How S’pore can ride the coming healthcare revolution
The Government, to its credit, has matched rhetoric with action by increasing healthcare funding and launching the Pioneer Generation Package. TODAY File Photo
Governments around the world are looking for solutions to the seemingly intractable challenge of providing high-quality healthcare to all citizens at a cost they can afford.
This challenge is further complicated by rapid changes in technology and manpower shortages across the healthcare sector, leading experts to believe that a global revolution in healthcare is looming.
How would these forces play out here and what should Singapore do to ride this wave of change? For a start, it is noteworthy that the language of healthcare governance here has shifted from the somewhat Darwinian “individual responsibility” to “shared responsibility”.
The Government, to its credit, has matched rhetoric with decisive action by increasing healthcare funding and launching MediShield Life and the Pioneer Generation Package. At the same time, it remains true to the selective use of co-payments to rein in overconsumption and maintains the adroit use of market forces in financing and delivering healthcare.
Co-payment, once condemned by well-meaning activists as unfairly penalising the poor, is widespread in many healthcare systems today and market mechanisms are increasingly used by governments to drive efficiency in healthcare systems.
ADDRESSING THREE KEY CHALLENGES
Beyond sustainable healthcare financing, there are three issues policymakers here should look at to address the challenges confronting healthcare.
First, how can we better tap technology to improve efficiency and reduce cost? At the recent Founders Forum Smart Nation Singapore Reception, Prime Minister Lee Hsien Loong described the use of sensors, remote monitoring and apps to keep seniors connected as a way to “help older Singaporeans age in place and live meaningful and fulfilling lives”.
If we can successfully create innovative technologies, we can radically reduce manpower needs and costs, and provide ground-breaking solutions to share with the world.
However, we need to not merely envision technology as enabling incremental improvements, but also imagine completely new and even radical ways of delivering healthcare.
Not so long ago, it was unimaginable that we could transfer money at any time of the day or night across continents at the touch of a button. Today, it would be unimaginable to not be able to do so. Similar ambition and boldness are needed in healthcare.
Second, how can we reform licensing to provide the most efficient healthcare without compromising quality and the lives and health of our citizens? Healthcare is tightly regulated to provide safeguards against profiteering and unsafe practices that endanger lives.
Due to the difficulty and expenses involved in measuring quality of care and outcomes, input factors such as professional licensure have been used as proxies. This should be re-examined in the light of new technology and the changing practice of medicine.
New data-capture methods and analytics can overcome previous constraints, allowing regulators to be much more imaginative in deciding what and who need to be licensed. Take, for example, prescription, which has traditionally been the domain of the physician. Can nurses and pharmacists also play a part here?
Which other practices restricted to physicians can, in select instances, be successfully performed by non-physicians or even be automated? This is worth a closer examination, given the manpower shortage in healthcare.
In a sign of things to come, Health Minister Gan Kim Yong said the role of pharmacists would be expanded in hospitals, polyclinics and the community setting.
Third, how can we reform the payment regime to one based on outcome and not service? Escalating healthcare costs are the bane of insurers and cash-strapped governments, but may be music to the ears of healthcare providers. As long as financial interests of healthcare providers and consumers are misaligned, healthcare costs will not shrink.
Healthcare has been structured almost wholly as a market in which fee-for-service payment models predominate. This means doctors and hospitals are paid piecemeal for services rendered, regardless of whether patients need them. Fee-for-service was the easiest model to administer in a data-poor age, but is clearly inappropriate today for applying blindly across the healthcare system.
In the United States, the Department of Health and Human Services has announced that it will move half of its Medicare payments to providers from the traditional fee-for-service to fee-for-value by 2018. In fee-for-value models, payers pay for outcomes, thus encouraging doctors and hospitals to innovate and offer only the highest-quality care at the lowest costs.
In Singapore, the Health Ministry has started recasting some payment models. For example, home palliative care is now funded on a “per patient-month” rather than a “per visit” basis, encouraging hospices to harness technology and non-medical staff to provide care where appropriate.
While still being finalised, doctors in the step-down care sector look set to be paid in future based on how well their patients do.
EMBRACING FUTURE CHANGES
So, what will healthcare in the near future look like? In general, we may see the following: More new types of healthcare workers, doctors not just in clinics, but also in control rooms, and healthcare providers being paid fixed rates with bonuses for improvement in their patients’ conditions rather than volume of services rendered.
We may also see insurers genuinely concerned about improving health and health promotion rather than only sickness care.
The implications of these are profound for healthcare policymakers, healthcare providers and the public.
Healthcare policymakers will have to be nimble and embrace the dual role of regulator and enabler. Payers will have to invest in robust and rigorous IT systems to collect and analyse data, so they can truly pay for value. Doctors need to cast aside old mindsets and work together with nurses, pharmacists and even health coaches.
Finally, Singaporeans as patients and society on the whole have to recognise that changes will bring risks. Some innovations will be successful, others less so and will need to be revised or even rejected. We need to accept that we will not always get it right, but such is the privilege and reality of being a pioneer.
Singapore has the opportunity to embrace the future and lead these changes. Doing so will not only enable truly universal health coverage for all Singaporeans, it can also become a model for the rest of the world.
ABOUT THE AUTHOR:
Dr Jeremy Lim is head of the health and life sciences practice for Asia-Pacific at Oliver Wyman, a global consultancy. He is the author of Myth Or Magic: The Singapore Healthcare System. This commentary is the second of a two-part series.
