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
Other Hospitals 20 20 20
Public Sector 8,935 9,180 9,387
Acute Hospitals 6,740 6,985 7,192
Specialty Centres 2,195 2,195 2,195
Private Sector 1,399 1,575 1,581
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Acute Hospitals 1,379 1,555 1,561
Other Hospitals 20 20 20
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.