The Changing Face of Healthcare The Asia Pacific (Singapore) Story DrLee Chien Earn CEO Changi General Hospital AdjA/Prof Saw Swee Hock School of Public Health Singapore Challenges Wave #3: Increasing Burden Of Chronic Diseases Wave #2: Rapid Ageing of The Population Wave #1: Rapid Growth In Population Vulnerable Groups e.g. Legacy Old 2 1
Changing Demographics and Impact on Demand for Healthcare Services Youth base narrows as fertility rate declines Elderly patients generally require longer stays and seek acute care services more frequently Account for 9% of population but 40.5%of total inpatient-days Compounded by falling birth rates, leading to an increasing dependency ratio (1980) Population 2.4 million (2010) Population 5.1 million 3 From Mortality to Morbidity Death Rates Per 100,000 Among Residents Aged 35 to 64 200.0 160.0 120.0 80.0 40.0 > 50% of total Disability-Adjusted Life- Years (DALYs) due to living with ill health or disability (YLD) Others Diabetes Mellitus Mental Disorders Neurological, vision & hearing disorders 0.0 1990 2000 2010 Cancers Cardiovascular diseases Source: Ministry of Health BURDEN OF DISEASE BY BROAD CAUSE GROUP SINGAPORE (2007) 4 2
Healthcare Cost Medical Advances Ageing Population New Drugs New Technologies Detection Increased Incidence of Chronic Illnesses Serious Illness Survival Rates Pressure on Healthcare Costs Triple Aim Singapore version Health Wellness Centric Aim is health not healthcare From Episodic ( snapshot ) to Longitudinal, Whole System approach to measuring and managing quality Care To Live Long, Live Well and with Peace of Mind Value From Cost to Costeffectiveness 3
Life-Cycle Approach Asymptomatic Stage Before Onset of Disease General health promotion Educational interventions Health Screening Symptomatic Stage Screening for Hypertension and cardiovascular disease Treatment Other prevention of Stroke Functional Decline Acute care Treat co-morbidities Adjustment Phase Care by Family Physcian Home care and rehab Stabilising functional condition Intervention to mitigate further disability Prevention of recurrent stroke Improve quality of life Functional Recovery Multidisciplinary rehab Starts in acute care Continues in CH Prevention Disease Stage Recovery 7Management of Stroke NATIONAL SCORECARD Measurement at the Macro, Mesoand Micro Level to support change management PUBLIC HOSPITAL SCORECARD PROVIDER / SPECIALTY-LEVEL SCORECARD 4
Person Based Outcomes Outcomes should be measured along multiple dimensions, including survival, ability to function, duration of care, discomfort and complications and the sustainability of recovery Functional level Acute Care Lasts days to weeks Active Rehabilitation Lasts weeks to months Maintenance Activities Lasts months to years 9 Source: MOH Phases of Rehabilitation Time Creating a health promoting ecosystem Whole-of- Singapore Government Private Sector VWOs Media Healthcare (egs. polyclinics, GPs, hospitals) (egs. Clubs, faith-based orgs) Capacity Building Development Councils Citizens Consultative Committees Other Grassroots Organisations Champion, own and drive health promoting activities by proactively engaging members of the ecosystem Sports/ Recreational (egs. sports halls, parks) Development Councils Consumer (egs. shopping malls, food courts) Residents within the Ecosystem Enablers used to influence members of the ecosystem and impact the health of the community Empowerment & Education Supportive Environments Research & Surveillance Educational/ Child Care (egs. schools, child care centres) Other (egs. workplaces) Policies & Guidelines 5
Health Promoting Ecosystem * Recommended Screening Tests Screening for: Diabetes High blood pressure Lipid disorders Obesity Breast cancer Cervical cancer Colorectal cancer Settings Screening Providers Primary Care (GPs) / Polyclinics Workplace Company Doctors Screening Providers Follow-up Screening Database Supportive Environment for Follow-Up interventions Medical Follow-Up Workplace Targeted Intervention CDMP Database 1. Subsidised screening & Follow-up 2. Data collection - central system 3. Quality Assurance & Capacity Building 4. Monitoring & Evaluation * Reference: Screening Tests Review Committee s Recommendations, 2011 Creating Social Movements From Bystander to Activists Creating a Critical Mass Army of 10,000 Health Ambassadors 6
Not only physical health..mental health too Network of care and support systems to improve access, reduce stigmatisation and enable integrated community living for patients General community-based mental health services Dementia services Specialist-Led Assessment & Shared Care Team (ASCAT) Allied Health-Led Mental Health Intervention Team (COMIT) Patient & Caregiver Develop psychiatric long term care facilities 13 New Care Model Needed to for Quality Care Hospital centric model is not sustainable Need to integrate care for patients to be cared for in the most appropriate setting and move seamlessly across care settings 14 7
Redefining Role of the Hospital Hom e Sc h o ol Chronic Disease Centre/ Polyclin ic Nursing Home Com muni ty Hosp ital Hospit al Neigbou rhood Link with Social Day Centre NP P FSCs* with Wellness Centre Dementia with Rehab Day Care Centre Shops/ GP Clinic * FSC: Family Service Centre NPP: Neighbourhood Police Post Transforming Care: From Silos to Systems Prevention and Early Diagnosis Primary Care Secondary/ Tertiary Care (Outpatient) Secondary/ Tertiary Care (Inpatient) Step Down Care End-of-Life Care From Institution to Population Based Care - Screening & Prevention Polyclinic Family Physician Rehab Centres Patient Acute Hospital Nursing Home Hospital Palliative Care JHS NUHS Alexandra Health NHG SHS EHA Patient education & empowerment IT Infrastructure Manpower capability and capacity Well Frail elderly 8
Invest for greatest impact Value Based Service Planning Enabling Key Sectors A multi-pronged approach to transform primary care to enhance chronic disease management in the community support Team-based care for better outcomes Closer collaboration between GPs and other providers National IT system that includes GPs linkages Transforming Primary Care Increase delivery options Enabling infrastructure to support chronic disease management Financing Schemes Portable Subsidies Start up support 18 9
Enabled by Dynamic Information Management System - Provider Enable adherence with best practice Reduce duplication Enhance safety Evaluation and outcome measurement NEHR Enabled by Dynamic Information Management System _ Patients EMR IT strategy Health Management Unit Personal Health Manager Improve tracking of patient issues Reduce frequency of visitation Enable better patient self health management Outcomes Telehealth Integration Optimise Resource Utilisation 10
THANK YOU 11