Primary care physicians to play larger role under Healthier SG
Published on
16 Oct 2022
Published by
The Straits Times
Healthier SG is Singapore's new preventive care strategy aimed at getting family doctors to help individuals take charge of their health. Insight looks at the benefits as well as some of the unanswered questions in this mega healthcare transformation strategy.
SINGAPORE - When Ms Vivien Goh's 81-year-old mother was still feverish a few days after being discharged from hospital in 2021, the family took her to their regular general practitioner (GP), who advised them to have her readmitted.
They did as he said as they knew how familiar he was with her case.
"We trust him with our lives. He's always very careful, very thorough," said Ms Goh, 51, a senior law firm executive.
In fact, the doctor had written an accompanying letter with his clinical findings - he suspected she had a swollen liver - when her mother first went into hospital, but Ms Goh is not sure if anyone there read it.
She believes it is why her mother needed to be readmitted.
"Hospitals need to respect the role GPs play in ensuring our healthcare system works well," she wrote in her Forum letter on Oct 7, arguing that the partnership between GPs and hospitals had to be good if patients were to benefit.
Primary care physicians will play a much larger role when Singapore's new preventive care strategy, Healthier SG, rolls out in the second half of 2023. They will eventually become the first point of contact for patients and oversee their healthcare.
Many questions can be answered only as more details are revealed, but it is undoubtedly a seismic shift in how healthcare here will be oriented away from "sick care" towards prevention at the most granular level. Dr Wong Chiang Yin, a private sector public health specialist, describes it as a "very ambitious, comprehensive and fundamental rethink on how healthcare will be delivered in Singapore".
Over the years, Singapore has come up with various initiatives to tackle the problem of an ageing population and the resulting rise in chronic diseases and healthcare costs, most notably the war on diabetes that was unveiled in 2016.
But the incidence of chronic conditions such as high blood pressure and high cholesterol is still rising.
With one in four citizens expected to be 65 and above by 2030, Singapore's total healthcare spending could rise to about $60 billion a year by then, compared with about $22 billion a year now, according to Ministry of Health (MOH) data.
Returns from Healthier SG, such as savings from less medical expenditure on hospitalisations, better mental and psychological health, and higher productivity because of better quality of life, will take time to show, said Dr Phua Kai Hong, an adjunct senior research fellow at the Institute of Policy Studies.
Costs, on the other hand, can be controlled by managing healthcare supply through primary care "gate-keeping" to limit Singaporeans' demand for specialist and hospital care, he said.
Under Healthier SG, the three healthcare clusters - National Healthcare Group, National University Health System and SingHealth - will get a set fee for each resident in their area of care. Singaporeans will each enrol with a GP or polyclinic physician as their primary doctor, and receive a health plan that will include some paid-for screenings and tests.
For Ms Teresa Koh, 60, this is enough reason to sign up, as she had paid for a health screening out of her own pocket some time back.
She started going to a polyclinic for her ailments after retiring as a buyer of precision engineering parts, but she might enrol with a GP under Healthier SG as the annual check-ups are free.
Another retiree in her late 60s, who declined to be named, said she would keep going to the polyclinic. "It's more convenient for elderly patients like myself," she said. "Most GP clinics are not equipped with services like X-ray and physiotherapy."
Polyclinics now handle the bulk of primary care for chronically ill patients.
There are about 1,800 GP clinics, of which 670 have formed primary care networks (PCNs), receiving funding and administrative support from MOH to care for patients with chronic conditions.
Meanwhile, the Government is getting more GPs to form PCNs to come on board Healthier SG.
Dr Phua, who is now a visiting professor at Nazarbayev University's Graduate School of Public Policy in Kazakhstan, said GPs will be concerned about cuts into current areas of profitability, such as drugs and tests, but this can be managed by giving them an appropriate fee for each patient enrolled with them.
An advantage for today's GPs and patients is the advancements in wearable monitoring technology that can help them keep an eye on the patients' health.
One example was unveiled on Friday with the launch of LifeHub+, a paid personalised health tracking app with a digital platform that links a patient to a GP and a health coach at Alexandra Hospital (AH).
The launch by StarHub was in partnership with AH and health technology company ConnectedLife, using Fitbit wearable technology. Users can opt to track their number of steps, sleep, heart rate, breathing rate, oxygen saturation and more, which GPs can then use to draw up personalised care plans.
More than 30 GPs, who will recruit their patients, have expressed interest in the pilot.
"What the GPs are interested in is that they can use it as a telemonitoring platform," said Dr Alexander Yip, clinical director of healthcare redesign at AH.
The idea is also to try to automate the creation of care plans as much as possible, so that the GPs can spend just a bit of time tweaking it, said ConnectedLife chief executive Daryl Arnold at the launch.
On the Government's end, the National Electronic Health Record (NEHR) system will be enhanced to ensure seamless sharing of patient data among GPs, healthcare clusters and community partners.
MOH has said it will look at how patients can opt to limit the sharing of data in their records.
Professor Teo Yik Ying, dean of the National University of Singapore Saw Swee Hock School of Public Health, said stringent controls on the access and use of NEHR data will be in place as the system is a crucial enabling component of Healthier SG.
There should be strict prohibitions on usage outside the healthcare framework, such as by employers, commercial entities or insurers, he said.
Additional reporting by Zhaki Abdullah
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
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