Singapore’s Healthcare System - What 50 Years Have Achieved

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