FEB 17 — As Singapore’s population ages, its healthcare needs are changing rapidly. This necessitates a re-assessment of how healthcare is delivered and how funds for it are spent. Here are four suggestions on how the Budget can be adjusted to realign the system.
First, do more to move care from hospitals to the community and home. Singapore has built a remarkable system of hospitals, polyclinics and a network of GP clinics that deliver high-quality healthcare.
When the population was younger and the focus was on treating acute illness, this approach worked well. However, continuing on the same tack by building new nursing homes and long-term care facilities may not be enough as a solution to an ageing population with chronic diseases.
A more effective approach would include increased use of community and home care to deliver healthcare services to the elderly at or near their home.
Train the caregivers
Singaporeans tend to prefer not to send their loved ones to long-term care facilities — but at the same time, they do not have the resources to effectively care for older folk with chronic diseases. It makes sense to support families with community and home-based resources such as visiting doctors, nurses, mobile health clinics and community health centres.
Furthermore, aged care often requires a multi-disciplinary approach beyond just nursing or medical care, and may include social, psychological and spiritual aspects. Developing training resources for families, community health workers and volunteers in such non-medical aspects could go a long way in building community resources to support our ageing population in their homes.
We need to explore innovative models for providing access to aged care services. These days, most Singaporeans have access to television, Internet and mobile phone services in their homes. Media and telecommunication companies can collaborate with service providers to offer, say, medication ordering, eVisits to GPs, dietary management and personal health record management targeted at the elderly living at home. Our Government needs to continue to support and incentivise innovation in this area.
Sharing the load
Second, ageing is going to result in labour shortages in the healthcare sector; increasing productivity is a key to softening the blow.
Most long-term care institutions now are run by voluntary welfare organisations (VWOs) focused on using their limited resources to deliver the best care possible. As a result, the sector is significantly behind in technology adoption. With support from the government, IT and new technologies (such as point-of-care electronic medical records and remote patient monitoring) can be deployed on a large scale to help reduce some pressure on the workforce at the VWO institutions.
Another area ripe for investment is in back office functions, where both primary and the long-term care sectors have limited IT adoption. As a result, day-to-day operations typically involve multiple staff making phone calls and faxes to manage purchasing of supplies.
Shared services, such as group purchasing organisations with enabled electronic ordering capabilities, could both reduce cost and increase the efficiency of operations. Encouraging the private sector to develop these capabilities could address concerns about choice in the market place for such services.
Getting patients and families to participate in managing chronic conditions can also improve efficiency. For instance, by enabling patients to collect periodic blood glucose data and upload it online where a GP or nurse can monitor for abnormal changes, patient visits to clinics can be reduced.
Government investments in shared infrastructure — such as 24-hour medical call centres staffed by trained nurses who can access patient information online and answer patients’ questions — can not only bring down the cost of care but also be an easy resource for the elderly. Rethinking some areas of healthcare in the same way the banking sector has done can increase efficiency and create convenience.
Career pathway, not dead end
Third, government funding could be the catalyst for a fundamental shift in talent development that increases high-quality jobs for Singaporeans and reduces reliance on foreign labour in the healthcare system.
One shift could be to develop a “Jobs to Career” programme that will attract Singaporeans into jobs in the long-term care sector. Today, for example, entry-level staff often just assist the elderly in the activities of daily living such as bathing and feeding, which holds limited appeal for many individuals.
Instead of offering jobs like these with little chance of upward progression, government funding could enable care facilities to create training programmes in collaboration with local universities that encourage Singaporeans to enter the field and use it as a pathway to develop credentials for higher level jobs.
Knowing that they can receive training and university credits to become a nurse, dietician, physiotherapist, facility administrator or other professional could incentivise more people to work in long-term care setting.
Other countries face similar issues in their healthcare sectors. If Singapore can develop a model that takes in staff without medical training and turns them into skilled healthcare professionals, it could export the model. This government investment could thus also be a catalyst for a new industry that helps other nations expand their own healthcare resources.
Robots for healthcare
Finally, focus on leading-edge research and development.
Singapore already has a multitude of high-end research labs at A*STAR, NUS, NTU and other institutions. These have developed innovative products such as NTU’s humanoid robot NASH, which has potential application in home care, and A*STAR’s online health monitoring platform for the elderly.
By channelling more government funding into research on healthcare technology such as robotics and sensors, for example, Singapore could create a medtech cluster focused on solutions that support aged care, which could have a huge flow-through effect on the economy. The additional funding for research would have the multiple benefits of providing better healthcare for Singaporeans, creating high-end jobs and expanding exports in a rapidly growing sector. — Today
* R. Raghunathan leads the consulting practice of PwC Singapore. He and his team provide consulting services to healthcare organisations here and in the region. Murali Gangadharan is a director in PwC’s healthcare consulting practice based here, and has spent the last year working with stakeholders in VWOs that run long-term care institutions.
* This is the personal opinion of the writer or publication. The Malaysian Insider does not endorse the view unless specified.
