Singapore is known to have one of the best healthcare systems in the world. This is evident in its infant mortality rate — which is among the lowest globally — and increased life expectancy, among other outcomes. What's remarkable is that this wealthy city-state spends significantly less of its economy (total GDP) on healthcare than other developed countries with comparable health systems.
While Singapore keeps getting much attention because of the way it pays for its healthcare system, what’s less noticed is its delivery system, according to Dr. Aaron Carroll, a paediatrics professor at Indianapolis-based Indiana University School of Medicine.
With government initiatives and support from the private sector, Singapore is "perfecting how to deliver care to people, focusing on quality, efficiency and cost," Dr. Carroll points out. Primary care, for example, is provided mainly by the private sector mostly at low cost. As care becomes more complicated — and therefore more expensive — Singaporeans turn to the government-run polyclinics. Presently, the country has a system of 18 polyclinics providing services to about 45 percent of patients with chronic conditions.
Dr. Carroll is quick to note that these polyclinics are a marvel of efficiency, with the ability to process as many patients as quickly as possible. This becomes possible as the citizens are encouraged by the government to use their online app to schedule appointments, see wait times and pay their bills.
EHR interoperability is key
This public-private partnership, along with the country's open EHR data sharing method, allows for a more streamlined healthcare delivery approach.
“The electronic health records are all connected, and data are shared between them,” said Dr. Marcus Ong, Singapore's Emergency Medical Services director "When patients are attended to for an emergency, records can be quickly accessed, and many nonemergencies can be then cleared with accurate information." In addition, Singaporeans have identifier numbers that are consistent across health centres and types of care.
Notably, care is relatively cheap. A visit for a citizen costs 8 Singapore dollars for the clinic fees, a little under US$6. Seeing a private physician can cost three times as much, which is "still cheap in American terms," says Dr. Carroll.
When it comes to hospitalisations, however, the public vs. private share is reversed. Only about 20 percent of people choose a private hospital for care. The other 80 percent choose to use public hospitals, which are heavily subsidised, according to Dr. Carroll.
"So Singapore isn’t really a more 'private' system," he writes. "It’s just privately funded. In effect, it’s the opposite of what we have in the United States. We have a largely publicly financed private delivery system. Singapore has a largely privately financed public delivery system."
Source: The New York Times
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