Healthcare in Singapore: the present and future

Abstract

Singapore’s rapidly evolving economy and social progress has helped accelerate the milestones of healthcare development in the country.(1) In 1970, a committee on specialisation was commissioned by the Singapore government to look into the development of specialised medical services and postgraduate specialty training. Since then, there has been a steady focus on the development of our healthcare sector and the advancement of medical specialties. This has catapulted Singapore’s health system to a level on par with other advanced nations.(2) Today, healthcare systems around the world spend trillions of dollars annually to tackle the growing challenges in healthcare.(2-6) These challenges include epidemiological transitions of death rates (from maternal, perinatal and infectious diseases to cardiovascular diseases and cancers) and an ageing population with improved life expectancies.(2,7) Current lifestyle trends, which are by and large the result of technological advancements, have led to individuals having an increased number of risk factors, leading to the increased prevalence of multiple chronic diseases.(2,6) These chronic diseases are also increasingly being diagnosed in the younger adult population in the recent years.(2,4-6,8) Such trends will result in greater financial costs for the nation and the individual, and our current healthcare system may not remain sustainable if we continue to invest in and develop what had served us well in the past five decades.(1) It is intuitive that the answer does not lie in ‘more of the same’. An increase in healthcare spending does not always translate to better outcomes due to the complexity of the healthcare situation. The fundamental question that should be asked is what will likely deliver better value or outcome per unit cost in the coming years. The new funding model for healthcare should be one that moves away from the episodic, fee-for-service model to one that is outcome- or value-based for a population. The targeted outcome or value should be patient-centred, with each member of the healthcare system providing for all the needs of a patient as a whole.(9) Members of the healthcare system should no longer be called healthcare ‘stakeholders’. This term is passe, and was used when we built and developed our healthcare system in parts.(1) As we move toward a more patient-centric healthcare system, healthcare institutions and services would be more correctly termed ‘providers’ because they serve as providers for the healthcare needs of a patient. The term ‘stakeholders’ should be reserved for the public, patients, payers (the government, employers or other third-party payers), policy-makers and the healthcare system (the regional health system and their partners). There are three main areas that we can focus on in order to deliver better value – healthcare integration, strengthening of primary healthcare, and collaboration for health in the community. These are further elaborated in the following text.