Forum: Time to strengthen private-public healthcare partnership

In Prime Minister Lee Hsien Loong's broadcast message on March 12, he referenced efforts to free up intensive care units (ICUs) and hospital beds to add capacity for Covid-19 (Covid-19 situation is serious but under control in S'pore: PM Lee, March 13).

While it is prudent to ensure resources are allocated to our fight against Covid-19, this results in many elective treatments being postponed, which is contrary to the desire to "carry on with our lives".

Electives, while not urgent, should not be neglected. Left undiagnosed and untreated, they can escalate to more serious issues.

Patients have shared their difficulties in scheduling elective procedures at public hospitals, but yet many cannot go to private hospitals because of restrictions in insurance coverage and costs. Colleagues in public hospitals have also voiced concerns privately about the expected surge in the elective caseload post-pandemic.

Professor Dale Fisher, an infectious diseases senior consultant at the National University Hospital, was quoted as saying that a lot of elective surgery needs to be done in the next three to six months, and the healthcare system must start adjusting to deliver services if Covid-19 is prolonged (Coronavirus: Elective surgery cannot be put off for too long, and mild and severe cases may be handled separately, says expert, ST Online, March 12).

So it was heartening to hear the Health Ministry's director of medical services Kenneth Mak affirm that the Government is exploring partnerships with the private sector.

The Public Health Preparedness Clinic network is a good example of a public-private partnership (PPP) that improves access to primary care. However, PPPs have enjoyed limited success in tertiary care, because the cost structure of a private hospital is high, leading to a huge gap in prices between private and public sectors.

Fortunately, recent years have seen the emergence of alternative models of care, such as standalone endoscopy facilities and ambulatory care centres (ACCs) with a full suite of hospital equipment and short-stay wards.

ACCs also deliver consistent and high-quality outcomes through focusing on a few high-volume procedures. Meanwhile, investment and operating costs are kept low because they need not cater to all disease types or employ a night shift of staff.

ACCs in Singapore, partnering specialists who price their services reasonably, offer accessto private healthcare at prices that match B2 subsidised rates in public hospitals for many common procedures.

The Ministry of Health should leverage this model and do more to lead a systematic approach towards building a sustainable PPP that will benefit patients, insurers and taxpayers.

Now is the time to start working on how the private and public sectors can help one another, stay calm, and carry on with our lives.

Louis Tan (Dr)