help for physical symptoms has more cultural acceptability. Other factors can influence how and when a person seeks help for a stress-related illness, including the health literacy levels of the individual, service availability and insurance coverage. 

“Challenging and breaking taboos will encourage people to seek help earlier, potentially reducing the impact and related cost of stress. Healthcare leaders, government, employers and individuals have a role to play in breaking taboos and encouraging people to talk to someone early and finding solutions.”

Previous studies have established the productivity losses from stress – from absenteeism to a reduction in tax revenue. Asia Care Group and Cigna’s research is the first in-depth analysis uncovering the extensive scale and impact of stress on health systems.

“Capturing health system usage by patients suffering from stress-related illness is complex,” said Thalia Georgiou, Managing Director - Advisory, Asia Care Group. “Chronic stress can manifest as mental health issues, physical symptoms or both.  But people and their doctors may not diagnose the underlying stress-related issues until they have been experiencing an array of symptoms for some time. Through our in-depth research, we uncovered that stress is one of the largest single areas of spend facing health systems today, at a time when they are already overstretched globally with some at breaking point.

“We estimate that over 160,000 admissions in Singapore relate to stress-related conditions.  Identifying patients suffering from stress-related illness earlier in their journey and upskilling hospital staff to detect and manage patients with stress conditions is likely to be highly effective in reducing the burden on hospital beds and financing.”

Although stress will always exist, Cigna believes better awareness, response and diagnosis can help people to live happier, more productive lives, reduce physical illness and avoid these significant misdirected costs on health systems worldwide.

“Cigna has been putting a major focus on the causes of stress and how to alleviate the issue among individuals and employees,” continued Ms Chang. “This latest research from Asia Care follows the findings from Cigna’s annual 360 Well-Being Survey which, this year, revealed that that globally, 87% of workers feel stressed and 12% feel their stress is unmanageable. At 92%, stress is higher among Singapore workers and almost one in eight (13%) say their stress is unmanageable. 

“Also, through our See Stress Differently programme, we have collaborated with doctors, educators and engineers to create an innovative way to visualize the effects of stress on the body and mind. We are also helping people create a personal Stress Care PLAN to take control of their stress.”

The findings of this research indicate a need for system-wide action to address both the causes of stress and to ensure systems are in place to provide timely support to those experiencing stress-related conditions.  Employers, healthcare leaders, payors and hospitals can do much to help reduce the impact of chronic stress. This report makes recommendations about how to help prevent stress-related illness, ensure effective treatment and recovery for people with a stress-related illness and better monitoring and evaluation.

“Our ambition is to help people change their behaviour and to start their own ‘stress care’ to highlight that by taking care of stress they are potentially avoiding serious, a chronic illness which can develop from un-managed, chronic stress,” continued Ms Chang. “We are also working with our employer clients to adopt strategies to create healthier workplaces for both the physical and mental well-being of their employees.”