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Healthier SG lowers hospitals’ load and cuts spending

Healthcare reform in Singapore empowers general practitioners and family doctors to provide preventive care in communities.

With the establishment of ambulatory care centres, some of Singapore’s big hospitals resolved their overwhelmed capacity. This same strategy is applied with The Ministry of Health’s Healthier SG, which seeks to place higher focus on preventive care with an ecosystem-based approach that engaged general practitioners and community care centres, offloading the burden from tertiary care hospitals.

“The main idea behind Healthier SG is to shift the emphasis of the healthcare system from treatment to prevention. In the long run, this will produce better health outcomes for the population at a lower cost. For this to happen, the locus of activity needs to shift from hospitals to community care providers, particularly GPs,” Dr. Alan Ong, principal at Boston Consulting Group (BCG), told Healthcare Asia

Patients can go to a family doctor first, and build that relationship and trust with them

Under the health reform, there are four goals: i) deploying family doctors for preventive care, developing health plans for lifestyle adjustments; ii) regular health screening and vaccinations, activating community partners to lead healthier lifestyles; iii) launching national enrolment exercise for residents to commit to seeing one family doctor and a health plan; and iv) setting up IT and manpower plans as well as financing measures to operate Healthier SG.

Naithy Cyriac, a Partner at YCP Solidiance, said the health reform also helps create a more seamless patient journey. For example, patients will first go to family doctors for preliminary health assessment; and for further consultation, they may be transfered to other tertiary hospitals.

She noted that since some community care centres might not have the most sophisticated medical equipment, a bigger hospital will act on the treatment that will need advanced technology. “Instead of patients directly going to bigger hospitals, they can go to a family doctor, first, and build that relationship and trust with them,” said Cyriac, in an interview with Healthcare Asia

Another way that health reform can help big hospitals is to promote the role of primary care through smaller clinics that large private hospital networks have now been focusing on. Cyriac cited Raffles Medical Group, IHH Healthcare, and Fullerton Health as some of the well-known healthcare groups investing in primary care facilities.

“The large private hospital groups are actively engaging their customer base by sharing insights on their website and allowing residents to register interest/enrol for the Healthier SG initiative easily,” said YCP Solidiance’s Cyriac.

The implementation of Healthier SG relies on the national enrolment programme, which will be in phases starting in the second half of 2023. The Ministry of Health will encourage residents aged 60 years and above to enroll with a family doctor in mid2023, followed by those in the 40-59 age group in the next two years.

Lower healthcare spending

A major goal of Healthier SG is to reduce long-term growth in healthcare expenditures. Preventive care is often substantially cheaper than treatment, whilst also resulting in better health outcomes for the population. Evidence for this comes from systems such as Kaiser Permanente which have a strong emphasis on prevention woven throughout all aspects of their interactions with patients, said BCG’s Ong. However, it is also important to recognise that cost savings will take time to materialise.

Ong said the initial phases of Healthier SG will boost recommended health screening and to increase uptake of regular follow-up and management of chronic diseases.

“This will have a short-term impact of increasing strain on the health care system as more people are found with medical conditions, and more people come forward for the management of their chronic conditions,” Ong said.

“However, in the long run, earlier detection and intervention will result in a lower burden of disease. It is therefore important to plan with an understanding that Healthier SG will take time to show the desired outcomes of lower cost and better quality of life,” Ong explained.

YCP Solidiance’s Cyriac said Healthier SG’s goal of lowering cost is a long-term effect, given the reform’s phased approach.

The idea is that the reform seeks to address vulnerability to chronic disease by enabling patients to have regular annual consultations with their family doctor for early diagnosis and treatment of potential symptoms linked to chronic diseases, Cyriac said.

Doing this would reduce the number of patients diagnosed with chronic illnesses in the long run, resulting in fewer patients in need of long-term care on a five- to ten-year timeline, she said.

One way of lowering the cost of healthcare under Healthier SG is also implementing more affordable drugs. This is where the pharmacist’s cooperation with GPs and family doctors will come in.

“Since more people register with GPs, it will be easier to deliver the screening in a community base. For example, through local clinics, people can receive recommended diabetes screenings to identify patients’ health conditions. With the increased screening coverage, patients could be identified at an early stage,” Chia Hsuan Lin, an analyst at GlobalData, told Healthcare Asia.

“It will be essential for GPs and pharmacies to provide medical consultations and personal advice,” added Lin. Spending on early-stage

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