It should reform payment models and encourage public-private collaborations in innovations
The challenges facing Singapore healthcare are formidable. Singapore needs another 30,000 healthcare professionals to help meet growing demand driven by a senior population that will double in size in the next 13 years and an explosion of chronic diseases which now afflict half the adult population. To compound matters, the Ministry of Health's (MOH's) budget has ballooned ninefold - from $1.2 billion in 2000 to $11 billion last year. All this in the midst of a slowing economy.
With these stark realities ahead of us, radical changes are necessary. The MOH has recognised this and has taken bold steps to transform the healthcare system, including reorganising the public system into three clusters. The changes are complex but the MOH has done an admirable job succinctly distilling the imperatives into three "Beyonds" - Beyond Healthcare to Health, Beyond Hospital to Community, and Beyond Quality to Value.
Recent announcements about adopting video consultations and the upcoming Woodlands Health Campus' plans to adopt "data analytics and AI (artificial intelligence) to improve patient care" hint at embracing technology as a much-needed potion to boost our ailing system. But we need to move beyond piecemeal, glitzy technology roll-outs and instead integrate technology in much more systematic and strategic ways. Four interwoven considerations are worth highlighting.
Under its Beyond Quality to Value imperative, the MOH is pivoting away from a fee-for-service model towards one in which payers pay for outcomes and results.
An oft-simplified definition of value is "outcomes divided by costs" and, to make meaningful value trade-offs, it is necessary to have data on both the numerator (outcome) and denominator (costs). A national electronic health record system is thus vital. Previously, it would have been simply too difficult and expensive to collect high-quality data on outcomes and costs but advances in IT now make this possible. Singapore has made tremendous strides in systematically collecting and analysing clinical and financial data but more needs to be done.
Our data is largely confined to what happens within hospitals, with very limited visibility of patients' experiences and costs at home and in the community - we need to extend the electronic reach to include these. It is a shame also that so many of our healthcare facilities outside the public ecosystem are standalone and not connected to a wider, national electronic health system. Wiring up and then integrating the entire nation's healthcare providers electronically should be a key priority for policymakers.
We also need to recognise that financing models must change fundamentally to exploit all that technology enables. If claims can be made only for in-person consultations, video consultations and even self-care will never take off. If insurers still generously fund inpatient episodes but limit or even exclude homecare payouts, as many do, the exciting possibilities technology offers for telemedicine will be strangled in a vice of archaic reimbursement models.
Let's be realistic - funding drives care delivery. We can pontificate all we want but nothing will change and Beyond Hospital to Community will remain a pipe dream - until funding changes. The Government, being the biggest payer of healthcare services, should rightly lead the way. It has tremendous influence and must cajole other payers such as private insurers and employers to do likewise.
Behaviours and lifestyle choices are critical determinants of chronic disease risks. But behaviour change is hard and generic counselling to exercise regularly, not smoke, drink alcohol in moderation and avoid excessive red meat is simply a waste of time. Instead, lifestyle advice should be based on individual profiles (biochemical, physiological, psychological and social) and life goals.
Why should Amazon and Netflix know so much about their customers that they can recommend what we should buy or view but our health professionals are limited to offering insipid general advice? Programmes such as AIA's Vitality and the Health Promotion Board's National Steps Challenge are helpful in introducing analytics and incentives but more needs to be done. The use of AI is crucial here, not only for the pinpoint personalised insights but also for the much lower costs of doing most of these automatically, leaving healthcare professionals to focus only on the most complex cases.
There is one Facebook employee for approximately 70,000 active users. What's the equivalent in healthcare? As long as the healthcare model remains dominated by the face-to-face, one-to-one individual care episodes, we will never be able to achieve what Singapore must achieve - high quality healthcare at low costs for every Singaporean.
Finally, we need to be bold. We are in uncharted waters. The health challenges are without historic precedent in Singapore. Globally, there is no model to follow. What this means is that the public and private sectors need to come together to co-create innovative solutions. Akin to start-ups, the MOH will have to learn by "trial and error", find like-minded partners to plug competency gaps and succeed through rapid course corrections.
Is relying on traditional procurement models with tenders for "fixed" deliverables the right construct? Would this run the risk of settling for mediocrity or yesterday's solutions? It sounds heretical but instead of a tender and an ensuing customer-vendor relationship, would we be better served by a partnering set-up? For example, Verily Life Sciences, part of the Google enterprise and pharmaceutical company GSK, announced last year they would jointly contribute $960 million over a seven-year period to develop miniaturised, implantable devices to treat illnesses in an exciting new field called bioelectronics. No commitment as to what these devices would look like or how they would work, but a commitment to create the future together.
As with our much-vaunted "water story", Singapore healthcare has the opportunity to make a virtue of necessity. To overcome the healthcare challenges, we need to bring together the different threads of world-class partners, cutting-edge technology overlaid on sophisticated national electronic platforms and new financing models driven by a bold vision and an even bolder government.
The writer is partner and head of health and life sciences for the Asia-Pacific at management consulting firm Oliver Wyman.
A version of this article appeared in the print edition of The Straits Times on April 26, 2017, with the headline 'Healthcare sector needs to make strategic use of IT'. Print Edition | Subscribe
We have been experiencing some problems with subscriber log-ins and apologise for the inconvenience caused. Until we resolve the issues, subscribers need not log in to access ST Digital articles. But a log-in is still required for our PDFs.