SINGAPORE'S healthcare system stands among the best in the world. In 2020, it placed second in the Bloomberg Healthcare Efficiency Index, which tracks life expectancy and medical spending and ranks healthcare systems with the best outcomes. It also ranked 12th in the 2021 World Index of Healthcare Innovation. But like most other healthcare systems, it grapples with worrying issues.
The foremost is a rapidly ageing population, which will significantly raise healthcare expenditure. Chronic diseases - arising from lifestyle risk factors - are also becoming more common, and will pose yet more strains on healthcare infrastructure and financing.
Enter Healthier SG, a fundamental reform of the healthcare system. Healthier SG aims to mobilise individuals and their doctors to focus on preventative care, long seen as a more sustainable solution to the knotty issues of escalating healthcare costs, an ageing demographic and a generally deteriorating health profile.
Currently, Singapore's system is based on a fee-for-care model, where residents seek care when they have health issues. This is reactive. By the time care is sought, the disease has likely worsened, and yet more care would be required. Healthier SG shifts Singapore's healthcare funding towards a capitation model, where general practitioners, mobilised as family doctors, will be paid an annual service fee for each person under their care.
Based on a white paper published recently, residents will be encouraged to choose and enrol with a family doctor who is expected to provide "holistic'' care focused on prevention and improved chronic care. Enrolment is expected to start next year for those aged 60 and above.
Family doctors will receive annual service fees for each person under their care, based on the individual's health risk, scope of required care and progress in preventative care or chronic disease management. They are also to create a health plan for each patient. To oversee the system, three healthcare clusters - National Healthcare Group, National University Health System and SingHealth - will function as regional health managers, each taking 1.5 million residents under their wings.
GET BT IN YOUR INBOX DAILY
Start and end each day with the latest news stories and analyses delivered straight to your inbox.
As Health Minister Ong Ye Kung said in the Budget debate earlier this year, the capitation model shifts the basis of healthcare funding, creating "a natural incentive for hospitals to try to keep residents healthy through preventive care''. To be sure, the devil, as they say, is in the details.
One question centres on fees. Would medication subsidies be extended to private clinics? Doctors in private practice typically charge less than S$30 for consultations, as they also earn from the sale of medicines. How much flexibility would there be for variable fees to take into account more complex cases arising from unhealthy patients? There may be scope, as well, for the government to pay more to doctors who have achieved healthier outcomes among patients under their care.
Singapore's healthcare reform, which takes place on a strong foundation, has come none too soon. Healthcare expenditure has tripled over the past 10 years from S$3 billion to S$10 billion, and may nearly triple to S$27 billion by 2030, according to the white paper. While it is almost inevitable that health deteriorates with age, lifestyle-related chronic conditions, such as high blood pressure and high cholesterol, can be controlled and reduced by relatively simple ways - a healthier diet or regular exercise, for example.
The burden of poor health, after all, falls on everyone even with the comfort of a strong healthcare system and financial safety nets. If Healthier SG can slow the rate of health deterioration by incentivising preventative care, it would go a long way towards achieving sustainable healthcare - and perhaps a lower cost curve to boot.
Keyword added to your list