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REACH 336 - What are your views on the Government’s shift from the traditional focus on illness-based hospital care to patient-centred preventive care? How can we encourage others to adopt a healthier lifestyle as a form of preventive care?

(SK)

11 Apr 2022 (10am - 7pm)

REACH

[10:04 am, 11/04/2022] +REACH: Dear Contributors,

Welcome back! 😊

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[10:05 am, 11/04/2022] +REACH: 📢 Topic 📢

Dubbed Healthier SG and announced last month during the Ministry of Health's (MOH) budget debate, the initiative aims to get general practitioners, family physicians and the community to play a larger role in spotting diseases earlier and keeping people out of hospital as much as possible. It outlines a “major reform of the healthcare sector”, including the integration of GPs into the public healthcare ecosystem and focus on preventive care.

💬What are your views on the Government’s shift from the traditional focus on illness-based hospital care to patient-centred preventive care? How can we encourage others to adopt a healthier lifestyle as a form of preventive care?

The five core components of the Healthier SG strategy are:-

📌 1: Mobilisation of our network of family physicians

MOH will reorganise care delivery, starting with transforming primary care to be an important pillar of the healthcare system. This requires the integration of primary care providers, especially General Practitioners (GPs), into the public healthcare ecosystem. MOH will partner the three healthcare clusters to better support the GPs who are operating within their region and integrating them more closely with the overall health system, such as by enabling data sharing and building up team-based care.

📌 2: Care Plans

Singaporeans will be encouraged to visit the same family physician clinic regularly for all their care needs and discuss their health goals. This could include completing key preventive care actions, addressing risk factors early and exploring together how to achieve health goals and delay the onset of diseases. Some proposals include exploring how to make recommended health screenings even more affordable, providing better coverage by Community Health Assist Scheme (CHAS) subsidies and/or MediSave at their chosen doctor, or offer insurance premium discounts for those who diligently follow their Care Plans.

📌 3: Community partnership to support better health

MOH will leverage community partnerships to strengthen support for residents by partnering agencies such as the Health Promotion Board (HPB) and Agency for Integrated Care (AIC) to provide programmes and services to help residents keep healthy and well in the community. MOH will also explore how we could extend such collaborations to private hospitals.

📌 4: National Healthier SG Enrolment programme

Each resident will be invited to enrol with a family physician of their choice as their first line of care, who would support them across their life-course for different health needs and care episodes, to ensure continuity of care from 2023. Family physicians may work with the polyclinic or hospital in the management of patients with more complex needs. This partnership will allow the care team that is supporting the patient to coordinate an integrated seamless care. A geographical approach will be used to enrol residents so that each individual can get care and support near where they live.

📌 5: Support structures and policies

MOH will put in place structures and policies to support the healthcare reform and shifts needed. These include: further investing in manpower and strengthening the training focus on delivering care in the community; reviewing financing schemes to focus on delivering key health outcomes; and building up critical support pillars in technology and data.

More info on Healthier SG is available on MOH’s website:

https://www.moh.gov.sg/news-highlights/details/promoting-overall-healthier-living-while-targeting-specific-sub-populations

👉🏻https://www.channelnewsasia.com/singapore/family-doctor-gp-healthcare-healthier-sg-2551331

👉🏻https://www.straitstimes.com/singapore/health/after-covid-19-spore-faces-far-more-challenging-pandemic-of-chronic-illnesses-like-diabetes-ong-ye-kung

👉🏻https://www.straitstimes.com/singapore/politics/budget-debate-push-to-get-singapore-residents-paired-with-gps-from-2023

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[10:38 am, 11/04/2022] +BL: Copy the private insurance companies and do rewards schemes to encourage healthier lifestyle. Also offer discounts on premiums, or 'upgrades': https://www.aia.com.sg/en/our-products/aia-vitality.html

[10:40 am, 11/04/2022] +BL: Already thinking about it! Mr Ong said: "Perhaps we can ....offer insurance premium discounts or vouchers if we diligently follow our care plans, or even better still, show good outcomes."

[10:41 am, 11/04/2022] +BL: Not sure I like this idea: "Once you settle on a doctor, you'll have to commit to see him or her for a period of time, for instance, a year, he added." I don't want to be committed to a Dr if I don't like them or want other opinions. Also creates a closed system for a doctor which can make them complacent.

[10:43 am, 11/04/2022] +BL: And please don't use the UK as an example of Health Care - it's pretty awful over there. Dr are leaving in droves. People are generally very disatisifed: https://www.bma.org.uk/bma-media-centre/thousands-of-overworked-doctors-plan-to-leave-the-nhs-bma-finds

[10:44 am, 11/04/2022] +BL: I'm not sure I agree with this model either: "MOH will provide the healthcare clusters with a pre-determined fee for every resident living in the region that they are looking after, Mr Ong said. This funding shift - from the current workload-based model - will give hospitals a natural incentive to try to keep residents healthy through preventive care."

[10:45 am, 11/04/2022] +BL: If they are getting paid regardless, they might be less likely to provide care.

[10:46 am, 11/04/2022] +BL: How will it be measured independently? Since the Dr themselves are the ones deciding. How will they be held to account?

[10:46 am, 11/04/2022] +Caleb: To see doc will it be a flat rate?

Or polyclinic will be cheaper?

[10:47 am, 11/04/2022] +BL: For example, here is a GP being asked if GPs can do it: The question is whether GPs here can provide this service or not, said Prof Tan who, as a family physician, has patients whom he has seen for 20 years. "And I think we can, if you look at how the GPs have stepped up to help fight Covid-19." - it's like asking someone would you like to be paid regardless of the work you do? of course everyone will say yes.

[10:49 am, 11/04/2022] +BL: Is it about saving money, or providing appropriate health-care? I believe in preventative measures of course, and appreciate flexibility. I'm not sure being 'locked-in' to a GP for a year to handle all my health care issues is the right approach. How can 1 GP be an expert in everything?

[11:25 am, 11/04/2022] +Guillermo Cabeza: I’m not keen on having to choose a GP - too limiting in terms of one particular doctor’s expertise vs one’s particular ailments. Also in my experience GPs would rather prescribe medicine than talk through healthy alternatives.

[11:32 am, 11/04/2022] +Sunshine Pooh: My GP refers me to the hospital specialist. Cos he is A GP.. general practitioner. He cannot be the expert in all diseases and I am not sure if they wld be ready to accept n recalibrate medications of someone who had many chronic illness

[11:49 am, 11/04/2022] +BL: Yes, this is what happens now. If this works, then why change it so that we always have to see the same GP just to get a referral? Not sure I understand the point. Maybe we should focus on more on making information more widely available and using online GPs more, if we just need referrals.

[11:56 am, 11/04/2022] +Guillermo Cabeza: agreed

[0:39 pm, 11/04/2022] ☸️ Danny 心:

Preventive care rather than cure - will be more cost effective to bring down healthcare costs through patient-centred preventive care than illness-based hospital care.

[0:39 pm, 11/04/2022] +Rama: Agree

[0:40 pm, 11/04/2022] +Rama: Definitely

[2:01 pm, 11/04/2022] ☸️ Danny 心:

1. My close friend suggestion to relook at healthcare reform to bring down the Nation healthcare spendings (and thus reduce the increasing yeatly fiscal budget) - is the right key that will help to arrest the ever escalating healthcare cost :-

Preventive care is a pre-emptive approach to prevent, detect any problem to our health before it happen or become serious - and nip the health problem at its bud.

It will be less costly as early treatment can prevent any problem that manifest into a bigger health problem at a greater healthcare cost - to both the people and the State which offer subsidised co-payment.

2. My close friend suggestion to allow greater autonomy for family physician (or pharmicists) to treat mild conditions - also resonate with the new Government 1st core component strategy of "1. Mobilisation of our network of family physicians" - of providing care-delivery with a team-based approach at the regional level close to the people residing in the neighborhood.

3. Finally all the rest of the Government 5 core components in preventive healthcare - make alot of sense to prevent serious illness from manifesting ---- which in the long run - the aggregating outcome of hospital needs will be greatly reduced - as many serious illness can be prevented and tackle early before it become serious ---- which thus will prevent our Nation healthcare cost from ballooning year after year as our population ages.

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[2:13 pm, 11/04/2022] ☸️ Danny 心:

1. Citing from my experience, my family members enrol in the bi-yearly healthcare screening programme with our nearest polyclinic - look after by a team of GPs.

2. Bi-yearly we will undergo a full-body healthcare check to look at our chloleterol level, blood sugar, blood pressure, blood test, urine test plus other necessary tests to ensure we are at the pink of health.

Any early symptoms will be prescribed with the necessary medications together with advice of appropriate exercises to keep fit, appropriate diet etc.

3. If specialist advice is needed, the GPs will refer the case to the specialists in the hospitals.

4. Though bi-yearly healthcare screening cost are incurred for my family - the cost is much lower than if any serious illness requiring hospital care.

Also we live with a peace of mind as we live a healthier living.

5. Hence, these Government 5 core component of preventive healthcare strategy resonate with me and my close friend ---- and I believe in the long run will help to arrest the ballooning healthcare cost every year that require a more costly hospital-care plus a less healthy aging population.

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[2:13 pm, 11/04/2022] +Smiley face: Government healthcare expenditure is estimated at $13.2 billion in 2020, and this is expected to triple to $36 billion by 2029. The Fitch report, however, estimated a modest rise for private healthcare expenditure, from a forecast of $8.2 billion in 2020 to $13.5 billion in 2029.

[2:15 pm, 11/04/2022] +Smiley face: Budget 2022: Healthcare spending to form bulk of increase in social expenditures by 2030

https://www.straitstimes.com/singapore/budget-2022-healthcare-spending-to-form-bulk-of-govt-expenditure-by-2030

[2:16 pm, 11/04/2022] +Smiley face: Already, the country's spending on healthcare has tripled to $11.3 billion in 2019, from $3.7 billion in 2010.

[2:18 pm, 11/04/2022] +BL: Yes, even a basic annual health care screening is the best preventative care.

[2:28 pm, 11/04/2022] +BL: How much is private and how much is public?

[2:35 pm, 11/04/2022] +Anne: Dear G, if your goal in preventive care is to spot disease earlier and keeping people out of hospital, then I’m out, because your mental model is still based on sickcare rather than healthcare. Many medical doctors are trained to focus on diseases and not health. How many hours are they trained on nutrition? I was told, at most 1/2 day out of their 5-year medical course in university. If medical science places so little importance on nutrition, which is one very important aspect on prevention, why should I trust a medical doctor for overall health advice? Also a medical doctor spends like 5-10 min with each patient. How do you expect any form of meaningful health dialogue to take place within 5-10 min? When I’m with a TCM physician, the consultation takes at…

[2:48 pm, 11/04/2022] +Caleb: +1

[3:04 pm, 11/04/2022] +Guillermo Cabeza: well said!

[3:08 pm, 11/04/2022] +Sunshine Pooh: polyclinics or GP may not have the expertise or time to do the full evaluation. As Anne pointed out, they only review 1 patient for barely 5mins. many a times not even spending time with the patient to understand other underlying matters. this contributes to diseases not being detected early or mental well-being of patients being neglected. there has to be a holistic review of how healthcare is being adopted and delivered to the pple

[3:09 pm, 11/04/2022] +Rama: So, having a dedicated and GP at Polyclinic cost is better and more productive!?

[3:24 pm, 11/04/2022] ☸️ Danny 心:

1. To do justice to a team-based approach with a team of GPs (in may case the Polyclinics) - it is not a 5 minutes or 10 minutes affair with the GPs.

2. My family experience is - we spend at least half a day with the polyclinics doing a series of test by medical professionals with the various specialist medical expertise.

3. Eg. blood test are taken by medical professional.

Medical Scientific readings are recorded.

ECG are taken by specialists radiographers.

MRI are taken by MRI specialists.

Blood pressure, BMI etc are recorded by trained medical professionals.

Notice that polyclinics and even hospitals - are operate in a team-based rather than one GP. The team have consultants on top of the GPs and any peculiar medical anomalies will be refer to their team specialists and even hospitals that have the required expertise.

4. My family experiences (including my extended families experiences) with the Government Polyclinics and Hospital Services are very positive.

And to do justice to the Government medical services - a big Thumb-up.

5. Another important things to note, TCM does perform a secondary role medical care - but not a primary medical care services.

Even China adopt western medical care services as their primary medical care while allowing TCM to play a secondary role.

The sinseh by putting their fingers on a patient pulses even with more than 1 hour - cannot match blood test, ECG, MRI etc specialist medical equipment. ---- This is science.

[3:28 pm, 11/04/2022] ☸️ Danny 心:

6. Eg. By putting a finger on the pulse can detect high cholesterol?

Can detect any growth or anomalies in any organs?

Can detect diabetes?

Etc ?

I only believe in science.

[3:31 pm, 11/04/2022] ☸️ Danny 心:

7. Even sinseh openly advise patients to refer to the polyclinic or hospital when they suspect the health condition is beyond their means of TCM - this is my experience with my Chinese physician when I am younger - as he told me only hospital has the right equipment and specialist.

[4:16 pm, 11/04/2022] ☸️ Danny 心:

My close friend comments:-

When I wrote about prevention-better -than-cure, I was thinking about 养生.

Health checkups do pick up conditions possibly leading to serious illness or detection of early illness.

That's ok, still contribute to lowering overall healthcare costs.

A stitch in time saves nine.

养生 emphasizes on living right. Right forms of exercise, nutrition, rest; right amount, right intensity, right balance etc

So we adopt a holistic view about wellness and target different programmes for different age groups, different population profiles.

Chinese saying 寿而康。 Living to good ripe age and still healthy.

We pride ourselves for living long but we do know that we pay a high price for this longevity. To cut back is also humanly not right.

[4:51 pm, 11/04/2022] +BL: Education is also helpful. Maybe run some workshops so family members can do simple health checks at home. Perhaps make equipment available that is only needed once or twice per year; and can be borrowed easily.

[4:51 pm, 11/04/2022] +BL: By sharing responsibility we take the pressure off doctors. Only need to see a dr if the results are not normal. Not expecting people to self-diagnose, just to see the Dr when needed, not if all is Normal.

[5:14 pm, 11/04/2022] +Smiley face: 2 in 3 working Singaporeans do not have savings to last them beyond 6 months: OCBC survey

https://www.straitstimes.com/business/banking/2-in-3-working-singaporeans-do-not-have-savings-to-last-them-beyond-6-months-ocbc

[6:16 pm, 11/04/2022] +Smiley face: Additional Reading:

https://www.straitstimes.com/business/banking/2-in-3-working-singaporeans-do-not-have-savings-to-last-them-beyond-6-months-ocbc

https://www.straitstimes.com/singapore/budget-2022-healthcare-spending-to-form-bulk-of-govt-expenditure-by-2030

https://www.straitstimes.com/life/feeding-many-mouths-in-a-time-of-rising-costs-how-do-3-big-families-cope

https://www.trade.gov/market-intelligence/singapore-healthcare

https://www.mckinsey.com/cn/our-insights/perspectives-on-china-blog/8-reasons-why-china-is-the-most-exciting-healthcare-story-in-the-world-right-now

https://www.gov.sg/article/quiz-how-many-hospitals-and-polyclinics-do-we-have

Mr Lee Kuan Yew's 10 most significant speeches in Parliament

https://www.straitstimes.com/singapore/mr-lee-kuan-yews-10-most-significant-speeches-in-parliament

[6:45 pm, 11/04/2022] +REACH: Dear Contributors,

⏰ We will be closing the chat in 15 minutes ⏰

Thank you very much for being part of our WhatsApp chat and participating actively.

Goodnight!

Megan

[6:48 pm, 11/04/2022] +~N: The shift is good, and important in view of our changing demographic profile and cost trends. One of the issues of public services is that for the end-user experience, sometimes it's too much control. You want to empower for health ownership, but it seems that you want to empower only this and that way. It's like a strict parent may not always have the desired outcome despite the best intentions. All the plans are great, but please allow for some organic development. With regards to internal issues of the healthcare system, do let us know the costs of recruiting private practice GPs. With regards to community partnership, again it's a great concept, but the culture is different, I hope you put in the right leadership.

[6:50 pm, 11/04/2022] +Bioon: Preventive care should not mean lots of medicine to immediately take, strong anti biotics for common illnesses, immediate steroid based medicines or surgery as an immediate option. Preventive care should not result in doctors frightened to take a gradual approach to medical care. There should be a updated definition of how to interprete preventive care for both patients and doctors.

[6:50 pm, 11/04/2022] +Bioon: doctors.

[6:52 pm, 11/04/2022] +Bioon: Healthier food is a core basis for a healthier lifestyle but today, food is about cheap quantity/GMO food. So, better and more transparent food labeling is important for consumers to make their decisions.

[6:54 pm, 11/04/2022] +~N: What needs less control: The framework for preventive care cannot be too limited

What needs more control: Healthcare and community care system integration

[6:57 pm, 11/04/2022] +Bioon: By enrolling with a family physician, this should not limit a resident’s choice to seek a 2nd or even a 3rd opinion. I personally know of someone who had baterial infection of the eyes that could have caused blindness but 2 GPs dismissed the red eyes as dryness from contact lens (my friend wasn’t wearing contact lens for a while).

[6:57 pm, 11/04/2022] +Darren Chua: On my way.

[6:58 pm, 11/04/2022] +Bioon: GPs need to be re certified to ensure their skills are up to date

[6:59 pm, 11/04/2022] +Rama: I believe there's a ongoing programme

[6:59 pm, 11/04/2022] +Smiley face: 11 April, 2022

To: Distinguished Ministers And Our Honorable Members

"Planning, Paving And Paying Ahead (超前部署)...from the first cry to the last breath, your new close friend maybe your doctor...?"

"Patient's CARE and doctor's CARING, from the consultation rooms to the palliative beds, so important, no money can buy it!

- - anonymous

What can we learn from nations that are facing aging population like Japan, South Korea and China? How each country healthcare and social systems working for their aging population? What's their valuable lessons?

Medical Infrastructure:

There are 10 private hospitals, 1800 GP clinics, 16 public hospitals, 23 Polyclinics. For private healthcare, Raffles, Healthway, Shenton, Parkway, Silver Cross, Q&M are sizeable medical groups and smaller ones making up our PHPC. What's the population and the breakdowns? Singaporeans 3.50 million, 0.5 million of PRs and 1.6 million non-residents.

To look further, we can view these private medical groups as 'contractors' that will bid for service contracts that will be based on number of patients assigned and scope of cares within a cluster of housing flats or a town council. It is a 'maintenance' fees model that relieves public clinics from overcrowding.

The coming total sum of the proposed public/individual from newborns to seniors, this medical heathcare initiative will add ups to higher cost for taxpayers into billion dollars. For the benefits, an increase in early preventions of illness, on timely interventions of illness and better delivery of healthcare services.

Medical Cost:

Medical Cost is one major sudden or can be a long term burden to many families and individuals should unknown illnesses strike upon any human. These unfortunate medical situations happened not only to the elderly but across all age groups. Can a typical middle class family afford such disruptions? Will employer dismisses an employee (non unionised) based on her/his existing medical conditions and needs? What's the rights of such employee (union or non union) in terms of employability, medical claims and the ultimate 'release' from work?

Basic consultation for GP is $38 per patient with additional cost for medications and/or further diagnostics. The cost and benefit analysis - the cost of these PHPCs are twice or triple of the Polyclinics. What are the derived benefits? Can the first 25% of Singaporeans especially the FAMILY MEMBERS of lower wage workers/ low family income / the unemployed / handicapped afford frequent medical treatments from simple sicknesses to major illnesses given the existing subsidises to all Singaporeans? What's the minimum expected dollars to foot for BASIC healthcare to COMPLEX treatments? Is the existing means test of affordability a realistic, robust and up to date system of checks and approvals for Singaporeans?

Perhaps, to save cost, there is a need to identify TOP 100 common illnesses and drugs dispensed for treatments at the GP level. MOH and HSA will have a good knowledge as to what to procure under the GENERIC drugs to lower the overall 'your preferred doctor' costs for all patients and tax payers. For serious or chronic illnesses, these PHPC doctors will refer patient's for further diagnostics or tests to public hospitals or private ones (if patient prefers to self pay or has existing insurance coverage either personal or employer).

Second consideration is the frequency of clinic visitations and hospitalizations. MOH will have the latest figures and trends for these crucial statistics that will be the service model and costing going forward this personalised medical protocol.

Below are suggested 4 broad based frequency allocated according to age groups. All Singaporeans will enjoy subsidised fees on these PHPC visits just like Polyclinics.

Frequency to PHPC Visits-

A) 65 yrs and above & 18 yrs and below - 24 annual visits to PHPC and unlimited access to Polyclinics.

B) 19 yrs to 30 yrs - 10 annual visits to PHPC and unlimited access to Polyclinics.

C) 31 yrs to 50 yrs - 12 annual visits to PHPC and unlimited access to Polyclinics.

D) 51 yrs to 64 yrs - 18 annual visits to PHPC and umlimited access to Polyclinics.

For hospitalisation, the subsidies for public hospitals, room types and the existing medisave/medicare shall remain status quo, if need to, can be changed for better use. Insurance scheme like rider programs for private / public hospitals will remain status quo. How about families with LITTLE or NO emergency funds should a medical crisis arise? How society and policymakers provide any means of 'lending hands' for these families or individuals?

An excellent and robust healthcare system is important for any nation. One lesson learned from the covid pandemics is a country's abilities to scale up and master resources in extreme crunching times and desperate moments such as capability and capacity within one's healthcare system.

The past twenty four months of the war on covid have proven that tangibles like facilities, equipments, doctors, nurses and medicines are keys to a strong and ready medical army, the entire public and private healthcare systems working in sync against one immediate threat-Covid!

What is life?

At the end of the day, there is a price to pay for everything tangibles and intangibles! Can the medisave saves most of us from financial miseries or serves us comfortably into our golden old age of retirement, all of us will need it sooner or later!

There is no escapement from aging, sickness and death. One intangible is, a trusting relationship that is patient's CARE and doctor's CARING, from the consultation rooms to the palliative beds, so important, no money can buy it!

Additional Reading: