Singapore's health care system : what 50 years have achieved

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Contents Preface 1. The Transformation of the Health of Our People: An Overview Health Services — The Early Years Preventive Health Services School health services Maternal and child health services Training and Health Education Unit Public Health Services Curative Services Fiscal policy Development and growth of healthcare professionals Hospitals and clinics Public hospital services British military hospitals Private hospitals Outpatient services Related services Medical Advances in Hospital Services in the Early Years Kernicterus Health Services — The Latter Years 1. Expansion and Enhancement of Services Preventive health services School Health Service Public health services Curative medical services 2. A Well-Trained Workforce Undergraduate and postgraduate training Accreditation of overseas schools Service obligation 3. Restructuring Public Healthcare Institutions (HCIs) HPB and HSA 4. Public Sector Remains Strong and Provides Leadership Providing a benchmark for healthcare Manpower retention — Competitive wages 5. High Standards of Service Through Policies and Regulations 6. Retaining Demand-Side Responsibility While Enabling Affordability 7. Cost-Effective Healthcare 8. Periodic Regular Review and Recalibration of Policies Conclusion References 2. A Brief History of Public Health in Singapor Pre-War Period: 1819–1945 Post-War Period: 1945–1965 Post-Independence: 1965 Onwards Modern Singapore: Emerging Challenges for Public Health and Healthcare Infectious Diseases Chronic Diseases Healthcare Financing 3M: Medisave, Medishield, Medifund Medishield Life: One step closer to universal health coverage? Health Systems Reform and the Regional Health System (RHS) Healthcare Manpower Challenges The Enduring Challenge of Public Health and Disease Prevention An Integrated, Comprehensive Approach to Public Health and Healthy Living The case of type 2 diabetes mellitus (T2DM) Total Workplace Safety and Health (TWSH) Conclusion 3. Evolving the Governance of Public Healthcare Institutions — A Continuous Improvement Journey Introduction Corporatisation Two Clusters Reforming Governance Six Regional Health Systems Strengthening the Horizontals MOHH and IHiS — Supporting the clusters and MOH Agency for Integrated Care (AIC) — Developing and championing primary and community-based care Conclusion 4. Paying for Healthcare Evolution and Innovation — Adding the 3Ms to Subsidies Advent of Medisave Risk-pooling Through MediShield and Other Insurance Private Insurance Plans The Medifund Safety Net A Progressive and Equitable System of Subsidies and Copayment Portable subsidies for Non-government Providers in Long-term Care and Primary Care Strengthening Coverage and Collective Responsibility Managing Costs, Navigating Choices Patient Copayment Influencing Practice Reimbursement Design Governance and Systems Design … But Continuous Building for the Future Conclusion 5. Healthcare Regulation Introduction Licensing and Regulation of Healthcare Services Regulation of Aesthetic Practices Regulation of Human Organ Transplantation Regulation of Biological Agents and Toxins Development of Enforcement Capabilities in MOH Regulation of Health Products Medicinal Products Developments in Good Manufacturing Practice (GMP) Regulation of Clinical Trials The Health Products Act and Medical Devices Strengthening of Pharmacovigilance Activities Moving Ahead Acknowledgements References 6. Fifty Years of Clinical Quality Regulation of Professional Standards Quality Assurance Programmes Sentinel Events Clinical Audit Clinical Performance Indicators Decade of Learning Institutional Initiatives, Clustering and Quality 7. The Growth and Development of Healthcare Professionals Policies and Philosophies that have Guided Manpower Development Professional Self-regulation Health Manpower Development Plan (HMDP) and Other Training Programmes Service Obligation Limiting Intake of the Best Local Students International Healthcare Graduates International Students Postgraduate Education and Recognition of Professional Advancement The Future References 7.1. Dental Manpower Development Dental Manpower Dental Specialists The Centre for Advanced Dental Education Oral Health Therapists References 7.2. Medical Manpower Development Postgraduate Education Specialist Certifi cation Conclusion References 7.3. Pharmacy Manpower Development References 7.4. Allied Health Professionals The Allied Health Professions in Singapore — An Overview Development of the Allied Health Professions in Singapore Training and Education of Allied Health Professionals Regulation of the Allied Health Professions References 8. Nursing Manpower Development Early Beginnings Public Health Nursing Working Conditions Expansion of Community and Home Nursing Professional Regulation Nursing Education New Career Pathways The New Paradigm Nursing Technology Recognition The Next Lap Annex References 9. Health Promotion — Our Journey Introduction Challenges to the Health System The Early Years (From 1950s –1960s) — Getting the Basics Right School Health Service School Dental Service The Formative Years (From 1970s –1990s) — Creating Awareness Through Public Education and Use of Legislation National Healthy Lifestyle Programme National Nutrition Campaigns Anti-Smoking Campaign 2000s — The Expansion Years — From Public Education to Infl uencing Choices to Achieve Better Health for Singaporeans Formation of the Health Promotion Board Healthy Living Master Plan — A Blueprint for Health Promotion Conclusion Acknowledgements References 10. Primary Care The Early Years — Before 1965 Initial Efforts Developing Primary Healthcare Post-War Challenges: Rebuilding and Consolidating Post-War General Practice A New Beginning — The Road after Independence Nursing, the Stalwarts of Care From General Practitioners to Family Physicians The Journey to Recognition for Family Medicine The Enlarging Demand on Public Sector Primary Care The Polyclinics Refi ned: Bigger and Better to Meet Modernised Demands Staying Resilient — Primary Healthcare Challenges Rise of HIV and AIDS A Hazy Situation Fighting the Unknown — Severe Acute Respiratory Syndrome (SARS) New Wave — Influenza A (H1N1) and What’s Next? Great Opportunities Ahead for Primary Healthcare Primary Care Master Plan — Changing the Care Delivery Vision for the Future Acknowledgement Bibliography 11. Singapore’s Hospitals — Introduction 11.1. Singapore General Hospital Pioneering Care 11.2. Changi General Hospital 11.3. Tan Tock Seng Hospital The Birth and Growth Adopting Technology Enabling the Community The Future 11.4. Alexandra Health System Not so Humble Beginnings From Caterpillar to Butterfly Taking Charge in the North Shaping the Future of Healthcare, the Alexandra Health Way 11.5. National University Hospital The Early Days and Close Links with the University Our Trailblazers and their Contributions to Medicine Contributing to Healthcare in Singapore and Beyond Celebrating the Best Talents Nurturing Future Generations of Healthcare Professionals Shaping Medicine for the Future 11.6. KK Women’s and Children’s Hospital Clinical Care Medical Research Education A Legacy of Pioneering Care for Women and Children 11.7. Institute of Mental Health The Early Years of Mental Healthcare The Foundations of Change Beginnings of Multi-disciplinary Care Expansion of Outpatient Services The Training of Psychiatrists Transforming the Care Delivery System Beyond the Walls of the Institution The National Mental Health Blueprint Targeted Mental Health Programmes A New Era of Collaborations Working with GPs Forging Community Partnerships Case Management Empowering Patients and Caregivers References 11.8. Parkway Pantai — An Integrated Healthcare Group Brief Write-Up of Parkway Pantai HCIs in Singapore (A) Hospitals Mount Elizabeth Hospital (Orchard) Mount Elizabeth Novena Hospital Gleneagles Hospital Parkway East Hospital (B) Primary Care Network Parkway Shenton (C) Ancillary Services ParkwayHealth Radiology ParkwayHealth Laboratory 11.9. Mount Alvernia Hospital The Beginning Hospital Development 11.10. Raffles Medical Group 12. Ages and Stages: Five Decades of Community and Residential Services in Singapore Beginnings Pubescence — Growth & Development Adolescence — Growing Pains Scandal and Standards “Not-in-my-backyard” Syndrome — Negotiating Space Utilisation within the Finite Still Growing Appendix 13. Our IT Journey: One Patient-One Record The Evolution of Health IT The Early Years Restructuring and Administrative Systems Clinical Systems Ministry and Stat Board Systems National Clinical IT Initiatives The Future Acknowledgements 14. Traditional Chinese Medicine Early Days Setting Standards and Regulation of TCM Practice and Chinese Medicines Visit to Singapore Thong Chai Medical Institution (Year TBC) Members of the First TCM Practitioners Board 2001–2003 Training of TCMPs Training of CMM Dispensers Introduction of Acupuncture in Health Care Institutions Upgrading Standards and Research Regional and International Cooperation on Traditional Medicines Chronology of Events (Summary) Annex A Annex B Acknowledgements References 15. Global Health — Singapore’s Contributions Introduction What is Global Health? A Flight Away — Importance of Global Health Diplomacy to Us Soft Diplomacy in Health Forging Stronger Relationships Bilaterally Our Engagement at theWorld Health Organisation ( WHO) Association of South East Asian Nations (ASEAN) Asia Pacifi c Economic Cooperation (APEC) Conclusion References 16. Challenges in Healthcare Investing Wisely Moving from Healthcare to Health Providing Care that Matters to Patients 1. Containing Fragmentation of Care 2. Strengthening the Role of the Primary Care Practitioner 3. Services for the Elderly The Business of Medicine 1. Managing International Demand for the Singapore Healthcare Brand — Singapore Medicine 2. Managing Inappropriate Utilisation Resilient Healthcare System 1. Emergency Preparedness 2. Improving Healthcare Productivity Conclusion References Index