Singapore's ambitious plan to have one family physician and one health plan for each of its residents will start with those aged 60 and above in the second half of 2023.
With this Healthier SG Programme, MOH aims to shift its focus from "sick care" to preventive care so as to eventually empower every resident to stay on the path to better health.
Eligible residents will be invited to enrol in the programme with a primary care clinic of their choice via SMS, so that they can start a relationship with a doctor who will holistically manage their health.
Those in the 40 to 59 age group will be invited to enrol in the following two years, the Ministry of Health (MOH) said in a White Paper that was submitted to Parliament on Wednesday, for debate in October.
On the first visit, which will be free, doctors will develop a health plan that can include lifestyle adjustments and regular health screenings and vaccinations.
Health Minister Ong Ye Kung told the media at the MOH headquarters in College Road on Wednesday that these are social prescriptions like "how you eat, how you sleep, how you cut down on salt and sugar, quit smoking, exercise, so on and so forth".
Community partners will be roped in to help manage residents' health, as the idea is to move healthcare away from acute hospitals to the community to help keep people healthy. Residents will be able to join free programmes to keep fit, for instance.
A key change that MOH will introduce to get residents on the programme is to make drug prices at participating general practitioner (GP) clinics more comparable with those at polyclinics through a combination of enhanced drug subsidies and drug price limits. This will be done for drugs used to manage common chronic diseases.
With this, people will no longer have to end their relationship with their long-time GPs when they develop diabetes or hypertension just because the drugs for these conditions are cheaper at polyclinics.
MOH will also fully subsidise nationally recommended screenings and vaccinations for Singapore citizens, and waive the need for residents to co-pay 15 per cent of their bills in cash when using MediSave for the treatment of common chronic conditions.
"We are shifting away from co-payment for this basic preventive care to fully support residents (in) preventive care," said Mr Ong.
However, to get Healthier SG off the ground, MOH will have to mobilise family doctors in private practice. It will offer GPs an annual service fee for each enrolled resident.
These doctors will need to join a so-called Primary Care Network, partner a healthcare cluster and be digitally enabled. There are currently 23 polyclinics and about 1,800 GP clinics, of which 670 clinics have formed such networks.
"Healthier SG is probably the most significant change to the health system since Independence. We have had six decades where we emphasised reactive sick care rather than health promotion," said Associate Professor Jeremy Lim, director of the Leadership Institute for Global Health Transformation at the National University of Singapore's Saw Swee Hock School of Public Health.
The incentives under Healthier SG are created to promote health, rather than healthcare and, for the residents, inertia will be the biggest enemy, he said.
It will take years for such a major transformation of the healthcare system to take off.
"Healthcare expenditure may rise initially and even more rapidly as we discover more people who have medical problems," said Dr Wong Chiang Yin, a public health specialist in the private sector.
"We must have the tenacity to stomach this and stay the course before the benefits of Healthier SG kick in at a later stage."
- Additional reporting by Lee Li Ying