This article is first seen at The Lancet Regional Health Western Pacific.
Authors: Chuan De Foo, Hui Xiang Chia, Ken Wah Teo, Aysha Farwin, Jumana Hashim, Gerald Choon-Huat Koh, David Bruce Matchar, Helena Legido-Quigley, and Jason C. H. Yap
Open Access. https://doi.org/10.1016/j.lanwpc.2023.100861
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Introduction
Primary healthcare has emerged as the central point of the Singaporean government’s strategy in addressing challenges posed by an aging population, an increasing burden of chronic diseases, and rising healthcare expenses.
In Singapore, the primary healthcare landscape is primarily shaped by general practitioners (GPs), who handle around 80% of the nation’s primary healthcare appointments. The public sector offers substantial subsidies for primary healthcare services and medications through polyclinics, which are multi-doctor practices.
Consequently, a significant portion of patients requiring prolonged medication for thier chronic conditions opt for polyclinics due to the considerably lower out-of-pocket costs.
Starting from July 2023, an extensive reform initiative named Healthier SG is being introduced in stages over the upcoming years. Healthier SG is designed to cultivate an environment that fosters improved health by harnessing the potential of the primary healthcare system and collaborating with community partners.
The initial phase primarily involves the enrollment of individual residents with their chosen GPs and the formulation of personalized health plans for each enrolled resident. The aim of enrolling residents with GPs is to cultivate robust patient-doctor relationships. This approach empowers GPs to better encourage patients to engage in preventive measures such as health screenings, adult vaccinations, and sustained care thereafter. GPs will also facilitate connections between residents and community partners to address their healthcare and social needs. Importantly, the decision to enroll GPs and residents in Healthier SG is voluntary. Residents are still at liberty to seek primary healthcare services from sources beyond the GP clinic they are registered with.
As the implementation of Healthier SG kicks off, we emphasize three pivotal areas crucial for the success of this healthcare reform.
Ensure that GP’s needs are considered
The Healthier SG initiative aims to expand their GP’s roles significantly, involving tasks like social prescribing, preventive monitoring, administrative duties, and managing drug inventories due to government-provided subsidized medications. This expansion presents challenges, especially for private GPs operating individually, who may struggle to balance these new responsibilities with their existing workload.
Although GPs will be compensated by the Ministry of Health based on per capita enrolment and specific clinical indicators for their expanded duties, concerns exist. There’s a call for a reassessment of the payment model to ensure fair remuneration – compensation might not adequately reflect the additional time and resources required.
Additionally, a comprehensive onboarding process is crucial to familiarize GPs with the clinical criteria and administrative processes for accessing funds. The enrollment rate of GP clinics into Healthier SG remains low, with only 712 out of 1800 clinics participating as of April 2023. With Singapore’s population of 4.07 million residents, more participation is needed to meet healthcare demands. Encouraging more GPs to join the initiative is essential as Healthier SG progresses.
Apart from administrative challenges, concerns also revolve around GPs’ readiness to provide new forms of care, such as social prescribing. The complex social service landscape and referral procedures might leave GPs unaware of available services and appropriate providers. Furthermore, skills like motivational interviewing and counseling are necessary to foster healthy behaviors and connect patients with community partners. Such abilities require training and strong relationships with community services. Despite the Ministry of Health’s plan to have at least one family medicine specialist in each clinic within seven years, immediate clinical and managerial upskilling is needed. This preparation will ensure GPs are equipped to face the challenges of Healthier SG as it launches in July.
Promote digital solutions
Singapore has embraced digital health innovation as a driving force behind its healthcare reforms. The Healthier SG initiative will utilize the Healthy 365 mobile app (H365) to encourage residents’ participation in Healthier SG and to reward healthier lifestyle choices. This app, combined with wearable fitness trackers provided to residents without charge, monitors various parameters including dietary intake, physical activity, and sleep patterns.
Simultaneously, enhancements are being made to GP clinic management systems (CMSs) to ensure compatibility with Healthier SG. These upgraded systems enable doctors to enroll residents, document health plans, make referrals, and submit data to the government.
Moreover, Healthier SG-compatible CMSs will be seamlessly integrated with Singapore’s National Electronic Health Records (NEHR) information system. This integration represents a significant advancement, facilitating healthcare providers’ access to patient health records across both public and private sectors.
Residents can also access their health records and test results through the HealthHub mobile app, empowering them to be well-informed and accountable for their health. Initially, these endeavors aim to assist in the formulation and documentation of a central health plan. The full potential of these IT capabilities, however, will depend on the efficient establishment of a comprehensive system for data sharing among providers, and between providers and patients along with their caregivers.
Foster trust
Building trust is vital for effective primary healthcare, emphasizing the importance of a responsible doctor-patient relationship for immediate and long-term healthcare needs. However, the financial disparity between GPs and polyclinics might hinder this trust. Patients needing ongoing medication often opt for polyclinics due to subsidies.
GPs are usually consulted for minor acute conditions, but a change in mindset is necessary to recognize their role in preventive healthcare. To establish trust, GPs must show accountability for new forms of care under Healthier SG. Financial incentives like free health plan consultations and reward points, along with emphasizing the value of a long-term relationship, contribute to this effort.
The initiative enhances government involvement in primary healthcare, necessitating new collaborations and performance accountability for GPs. This collaboration relies on mutual trust as GPs yield some autonomy. They need assurance of government support and resolution of implementation challenges.
Healthier SG aims to improve Singaporeans’ well-being by reshaping the healthcare system. The dedication of Singaporean GPs during the COVID-19 pandemic reflects their commitment to vaccinations, testing, and case management. This unity reinforces the belief that the primary healthcare sector can achieve Healthier SG’s objectives. To maximize the initiative’s potential, understanding GPs’ needs, using digital solutions effectively, and cultivating trust among residents, providers, and the government are paramount.
Link to the full Article (The Lancet Regional Health Western Pacific):
https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00179-7/fulltext
