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5 Patients with HDH and/or conditions co-morbid with HDH may require the use of
medication as part of their management regime. Within the Scheme, we propose that
the Government and purchaser consider the provision of medication for
management with either generic medications (such as those available
for patients in the public sector) or brand-name medication from
private sector doctors. For the latter option, we implore the Government and
purchaser to consider offering subsidies or employ a co-payment option
to ensure financial affordability of the medication.

5.1 We acknowledge that many patients who have traditionally relied on HA services
may prefer the lower pricing of medications available in the HA; vice versa,
patients visiting private sector doctors may prefer the use of brand-name drugs.
To incentivise patients to remain in the private sector for continuous chronic
disease management that includes prescription of medications, we propose that
both options should be available for patients within the Scheme.

5.2 Our economic projections (Chapter 4.3) accounted for the cost of medications
when calculating the cost of disease management and showed that even when
medication is fully subsidised by the Government, there are likely to be cost
savings to the health system, thereby increasing the feasibility of offering subsidies
for medication purchase.

5.3 THE GOVERNMENT MUST CONSIDER

KEY POLICY DIMENSIONS TO ENSURE
EFFECTIVE APPLICATION OF

STRATEGIC PURCHASING

In moving our health system towards one that is fit-for-purpose, in addition to implementing
the Scheme as a specific example of applying strategic purchasing to purchasing primary
care, we additionally propose that further efforts be made to strengthen the strategic vision
of this Scheme. In keeping with the synthesised elements of the various strategic purchasing
definitions (Figure 5.3) (Klasa et al., 2018), we recommend that additional policy dimensions
be considered to complement strategic purchasing efforts as listed below:

Element 1:
Population health, as indicated by information sharing systems

To ensure that policy decisions related to the Scheme are based upon the latest population
health data and information on past provider and purchaser performance, it is critical to
ensure that information sharing systems are in place.

1. First recommended in our 2018 report, there is a need to invest in 21st century
information architecture, which is essential for facilitating continuity of care as patients
navigate across different care settings, such as between public and private sectors. We
recommend that the Government further leverage and strengthen existing
infrastructure, such as the Electronic Health Record Sharing System
(eHRSS) to better link patients with various providers. At the same time, leveraging the
eHRSS allows policymakers to more systematically track population health needs, as
regular population needs assessments are necessary to ensure that policies fill existing
gaps in the system.

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