Expanded state role in the care of the dying

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 12

Abstract

The government has said that it will play a greater role in caring for the dying. It has announced a slate of initiatives to encourage the development of palliative care in Singapore and to help Singaporeans die with dignity.

Purpose of health policy or idea

The aim of these initiatives is to "raise the quality of life of the dying, ease their pain, and preserve their dignity and support their care". 

The initiatives include:

• Expanding hospice care. MoH plans to increase the 125 hospice places now available in the country by 20 percent over the next five to seven years 
• Bringing "end-of-life planning" into nursing homes. A pilot project will start with six nursing homes with the support of a nearby public hospital with staff trained in palliative care.
• Training more doctors and nurses in palliative medicine to create a national pool of palliative health care professionals .  MOH will move to amend its regulations to recognise palliative care as a medical sub-specialty.
• Developing a set of guidelines for healthcare professionals that touch on advance care planning, providing information on care options to patients and their family, and helping to incorporate their wishes into future treatment plans.
• Simplifying the process of making Advanced Medical Directives (AMD), or "living wills  to encourage more people to lodge AMDs. 
• Also on the cards are "die-logues" - or public education efforts to get people thinking about what they want for the end of their lives , instead of sweeping the topic under the carpet.

Groups affected

Patients in need of palliative care, Hospices and Nursing homes

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

As Singapore's population ages, end-of-life issues inevitably receive greater attention. Palliative care, however, is an underdeveloped area in Singapore, where it has been left largely to charitable and voluntary welfare organizations.

Currently, 55 per cent of Singaporeans who are sick or at the end of their lives die in hospitals, while 28 per cent die in their homes. And according to the Singapore Hospice Council, about 70% of people with terminal illnesses are dying without hospice palliative care in Singapore.

Presently, all four existing hospices in Singapore are run by voluntary groups that receive generous government subsidies. In 2007, they were about 70 percent full with 1,200 patients. An additional 3,200 patients were cared for through five home-based hospice services. In all, about $5m in subsidies went to 4,400 patients, an amount the Ministry of health has conceded is small, given the 17,000 deaths here every year. 

Nursing homes are presently ill-equipped to care for the dying. In fact they frequently send their patients back into the hospitals the moment their conditions deteriorate.

There are currently about 15 doctors working in this area, dedicated to improving quality of life of patients and their families facing the problems associated with life-threatening and or terminal illness.

Currently fewer than 10,000 people have signed an AMD, though it had been available for 11 years. It is thought that steps such as removing the legal requirement for a doctor to witness its signing and allowing download of the form from the internet would help. But before any amendment to the law is made, public consultations would be held on what people wanted from and in an AMD.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung

• Leistungserbringer

Stakeholder positions

Those involved in palliative care expressed strong support for the initiative. The existing five home-hospice services welcome the move. They could do with more money to expand, especially if more people are to get their preference to die at home.Similarly, nursing homes also welcomed the move as they could expect additional funding support to upgrade the level care they can provide.   

 

Actors and positions

Regierung
Ministry of Health	sehr unterstützend		stark dagegen
Leistungserbringer
Hospices	sehr unterstützend		stark dagegen
Nursing homes	sehr unterstützend		stark dagegen

Actors and influence

Regierung
Ministry of Health	sehr groß		kein
Leistungserbringer
Hospices	sehr groß		kein
Nursing homes	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

All these initiatives are expected to roll out in early 2009.

Monitoring and evaluation

By recognizing palliative care as a sub-specialty, the  MoH is countering the lack of enthusiasm among doctors for specialising in that field with an incentive.

Expected outcome

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The MoH's new approach to end of life issues and the care of the dying has struck a chord with those who feel that society shows its humanity best by succoring its old and terminally ill, and not just investing in the young and the productive.  Expanding hospice care will reduce pressures on the hospitals as well as save costs since palliative care is more cost-effectively provided in nursing homes and hospices.

References

Sources of Information

 Wong A. Care of the dying. Today newspaper, 15 October 2008, page 1.

Author/s and/or contributors to this survey

Lim Meng Kin

Empfohlene Zitierweise für diesen Online-Artikel:

Lim Meng Kin. "Expanded state role in the care of the dying". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/sg/a12/3