For the longest time, our community hospitals have been underutilised as rehabilitation hospitals . The latest vision of community hospitals under the Healthcare 2020 Masterplan is exciting ("Community hospital gives glimpse of future care"; Nov 27).
Under the World Health Organisation's Health for All initiative, countries are encouraged to adopt a three-tier system, with primary care as its base, secondary hospitals, and tertiary hospitals with subspecialist centres.
As we are a small country, we did not really require a secondary hospital previously.
With increasing patient load and hospitals reaching full occupancy continually, it is timely that MOH thinks of expanding the community hospitals to take on the role of secondary hospitals.
This will empower primary care physicians and help reduce referral to tertiary care institutions at the same time.
Here are some suggestions:
First, secondary hospitals need general specialists to handle a spectrum of conditions that is too severe for general practitioners but too mild for the tertiary hospitals.
MOH can create a new speciality of community hospital specialists to assume that role.
Second, the original WHO concept involves patients flowing from primary to tertiary care in a timely and seamless manner. The coordinating doctor should ideally be the GP.
When the new community hospital concept evolves, it is key to get the system properly in place and for the public to understand the role of each facility.
A brand new and truly integrated IT system for all practitioners should be in place to harness the potential of this healthcare system.
Third, admitting rights can be granted to GPs to look after their patients who only need intravenous treatment, or for constant monitoring or performing minor surgery.
Fourth, we can learn from Australia and create a category of GP specialists, with interests such as palliation and geriatric care, to see patients both at their own clinics and at the community hospitals.
Finally, the financing of these services must be carefully reviewed. It is time to consider full means testing for the use of community hospital services.
Leong Choon Kit (Dr)
