INFORMATION TECHNOLOGY
is met by private clinics run by general practitioners, public health facilities account for about 80 per cent of total acute hospital inpatient admissions and 40 per cent of total nursing home beds. The remaining demand for beds in acute hospitals and nursing homes is met by a combination of private and not-forprofit health facilities. The bedrock of Singapore’s healthcare financing system is what is known as the S+3Ms scheme —Subsidies plus Medisave, MediShield Life and Medifund—which is based on the philosophy of shared responsibility. This means the government would subsidise healthcare costs, but the people would still have to assume personal financial responsibility for their healthcare through co-payments and voluntary, supplemental private insurance coverage for higher benefits, in order to keep the healthcare system viable and sustainable. It therefore comes as no surprise that Singapore’s total health expenditure expressed as a percentage of its GDP, remains at around 4 per cent. Notwithstanding the accolades Singapore’s healthcare system has garnered, its risk-shifting policy has resulted in an out-of-pocket health expenditure for its population that stands at a whopping 30 per cent of its total health expenditure. To put this in perspective, this is more than double the 14 per cent average for both the ‘OECD’ and ‘high-income’ categories of countries. Such a situation does not bode well for Singapore’s ‘hyper-ageing’ population which is soon bound to confront the double whammy of a higher prevalence of noncommunicable diseases and a corresponding escalation in demand for healthcare services, further driving healthcare costs. It goes without saying that out-of-pocket health expenditure will also rise in tandem, potentially inflicting financial distress on the country’s population. Recognising that the demands of such a rapidly ageing population could possibly render the predominantly
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A SI A N H O S P I T A L & H EA LT HCA R E M A N AGE M E N T
hospital-centric healthcare model unsustainable in course of time, the Singapore government evolved what is called the ‘3 Beyonds’ strategy in 2016, to guide the long-term transformation of its healthcare system. The ‘3 Beyonds’ are namely, ‘beyond healthcare to health’ focusing on health promotion and disease prevention, ‘beyond hospital to community’ focusing on care in the community or at home in lieu of hospital admissions where appropriate, and ‘beyond quality to value’ focusing on researching treatments that provide the best value for money. To support the ‘3 Beyonds’ strategy that reiterates personal responsibility for health and healthcare, a prerequisite is patient-centrism – genuinely putting patients at the centre of healthcare. This translates to taking cognisance of the barriers that stand in the way of delivering truly patient-centric care and eradicating those. The most fundamental of these barriers have to do with information, or rather, the lack of (or limited) access to it for patients.
According to a 2018 study, only an estimated 27 per cent of private licensees in ambulatory care comprising general practitioners, specialists and dentists, accessed and reviewed patient data on the NEHR.
IS S UE - 56, 2022
A patient-centric healthcare system is expected to reduce information asymmetry in the provider-patient relationship, benefitting patients and empowering them in their healthcare decisions and choices. However, such an outcome may not be desirable for healthcare providers, particularly those from the for-profit sector, who have been traditionally leveraging such information gaps to their advantage. Although there are some of these healthcare providers who may seemingly be willing to share health information with their patients, they may only want to do so within a private network – a mutually beneficial arrangement for the entities in the network. Any patient information is strictly shareable only within the network, resulting in information blocking. This restricts patients’ healthcare choices to the entities in the network or increases their healthcare costs (by way of duplicative consultations and tests) if they opt to move out of the network. Singapore has no doubt made some headway with respect to addressing the aforementioned information barriers through their National Electronic Health Records (NEHR) initiative launched in 2011. However, 10 years later, it continues to remain a work in progress. The NEHR, conceptualised to