Health Care Delivery Systems SINGAPORE REPORT

8/12/2019 Health Care Delivery Systems SINGAPORE REPORT

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La onsolacion University Philippines

(formerly University of Regina Carmeli)

Graduate School Department

Name: Allan M. Manaloto, RN Professor: Dr. Claudio Saratan Jr.

Almabella Dumon, RN Date: May 03, 2014

Subject: Management of Health Care Organization

HEALTH CARE DELIVERY SYSTEMS:

S I N G A P O R E

Learning Objectives:

I. Discuss the health care delivery systems in Singapore in terms of its financing,

services, providers of health, and structure.

II. Identify the strong points on health care delivery systems in Singapore.

III. List several issues/challenges and concerns on health care services provided

in Singapore.

I. I N T R O D U C T I O N

Singapore ranked 6th in the World Health Organization's ranking of the

world's health systems in the year 2000 (the only Asian country apart from

Japan, in the top 10 countries). Bloomberg ranked Singapores healthcare

system the 2nd most efficient in the world after Hong Kong. Healthcare in


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Singapore is mainly under the responsibility of the Singapore Government's

Ministry of Health (MOH).

Singapore has evolved a mixed financing system, with multiple tiers of

protection to ensure that no Singaporean is denied access to basic healthcare

because of affordability issues.

1.) The first tier of protection is provided by heavy Government

subsidies of up to 80% of the total bill in acute public hospital wards,

which all Singaporeans can access. The second tier of protection isprovided by Medisave , a compulsory individual medical savings

account scheme which allows practically all Singaporeans to pay for

their share of medical treatment without financial difficulty. Working

Singaporeans and their employers contribute a part of the monthly

wages into the account to save up for their future medical needs and

this is portable across jobs and after retirement (contributes 7% - 9.5%

[depending on age group] of his monthly salary to a personal Medisave

account). As at 31 Dec 2010, the average Medisave balance

is $16,900. This is sufficient to pay for about 9 to 10 subsidised acute

hospitalization episodes (day surgery, immediate familys

hospitalization and certain outpatient expenses).

2.) The next level of protection is provided by MediShield , a low cost

catastrophic medical insurance scheme. This allows Singaporeans to
http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/medisave.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/medisave.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/medisave.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/medisave.html


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effectively risk-pool the financial risks of major illnesses. Individual

responsibility for ones healthcare needs is promoted through the

features of deductibles and co-payment in MediShield. ElderShield, a

severe disability insurance, is also available for subscription by

Singaporeans to risk-pool against the financial risks of suffering a

severe disability. Many middle and higher income Singaporeans have

also supplemented their basic coverage with integrated private

insurance policies ( Integrated Shield plans ) for treatment in the

private sector. Singaporeans must subscribe to the basic MediShieldproduct before they can purchase the add-on private Integrated Shield

Plans. This industry structure preserves the national risk pool and

guards against cherry picking of healthy lives by private ins urers.

Similarly, ElderShield Supplements allow policyholders to enhance

the disability benefits coverage offered by the basic ElderShield

product.

3.) Finally, Medifund is a medical endowment fund set up by the

Government to act as the ultimate safety net for needy Singaporean

patients who cannot afford to pay their medical bills despite heavy

subsidies, Medisave and MediShield.

Those working in Singapore who are not classed as Permanent

Residents (which includes almost all foreign workers and a large proportion of
http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/ElderShield.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield/Medisave-approved_Insurance.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield/Medisave-approved_Insurance.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield/Medisave-approved_Insurance.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/ElderShield/ElderShield_Supplements.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/ElderShield/ElderShield_Supplements.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/ElderShield/ElderShield_Supplements.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medifund.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medifund.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medifund.htmlhttp://en.wikipedia.org/w/index.php?title=Permanent_Residents&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Permanent_Residents&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Permanent_Residents&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Permanent_Residents&action=edit&redlink=1http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medifund.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/ElderShield/ElderShield_Supplements.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield/Medisave-approved_Insurance.htmlhttp://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/ElderShield.html


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expatriates) do not enjoy any subsidized or preferential access to healthcare in

Singapore, despite paying the same tax (usually more) than Singapore citizens.

They can, and do, use the primary healthcare facilities such as general

practitioners, polyclinics at cost, however their quality varies widely: it is normally

recommended to ask locals to advise on which doctors to use. For inpatient

services, the government restructured hospitals provide a reasonably good

service, but it is costly and patients will normally be asked to provide a credit card

and pay a very large deposit upon admittance. The cost of these services can

easily exceed the cost of private healthcare, especially for maternity/childbirth.Many white collar foreigners are provided with health insurance by their

employers. If not, local organizations such as NTUC Income have a number of

schemes, usually with co-payment terms, for health coverage (NTUC is the

National Trades Union Congress, a non-profit making organization). The main

NTUC Income medical plans used by foreigners (called iMedicare) are

configurable to allow patients to visit primary and secondary health providers,

with just their passport and iMedicare card to enjoy immediate, cashless,

treatment (or treatment for a very low flat rate, perhaps just $5). In general,

Singaporeans tend to subscribe to a number of insurance plans, which may

include healthcare, total and permanent disability (TPD) insurance, dread

disease insurance and life insurance. Foreign residents may wish to inquire into

similar schemes. Short-term Foreign visitors to Singapore are generally advised

to ensure that they have medical coverage as part of their travel insurance.
http://en.wikipedia.org/wiki/National_Trades_Union_Congresshttp://en.wikipedia.org/wiki/National_Trades_Union_Congresshttp://en.wikipedia.org/wiki/National_Trades_Union_Congresshttp://en.wikipedia.org/wiki/National_Trades_Union_Congress


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II. HEALTH CARE DELIVERY SERVICES AND HEALTH CARE AGENCIES

Singapores well -established healthcare system comprises a total of 13

private hospitals, 10 public (government) hospitals and several specialist clinics,

each specializing in and catering to different patient needs, at varying costs.

Singapore's medical facilities are among the finest in the world, with over 11,500

well qualified doctors and dentists, many trained overseas. Singapore today has

a mixed delivery model. The public sector dominates the acute care sector,

delivering 80% of the care in this sector. The primary care sector is dominated by

private sector providers, which account for about 80% of the market. In the step-

down care sector (e.g. nursing homes, community hospitals and hospices),

service provision is mainly provided by voluntary welfare organisations, most of

which are funded by the Government for their services rendered to patients.

1. Primary Healthcare Services

Primary healthcare services are provided by professionals usually general

practitioners in polyclinics and private medical clinics within the community.

These healthcare professionals are often the first point of contact with patients.

2. Hospital Services

Singapore have public hospitals comprising of a general hospitals, a

women's and children's hospital, and a psychiatry hospital. General

hospitals provide multi-disciplinary inpatient and specialist outpatient


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services, and 24-hour emergency departments. Six national specialty

centres provide cancer, cardiac, eye, skin, neuroscience and dental care.

3. Dental Services

Public dental services are available through the National Dental Centre

and in some polyclinics and hospitals. The Health Promotion Board

primarily focuses on preventive dentistry, targeted mainly at school pupils.

4. Intermediate and Long Term Care (ILTC)

These continuing care facilities are for patients who no longer require the

level of care dispensed by a hospital, but nevertheless requires continued

care. They are typically required for persons who need further care and

treatment after being discharged from an acute hospital as well as

community-dwelling seniors who may be frail and need supervision or

assistance with their activities of daily living.

a.) Community-based ILTC Services comprise centre-based and home-

based healthcare services that are provided to patients during the day.

a.1) Home Based Services

>Home-based services are provided within the homes of frail

and home-bound elderly. The services address the health and


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social needs of the person and support families in the care of their

seniors. The services include:

Home Medical Care

Doctors visit the patient to provide services such as

consultations, and the assessment and management of the

patient's condition from his or her own home. The primary

aim of home care is to keep clients healthy and functionally

independent at home and in the community for as long as

possible, hence delaying institutional care (such as

admission into a nursing home).

Home Nursing Care

Nurses provide nursing care such as wound dressing,

stoma care and insertion of nasogastric tubes in the patients

own home. These nurses may also play a key role in

managing and reviewing the care plan of the patient, in

consultation with doctors, as well as training caregivers in

basic care.

Palliative Home Care

Palliative home care provides holistic support (e.g.

medical and nursing care) to terminally ill patients and their

families. Patients and their loved ones are supported in their


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homes by a multi-disciplinary team of doctors and nurses,

and for some service providers, social workers as well. The

focus of home palliative care is to improve the quality of the

patients remaining days through services such as pain

control, symptom relief, nursing care and counselling.

Meals-On-Wheels

Daily meals are provided at the doorstep of the elderly

who is unable to buy or prepare meals for him/herself.

Escort / Transport Services

The service allows for arranged transportation for the

seniors medical appointments if he/she is unable to utilise

public transport due to his/her semi-/non-ambulant status, or

if the frail and/or working caregiver requires such assistance.

A medical escort will accompany the elderly, if required.

Ensuite Services

The senior may choose from a variety of care services,

such as personal hygiene, housekeeping, medication

reminder service, mind-stimulating activities and other

personal care tasks, that best meet their needs.


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a.2) Centre-Based Services

Centre-based healthcare services cater to older persons who

require care services during the day, usually on a regular basis. These

centres are mostly located within the community, enabling those in need

to receive services in a familiar environment close to their homes, and

allow working caregivers to conveniently drop off their seniors at during

work.

Community Rehabilitation Services

Community rehabilitation services provided by day

centres (e.g. Day Rehabilitation Centres, Senior Care

Centres) refer to the provision of physiotherapy and

occupational therapy services targeted at people suffering

from conditions that impair their functional abilities (e.g.

strokes, fractures, lower limb amputation). The key aim is to

improve the clients functional status to the maximum level

medically possible, hence allowing them to regain their

ability to perform activities of daily living (washing, feeding,dressing, toileting, mobility etc.) and remain active in the

community.

Dementia Day Care Services


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Dementia day care services provided by day centres

(e.g. Dementia Day Care Centres, Senior Care Centres)

refer to the provision of maintenance day care (i.e. primarily

general monitoring and personal care) and a range of

activities (e.g. therapeutic, social and recreational) to

engage, empower and care for clients with dementia in the

community. These centres serve to support working family

caregivers who are unavailable during the day, who can drop

off their elderly family members at a place that provides thenecessary c are and supervision required for the patients

safety and well-being.

Social Day Care Services

Social day care services provided by day centres (e.g.

Social Day Care Centres, Senior Care Centres) refer to the

provision of care for seniors who need supervision when

their family members are at work. Typically, a social day

care programme includes the following core components: (i)

simple maintenance programmes (e.g. exercises) to help

maintain health and functional status, (ii) activity

programmes (e.g. handicraft, reading, karaoke) to promote

social interactions and quality of life and (iii) caregiver


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support programmes (e.g. support groups, talks) that help

support family caregivers to continue caring for their seniors.

b.) Residential ILTC services care is for patients who stay in these facilities

both in the day and at night. They comprise:

b.1) Community Hospitals

Community Hospitals are intermediate care facilities. They cater to

patients who are fit for discharge from acute hospitals but require

inpatient convalescent and rehabilitative care.

b.2) Chronic Sick Hospitals

Chronic Sick Hospitals provide skilled nursing and medical care on

a long-term basis to older persons with advanced, complicated medical

conditions.

b.3) Nursing Homes

Nursing Homes provide long-term skilled nursing care for older

persons. These older persons do not have families or caregivers to look

after them at home, or the caregiver is unable to provide the level of

nursing care required. Some nursing homes provide care for persons with

special needs like dementia and persons with stabilized psychiatric

conditions.


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VWO Nursing Homes receiving MOH subsidies

Patients who meet the means test criteria are referred by Agency for

Integrated Care (AIC) to VWO Nursing Homes which receive MOH

subsidies. The VWOs provide additional support if the patient requires

further financial and social assistance.

VWO Nursing Homes that do not receive MOH subsidies

Some VWO-operated Nursing Homes are self-funded through their

own fund-raising and do not receive MOH subsidies. Although patients

here are not subsidised by MOH, these VWOs are able to provide thenecessary financial and social assistance to patients who are unable to

afford the Nursing Home fees.

Private Nursing Homes which are under MOH portable

subsidy scheme

Since April 2003, MOH has extended subsidies to patients who meetthe means test criteria and are admitted to accredited Private Nursing

Homes. These homes have set aside a certain proportion of their beds

for patients who are eligible for MOH subsidies and referred by AIC.

This allows for greater private sector participation in the provision of

MOH-subsidized care.

Private Nursing Homes which are not under the MOH

portable subsidy scheme

These are Private Nursing Homes, which cater to full-paying patients.


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b.4 ) Inpatient Hospice Care

An inpatient hospice provides pain management and treatment for

terminally ill patients who are in the final stages of their illnesses.

b.5) Sheltered Home for Ex-Mentally ill

This sheltered home is for patients with stabilised psychiatric

conditions, which require minimal maintenance medication. Patients have

no serious medical conditions that need intensive care and physically fit

with good eyesight and without any severe form of physical or intellectualdisabilities.

b.6) Respite Care

Respite care is available at some of the community hospitals and

nursing homes where provision for short-term care of a few weeks could

be arranged with the institutions separately.

NOTE: Agency for Integrated Care (AIC) is the coordinating agency which

facilitates referrals to Nursing Homes receiving subsidies from MOH.

5. Support Services

Support services to hospitals and primary healthcare programmes include

forensic pathology, pharmaceutical services and blood transfusion service.
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6. Legislations

MOH establishes and monitors legislations to ensure we deliver our

services to Singaporeans. Broad policy guidance often takes the form of

Statutory Acts. These ensure appropriate allocation of resources, and that

we achieve clinical outcomes and professional standards. Legislated

policies also ensure we deliver our services in a manner appropriate to

each patients needs.

7. Traditional Chinese Medicine (TCM We base our healthcare services on Western medical science. However,

our ethnic groups occasionally consult traditional medicine practitioners for

general ailments. Of particular interest is Traditional Chinese Medicine

(TCM).

Interest in TCM and other traditional or alternative medical treatments is

increasing both here and around the world. We are therefore reviewing

standards of training and practice of TCM in Singapore. Our aim is to

ensure a higher quality of TCM practice, for the benefit of patients who

consult TCM practitioners.

SUMMARY OF HEALTHCARE FACILITIES:

2011 2012 2013

No. of Acute 23 25 25


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Hospitals/Specialty Centres

Public Sector 15 15 15

Acute Hospitals 7 7 7

Specialty Centres 8 8 8

Private Sector 8 10 10

Acute Hospitals 7 9 9

Other Hospitals 1 1 1

Total No. of Beds 10,334 10,755 10,968

Acute Hospitals 8,119 8,540 8,753

Specialty Centres 2,195 2,195 2,195


Public Sector 8,935 9,180 9,387


Specialty Centres 2,195 2,195 2,195

Private Sector 1,399 1,575 1,581


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No. of Residential Intermediate and Long Term Care Facilities (by services offered)

Community Hospitals 6 5 na

Chronic Sick Hospitals 3 3 na

Nursing Homes 65 65 na

Inpatient Hospice Care 4 4 na

Total No.of Beds 10,603 10,692 na

Community Hospitals 800 822 na

Chronic Sick Hospitals 228 228 na

Nursing Homes 9,444 9,495 na

Inpatient Hospice Care 131 147 na

No. of Community Facilities(by services offered)

Dementia Day Care 9 10 na


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Day RehabilitationCentres/ Day Care Centres 1

29 38 na

No. of Home Care Providers(by services offered)

Home Nursing 11 11 na

Home Medical 8 8 na

No. of Palliative Home Care Providers 2

(by services offered)

Palliative Nursing 4 5 na

Palliative Medical 4 5 na

Psychosocial 3 4 na

No. of Polyclinics 18 18 18

No. of Public Sector DentalClinics 3

240 239 235

Hospitals 5 5 5

Polyclinics 9 9 9

Schools 226 225 221


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No. of Pharmacies 249 245 247

Public Sector 56 50 51

Private Sector 193 195 196

TOP 10 CONDITIONS OF HOSPITA

2012

Total No. of Discharges ('000) 476.1

% of Total Discharges

1. Accident, Poisoning 8.3& Violence[ ICD10AM: S00-T98 ]

2. Cancer 6.0[ ICD10AM: C00-C96 ]

3. Ischaemic Heart Diseases 3.6[ ICD10AM:I20-I25 ]

4. Intestinal Infectious Diseases 2.9[ ICD10AM: A00-A09 ]

5. Pneumonia 2.8[ ICD10AM: J12-J18 ]

6. Other Heart Diseases 2.6[ ICD10AM: I00-I09, I26-I52 ]

7. Obstetric Complications 2.3affecting Fetus and Newborn[ ICD10AM: P00-P03 ]

8. Infections of the Skin and 2.0Subcutaneous Tissue

[ ICD10AM: L00-L08 ]

9. Cerebrovascular Diseases 1.8(including stroke)[ ICD10: I60-I69 ]

10. Diabetes Mellitus 1.8[ ICD10AM: E10-E14 ]


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Leading causes of morbidity and mortality are major non-communicable

diseases such as cancer, coronary heart diseases, strokes, pneumonia,

diabetes, hypertension and injuries. In 2009, cancer, ischaemic heart disease

and pneumonia together accounted for approximnately 60% of the total causes

of death. These diseases share many common risk factors such as smoking,

obesity, physical inactivity and alcohol consumption.

Are S'pore public hospitals on track to meet future healthcare needs?

SINGAPORE: By 2020, there will be six new public hospitals, which arepart of the Health Ministry's plan to boost infrastructure to deal with the rise in

demand for healthcare services.

But with Singapore currently experiencing a bed crunch at hospitals, are

the ministry's plans on track to meet future healthcare needs? Construction of the

new Ng Teng Fong General Hospital and the adjacent community hospital has

been ongoing since 2009.The new general hospital in Jurong is gearing up for its

opening in December. Preparations include having numerous meetings on

matters like patient management, infection control, and on-site visits to oversee

safety issues. The new hospital hopes to give patients an integrated healthcare

experience, combining critical care service with the streamlining of bills. Foo HeeJug, CEO of Jurong Health Services at Ng Teng Fong General Hospital said:

"The successful smooth opening of a hospital actually requires us to not only

envision the big picture. "Now it's about getting into all the details, ensuring that


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we take note of the specifics about the patient experience, the systems that need

to come out, the instruments that need to be there. "Over in Queenstown, about

2,000 nurses are being trained for the new hospital. The Health Ministry says

training of manpower starts between six months and two years prior to the

opening of a new hospital. Other than familiarizing themselves with the hospital's

new electronic systems, nurses will also be trained to deal with cases specific to

the Ng Teng Fong General Hospital. Kuttiammal Sundarasan, director of nursing

at JurongHealth, said: "Being in the centre of the industrial area, we have a lot of

factories and shipyards... so we expect to see certain type of problems morewhile in NTFG. "For example, we may see a lot of traffic accident patients or

industrial accident patients and therefore we are actually gearing up, in

anticipation of all this. We are gearing up our nurses' training to be able to handle

more complex cases. "Ng Teng Fong General Hospital has also set aside 6 to 12

percent of hospital space to cope with possible surges in demand. These "white

spaces" are typically non-clinical areas, used for administration work, for

example. If emergencies occur, these "white spaces" can be used for extra beds

or operating rooms.

In Singapore, healthcare infrastructure has been ramped up to meet the

demands of an ageing population. There are currently six acute general hospitals

in Singapore. Ng Teng Fong General Hospital will add 700 beds by the end of

2014, and the general and community hospitals in Sengkang in 2018 will add

about 1,400 beds. Between 2020 and 2030, the government plans to build four


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new acute hospitals, with Woodlands as a possible site. The Health Ministry says

the entire planning process from conceptualizing a new hospital to its opening

can take an estimated 8 to 10 years, depending on the size and complexity of the

development. The ministry works with agencies, such as URA, to select

appropriate sites. The eventual size and capacity of a proposed hospital

development is finalized after factors like demographics and site accessibility are

taken into consideration.

Health economist Associate Professor Phua Kai Hong has said it comesdown to demand and supply. While the total number of hospital beds has kept

pace with population growth, he said the growth of the elderly population is not

being responded to. Assoc Prof Phua of Health Policy & Management said: "The

hospital bed supply has been growing at about 1 percent a year for the last 10

years, and some of the newer hospitals have only been commissioned and are

due to open in the coming years. But if you actually look at the population

demand in terms of ageing and the population -- baby boomers will retire from

2010 onwards. "We have done projections in the past to show that this increase

is going to go from 10 percent of population to more than 20 percent within the

next 20 years... So you would expect lots more chronic degenerative conditions."

Singapore residents aged 65 years and above made up close to 11

percent of the population in 2013, rising from 9.9 percent the year before. A

higher proportion of the elderly were staying in older estates such as Toa Payoh,


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Marine Parade and Queenstown, and less than 15 percent in areas such as Ang

Mo Kio, Jurong East and Bedok. Not everyone agrees though that the bed

crunch was due to a lack of proper planning. Rather, it is the area of home care

which needs to be looked into. Dr Lam Pin Min, chairman of the Government

Parliamentary Committee for Health, said: "The truth of the matter is that it is

quite difficult to plan the bed situation as well as the requirements to pinpoint

accuracy. "There needs to be a support system to support both the caregivers

and the patient. I think there is this condition called 'caregiver syndrome' whereby

after a certain number of years the caregivers get stressed looking after the lovedones at home." Several hospitals have started transitional care services to

provide such support. 80-year old Madam Lim spent three weeks at Khoo Teck

Puat Hospital after having a stroke. When she was released, a doctor and nurse

visited her at home for three months. Her caregiver was also trained on how to

take care of her, such as how to tube feed. Elaine Chua, daughter of Madam

Lim, said: "It makes a difference because there is some very basic care which we

can provide to the patient. "It's not necessarily that every time there is something,

that we take out the phone and call 995. Sometimes we just have to discern what

to do." In the short term, the Health Ministry is planning to tap spare capacity in

the private sector. It currently has 50 beds from private hospitals like Parkway

East Hospital and Westpoint Hospital.

Assoc Prof Phua said: "Most Singaporeans would perceive if they go into

that system, at least, not only the quality, but the prices will be monitored very


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carefully. And so if that is the public perception, perhaps if you bring in the private

sector, the private sector would also have to play by the same rules." Associate

Professor Phua also weighed in on long stays at hospitals, saying occupancy

rates are higher in subsidized wards. He suggested the healthcare financing

schemes -- such as MediShield, Medisave and Medifund -- be tweaked so that

instead of being geared towards acute hospital based care, they can be used

towards preventive care and primary care. Piling work on the upcoming

Sengkang General Hospital and Community Hospital is about halfway through.

The 1,400-bed integrated hospital will include 200 "swing beds" for either acutecare or intermediate wards. Professor Christopher Cheng, pro tem CEO of

Sengkang Health, said: "These bed numbers are arrived at by calculating the

projected population needs in the northeast. "This is based on the current

utilization of hospital beds from the citizens around the area, projected to grow in

the future -- 2025 and 2030 -- to close to 1 million. "These are very young

families with young children so the services that we plan will be geared towards

their needs." While the hospital's building is on track, experts say its opening

cannot be rushed. One of the biggest challenges it faces is recruiting 5,000 staff.

Dr Chia Shi-Lu has been involved in the medical manpower planning for the

hospital since 2010. He says hiring senior doctors will be the toughest part for the

hospital that will open in 2018. Dr Chia said: "Sometimes it is very difficult to

commit doctors six or seven years down the road. The problem would be --

probably when we look at staff who are a bit more senior because some of them

might want to retire, they might want to branch off into other aspects of hospital


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available at some of the nursing homes where provision for short-term care of a

few weeks can be arranged.

VI. PYRAMID OF HEALTH STRUCTURE

REGIONAL HEALTH SYSTEMS AS THE NEW PARADIGM: Hospitals

are not only for the sick. Hospitals are most successful if they can help the

residents avoid falling sick. We have been progressively making this strategic

shift in healthcare policy and delivery: going beyond sickness to health; beyond

treatment to prevention, beyond the hospitals to the community. In this new

model of healthcare delivery, hospitals are without walls. Their responsibility

does not begin only when a patient walks into the hospital or ends when

the patient departs. Their responsibility extends far beyond the hospital

walls, going deep into the community at large. They will interact with more

healthy people than sickly ones, trying to get them to stay healthy and managetheir chronic illnesses, avoiding complications and unnecessary hospitalization.

Hospitals cannot do this alone. They need to build a strong network of trusted

relationships with GPs, grassroots organisations, schools, factories,

polytechnics, universities, VWOs and the people . They need to leverage on

these relationships to help spread the health messages, conduct regular

screenings, and persuade people to change lifestyle. [Khaw Boon Wan, Blog

Post 26 April 2010]


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VII. C O N C L U S I O N

All health planners aspire to achieve a high quality, affordable and

universally accessible healthcare system. The relative emphasis on cost, quality,

and access differs amongst different health systems with resultant stark

differences in how health services are designed and delivered. In one study

entitled Public perceptions on health care in Singapore (Jeremy FY Lim), it was

concluded that Singaporeans are confident in the Singapore healthcare system


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and sentiments appear to be more positive when compared to other countries.

There is assurance that the quality of Singapore healthcare is generally high

though there are concerns, albeit not as pronounced in other developed

countries, regarding the affordability of healthcare. Primary and tertiary care

enjoy equally high quality ratings although there is a perception that tertiary

healthcare is less affordable compared to primary healthcare. The confidence in

quality across the various echelons of care in the Singapore system can be used

effectively in promoting right siting .

IX. R E F E R E N C E S

http://www.moh.gov.sg/content/moh_web/home/our_healthcare_system.html

Wikipedia, the free encyclopedia

Myth or Magic, the Singapore Health Care System, by Jeremy Lim.

Documents

Health Care Delivery Systems SINGAPORE REPORT