Page 61 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

and facilities are highly centralised, with several national organisations besides the Ministry of
Health governing public health and medical services, and coordination with accredited
private PHC facilities is now a priority of the healthcare system.

PHC is currently available at the 20 subsidised public polyclinics and more than 2,300 private
GP clinics (Ministry of Health of Singapore, n.d.-b). Over the past decade, Singapore has
made progress in strategic purchasing for PHC. In 2014, the Community Health Assist
Scheme (CHAS) was expanded to allow Singaporeans to seek PHC at subsidised private GP
clinics, with SGD 42 millions allocated in the first eight months of the scheme (Lim, 2017).
Several programmes have been launched by the Ministry of Health to mobilise both public
and private healthcare stakeholders and address chronic disease prevention and expand the
capacity of GPs in PHC, including the Chronic Disease Management Programme and the
development of Primary Care Networks (PCN). The Chronic Disease Management
Programme is a systemwide framework that allows patients to use MediSave benefits to pay
for the cost of chronic disease management, including for diabetes, hypertension,
hyperlipidemia, and stroke (Wee et al., 2008). The PCNs scheme is a national programme
connecting private GPs with a shared mission to improve holistic chronic disease care and
management in PHC through private GP settings and with a multidisciplinary team of
clinicians and allied health professionals (Commonwealth Fund, 2020b; Ministry of Health of
Singapore, n.d.-a). As of 2018, the Ministry of Health has committed an annual budget of
SGD 45 millions per year for the PCNs scheme (Ministry of Health of Singapore, 2018).
Currently, there are 10 PCNs with more than 350 participating private clinics, and the MOH
provides direct administrative, financial, and workforce capacity support to PCNs. Since
2015, studies have shown that PCNs can improve health outcomes among diabetic and
hypertensive patients seeking care in private PHC facilities, and are worth allocating further
financial investments into for sustaining equitable and effective PHC (Luo et al., 2018).

Innovative strategic purchasing of private healthcare to manage chronic diseases was also
evident. The Singapore General Hospital (SingHealth) Delivering on Target (DOT) Programme
is one such example. Singapore General Hospital is a tertiary hospital wholly owned by the
government and a member of the SingHealth cluster of healthcare institutions (Singapore
General Hospital, n.d.). In 2005, the SingHealth DOT Programme was launched with the
objective of “right-siting”, or referring, patients with stable chronic conditions from Specialist
Outpatient Clinics (SOCs) in public healthcare facilities to partner private GP clinics for ongoing
treatment and management (SingHealth, n.d.). Right-siting patients was enabled through
various patient incentives, including laboratory test vouchers and subsidised prescription
drugs (Yeo et al., 2012). Other benefits include patients being matched with DOT GPs who
are near patients’ homes, GP consultation charges capped at a maximum of SGD 28, fast
track referrals back to SOCs as subsidised patients if specialist care is required for severe
cases, subsidised medication with the option for delivery to patients’ preferred address, and
continual follow-up with Right-Siting Officers who engage as the liaison between patients
and healthcare providers (SingHealth, n.d.). Besides reducing long wait times for care, the
DOT Programme also aims to reduce unnecessary utilisation of specialist resources and thus
reduce costs while also providing greater community health and lifestyle outcomes.

Evaluation of the DOT Programme shows favorable outcomes over the past decades. In
2016, more than 85% of DOT patients remaining in the programme for more than one year
were assessed to be highly satisfied with the support offered by right-siting officers in
coordinating their care between SOCs and private GP clinics (Ho and Chew, 2016). There
were also benefits to the public sector as they offloaded more of the care burden through
right-siting. The average waiting time for subsidised patients to seek care at SGH Diabetes
Centres was reduced from eight months to 28 days. Savings for public hospitals were
projected to increase if right-siting capacity grows, leading to long-term reduction in total
health expenditure, but savings on healthcare are still being evaluated from longitudinal data
collected on the DOT Programme (Ho and Chew, 2016; Yeo et al, 2012).

59