New Primary Healthcare Initiatives

18 Aug 2000

As part of the overall strategy to upgrade the level of primary healthcare, the Ministry of Health (MOH) will launch two new schemes on 1 Oct 2000:

a    "Comprehensive "Chronic Care Programmes" at selected polyclinics; and

b    "Primary Care Partnership Scheme" involving selected private general practitioners (GPs) in treating patients for common medical conditions.

MOH will be working in partnership with Community Development Councils (CDCs) to assess the eligibility of Singaporeans for subsidy under the 2 schemes.

Restructuring of polyclinics

MOH had announced in Nov 99 that it was reorganising the public healthcare system into two vertically integrated delivery networks to provide more integrated and holistic healthcare to Singaporeans. The Ministry had also announced that it was restructuring Alexandra Hospital, Woodbridge Hospital and the polyclinics.

The restructured polyclinics will be integrated with the acute hospitals in the two healthcare delivery networks, Singapore Health Services and National Healthcare Group. This is expected to result in better management of patients, especially those with chronic illnesses, across the polyclinics and hospitals through integrated programmes. The restructured polyclinics will also have more operational autonomy to improve their efficiency and quality of care, and to respond faster to changing healthcare needs.

The Ministry will also undertake upgrading works for the older polyclinics. The scope of works includes upgrading existing facilities and setting up of essential IT systems to integrate the information systems of the polyclinics with the hospitals so that they can provide more integrated care for patients. The restructured polyclinics will be gearing up to provide higher spectrum services, including higher level screening programmes such as mammography.

Comprehensive Chronic Care Programmes

MOH will launch comprehensive programmes for patients suffering from 3 major chronic illnesses: the "Diabetes Care Programme", "Blood Pressure Care Programme" and " Blood Cholesterol Care Programme".

High blood pressure, diabetes and high blood cholesterol are strong risk factors for a number of major causes of death and disability in Singapore, such as coronary heart disease (2nd most common cause of death), stroke (4th most common), and end-stage kidney failure. Expensive-to-treat and crippling complications caused by diabetes, hyperlipidaemia (high blood cholesterol) and hypertension (high blood pressure) can be avoided if these conditions are managed properly and complications detected and dealt with early.

The 1998 National Health Survey found that 53.2% of known diabetics and 70.1% of known hypertensives in Singapore had poor blood sugar and blood pressure control respectively. This is in part due to poor patient compliance and in part due to the inability of the system to optimally track these patients over the long-term.

Each of these 3 programmes will provide a structured care package which should ensure good control of diabetes, blood pressure and blood cholesterol, and consequently, in the long-term, a reduction in complications such as blindness, stroke, kidney failure and heart attacks. The programme will ensure a uniformly good standard of care for patients with these conditions who are currently on follow-up in polyclinics, as well as those picked up during the Community Health Screening Programme for all persons aged 55 years and above.

Under these programmes, a 3-pronged approach would be taken. First, each polyclinic will establish dedicated clinics for these programmes run by teams, each comprises medical officers, diabetic care nurses, nurse educators and other healthcare professionals. Hospital specialists will advise the teams and will review the management of complex cases on a regular basis. Second, the clinics will adopt standard management protocols based on cost-effective treatments. This ensures that each patient follows a prescribed care programme that provides comprehensive evaluation and treatment for each patient, including providing home glucose-monitoring for diabetics. Third, a database will be set up to track progress indicators and to consolidate the efforts of the various organisations conducting mass-screening for such diseases.

Patients enrolled in these programmes will benefit in 4 ways: from the integrated care and comprehensive health education; from the expertise which hospital specialists will bring to the management of more difficult cases in the polyclinics through the shared-care system; from the call-up system to track persons who default treatment; and from a formalised system of identifying patients with complex problems who would benefit from referral to specialists in the tertiary centres.

Currently, all polyclinic patients with diabetes have to pay market price for glucometer and the test strips for home monitoring. Under the comprehensive Chronic Care Programmes, needy and elderly Singaporeans will enjoy additional subsidies for the entire package depending on their age and income level. (see Annex A)

(Table 1)

Annex B illustrates the differences between current polyclinic management and Diabetes Care Programme for patients suffering from Diabetes with high blood cholesterol. This scheme will be piloted at Tampines polyclinic and Chua Chu Kang Polyclinic on 1 Oct 2000 and rolled out to all the other polyclinics on 15 Apr 2001. The programme is expected to cost government an additional $24.5 million a year.

Primary Care Partnership Scheme

MOH will pilot the "Primary Care Partnership Scheme" on 1 Oct 2000. The aim is to provide responsive primary healthcare to elderly Singaporeans needing subsidised care. Under the scheme, private general practitioners (GPs) will be contracted to serve the elderly needy who do not live within close proximity to the polyclinics.

The GPs are invited to provide common outpatient medical services for simple medical conditions, such as coughs and colds. (Annex C). Singaporeans aged 65 years and above with per capita household income of $700 and below are eligible for the scheme. Those under the Public Assistance Scheme can also access such services. Similar to the polyclinic services, patients under the scheme have to pay $4 per attendance and 70 cents per drug item per week. (see Annex D). Patients with chronic illnesses will continue to be managed by polyclinics.

This scheme will be piloted for the residents in 4 areas - Kreta Ayer Division of Kreta Ayer-Tanglin GRC, Jalan Besar Division of Jalan Besar GRC, Simei estate and Bukit Panjang new town. The pilot scheme is expected to cost government $1.65 million a year. Based on the feedback received during the three-year pilot for this scheme, roll out plans will be considered. The clinics that had indicated that they would be participating in this scheme are at Annex E.

Working in partnership with the Community Development Councils

The Community Development Councils (CDCs) will be working in partnership with the Ministry to assess the eligibility of the needy and elderly Singaporeans for subsidy under the "Diabetes Care Programme", "Blood Pressure Care Programme" and "Blood Cholesterol Care Programme" as well as the "Primary Care Partnership Scheme". The CDCs will issue a "Community Medical Benefits Card" to those who qualify.

For the pilot, the Central Singapore CDC, the Northeast CDC and the Sembawang-Hong Kah CDC will be involved. Application forms are available in the Community Development Council and Community Centres involved in the pilot (Annex F) and Tampines and Chua Chu Kang polyclinics. The patients on the Chronic Care programmes can collect and hand in their completed forms to the polyclinics. The elderly who wish to participate in the GP programme can collect the forms from the CCs and CDCs. The CDCs involved will issue one common Card to the applicant.

The Primary Care Partnership Scheme to contract private general practitioners for the needy elderly will be a tripartite collaboration among the private sector GPs, the people sector CDCs and the public sector, to reach those who are in need of low-cost and convenient medical outpatient services.

For more enquiries, the public can call Tampines polyclinic at Tel : 783 9721 or Chua Chu Kang Polyclinic at Tel : 764 8364.