Science Talk: Delivering value – why appropriate healthcare matters

Not long ago, a patient told me her asthma was “fine”.

It was a familiar response — said quickly, politely, almost reflexively. But when we reviewed her asthma questionnaire together, a different story emerged. She was waking up coughing several nights a week and avoiding daily activities she once enjoyed. What she had normalised as “fine” was, in fact, a daily burden.

That short conversation changed the consultation. It shifted my focus from prescribing “just in case” treatments to understanding what truly mattered to her, and how appropriate care could meaningfully improve her life.

Moments like these remind me why appropriate and value-based care (AVBC) should not just be a theory, but a practical and ethical necessity for doctors today.

As a doctor who has spent decades caring for patients and studying healthcare systems, I have seen both the strengths and the growing strains of Singapore’s healthcare landscape.

We are rightly proud to have one of the world’s most effective systems. Yet we face pressures familiar to healthcare systems everywhere: a rapidly ageing population, rising rates of chronic diseases, escalating healthcare costs and patient expectations, as well as a workforce stretched by demand.

It is because of these challenges that AVBC has become not just timely, but essential.

Understanding what AVBC means

Simply put, AVBC is about ensuring all patients receive care that genuinely helps them, at a cost that both the patients and the system can afford.

This means three things.

First, care must be appropriate for the individual.

Being appropriate is not about withholding care, but doing what is medically prudent and meaningful. It means avoiding unnecessary tests, procedures and medications that do not improve outcomes. Sometimes this means doing more; often, it means recognising that less is more.

Second, care must be value-based.

This means achieving the best possible outcomes for patients while using our finite resources wisely. 

And the quality of care cannot be sacrificed to reduce cost, and cost cannot balloon without improving results. Value is not cheaper care or more care, but smarter care.

Third, every decision must be what matters to the patient.

This requires understanding patients’ goals, fears, what they need to live well, and what a “good outcome” looks like to them, and not simply assuming we already know.

At its heart, AVBC means thoughtful, patient-focused, evidence-based practice.

Why AVBC matters now

Healthcare in Singapore has reached a pivotal moment.

The country’s population is ageing at an unprecedented pace, and more people have chronic conditions such as diabetes, lung disease and heart failure. These are not illnesses cured by a single treatment. They require long-term, coordinated and person-centred care, which is precisely what the AVBC approach seeks to achieve.

At the same time, medical equipment and treatments have become increasingly advanced, with some more expensive than others. New tests and therapies can bring enormous benefit, but they can also strain resources if not used judiciously.

If we continue with the traditional way of just adding more beds, tests and referrals, we face the risk of achieving medical excellence but losing long-term financial sustainability.

AVBC is our shared response to this challenge. It allows us to improve outcomes through evidence-based practice, reduce avoidable admissions and complications, and direct resources where they provide the greatest benefit. Furthermore, it empowers patients as active partners in their own care while sustaining our healthcare system.

Around the world, healthcare systems are already making this shift. Singapore is strengthening its own journey to better health, guided by national programmes such as value-driven care, Healthier SG and Age Well SG, and payment models that shift from paying for service to paying for outcomes. 

 Adopting AVBC in medical practice

Transforming care delivery is complex. But AVBC can be put into practice in several ways that guide how we do things on the ground.

The foundation lies in measuring what truly matters. Healthcare improvement is possible when there are good systems that track both medical outcomes and patient-reported measures such as pain levels, daily functioning and quality of life. Such data helps us make better decisions.

Equally important is reducing unnecessary differences in treatment.

When similar patients receive very different care without clear medical reasons, it shows inconsistency instead of informed choice. AVBC addresses this by ensuring standardised, evidence-based care pathways based on established best practices for consistent and effective outcomes.

This approach also focuses on managing costs through medical excellence rather than cost-cutting. Smoother care transitions, fewer unnecessary tests, improved surgical management and cost-effective treatments can together enhance outcomes while managing resources responsibly.

Healthcare sustainability further depends on shifting appropriate care to community settings. Strong primary care, community nursing, and home-based models of care help keep patients well and out of hospital, improving experience and reducing unnecessary hospital admissions.

Patient partnership in decision-making is also essential. Shared decision-making and clear communication ensure that patients are informed, engaged and empowered throughout their care journey.

Finally, building organisational capability and a culture that embraces AVBC is critical to this transformation. Doctors, nurses, allied health professionals, administrators and data teams must be supported through training programmes to change how we work beyond policy directives.

When all these principles work together, AVBC is no longer an isolated healthcare idea. It becomes the default way of how care should be delivered. 

Why patients’ voices matter

A key shift to AVBC is recognising that patients’ voices matter as much as medical test results.

Take, for example, patient-reported outcome measures (PROMs), which ask patients directly about their symptoms, function, mental well-being, and quality of life. These structured questionnaires help us understand whether the treatment given truly improves their daily living. Or patient-reported experience measures (PREMs), which capture how patients experience care, including communication, coordination, respect and trust.

Together, these questionnaires shift the conversation from “What is the matter with you?” to “What matters to you?”, strengthening doctor-patient relationships, guiding service improvement, and helping us to direct resources towards patient priorities. In my own practice, they often reveal concerns patients might dismiss as unimportant, or which doctors might otherwise overlook.

Across Singapore, the growing use of these patient tools is already showing encouraging results, including more engaged patients, clearer understanding of patient needs, and better-aligned care.

How Singapore is reshaping healthcare delivery through AVBC

Across Singapore’s healthcare clusters, it is heartening that AVBC is gaining pace across clinics, wards and communities.

Care plans for chronic diseases increasingly focus on evidence-based practice, prevention, and providing care in the right place. Capability-building through various programmes gives teams practical tools for improvement. Enhanced recovery programmes, prudent use of tests, and imaging optimisation improve outcomes while minimising waste.

Beyond hospital walls, there are programmes that help patients move between different care settings, community nursing and home-based care, as well as partnerships with general practitioners that strengthen ongoing care. PROMs are being added to selected care plans to ensure care decisions reflect patient priorities, even in community care settings.

As funding models evolve, there is also a growing emphasis on prevention, community health, and outcomes that matter over time.

These efforts demonstrate that AVBC is not about doing less, but about doing better, together.

AVBC as a professional responsibility

AVBC is neither a way to save money, nor a passing trend. It reflects our professional responsibility to deliver the right care, at the right place, at the right time, for the right outcome that truly matters to our patients.

It challenges us to reflect on our daily practice: Are we ordering tests out of habit rather than necessity? Do we understand our patients’ goals? Are our care plans improving meaningful outcomes? Are we learning from what patients tell us? Are we managing resources responsibly for future generations?

This approach cannot be improved by policy alone. It requires the commitment of the whole care team and patients themselves. As with our asthma patient, we improved her inhaler technique, simplified her treatment plan, and adjusted her care plan with new goals that reduced night-time symptoms and helped her to return to her daily activities.

When we checked on her next, she was sleeping better and active again. This was the AVBC approach in practice. With it, Singapore will not only sustain a world-class healthcare system, but will also redefine what person-centred, meaningful, and sustainable care truly looks like for the future.

And that is a goal worth striving for.