Disease Management
- Country:
- Singapore
- Partner Institute:
- Department of Epidemiology and Public Health, National University of Singapore
- Survey no:
- (7)2006
- Author(s):
- Lim Meng Kin
- Health Policy Issues:
- Quality Improvement, HR Training/Capacities
- Reform formerly reported in:
Upgrading family medicine
Current Process Stages
| Idea | Pilot | Policy Paper | Legislation | Implementation | Evaluation | Change | ||
|---|---|---|---|---|---|---|---|---|
| Implemented in this survey? |  |
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Featured in half-yearly report:
Health Policy Developments 7/8
Abstract
The MOH intends to improve care of common chronic diseases, i.e. their treatment is to be in accordance with established disease management protocols. The aim is to reduce the medical complications which would otherwise arise as the patients age. So far, the MOH has identified four chronic diseases: diabetes mellitus, hypertension, hyperlipidemia, and stroke. The disease management programs for these chronic conditions will be implemented by the end of 2006.
Purpose of health policy or idea
There is a public perception that general practitioners (GPs) only treat minor ailments such as cough and cold and that for "major" illnesses, it is better to seek treatment from specialists. The
programme therefore aims to educate the public that GPs are just as good as and less expensive than seeing a specialist. The public would also be assured that the GPs they enroll with are actively
upgrading their professional skills, while the GPs will have the chance to demonstrate that patients with chronic illness that require monitoring get better and more responsive services if seen by a
regular family physician.
This move should be seen as the first step in an effort to progressively steer patients with chronic diseases and their doctors, mainly by official encouragement and facilitation, towards a model of
"seamless" care, whereby hospitals will routinely discharge patients with chronic illnesses to receiving GPs who have enrolled in the programme. The latter will track patients'
progress as well as participate in the hospital-run continuing medical education programmes that keep them updated on the latest developments in chronic disease management.
It should also be seen as part of a larger MOH public-private partnering initiative to rope in private GPs to take care of patients who are in stable condition, thus substantially reducing the burden
on overcrowded public hospitals.
It should also be remembered that to enhance the primary care of patients by GPs, the MOH has earlier announced that a Family Physician Plan would be introduced under which MOH would conduct courses
for doctors to upgrade their knowledge and increase their expertise and capability in the treatment of chronic illnesses. However, MOH had also stated that it would not coerce all GPs to
become family physicians but would leave the speed of this progress to market forces and the doctors themselves to make the choice. (refer to Survey no: 6(2005)).
The benefits, in addition to expected better health outcomes for patients, include expected cost savings.
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Characteristics of this policy
| Degree of Innovation | traditional |
|
innovative |
| Degree of Controversy | consensual |
|
highly controversial |
| Structural or Systemic Impact | marginal |
|
fundamental |
| Public Visibility | very low |
|
very high |
| Transferability | strongly system-dependent |
|
system-neutral |
Political and economic background
Purpose and process analysis
Current Process Stages
| Idea | Pilot | Policy Paper | Legislation | Implementation | Evaluation | Change | ||
|---|---|---|---|---|---|---|---|---|
| Implemented in this survey? | |
|
|
|
|
|
|
|
Origins of health policy idea
There is growing medical consensus that a disease management approach for chronic diseases can achieve better health outcomes. For example, if diabetes is well-managed through good control of blood sugar by having the patients work in close cooperation with their doctors and nurses, serious and costly complications like blindness, kidney failure or foot amputation could be avoided.
Stakeholder positions
GPs and patients have generally welcomed the move. However some GPs who were not happy in the first place with the planned Register of Family Physicians to be implemented sometime in 2007 saw this as yet a move to create two classes of general practitioners - those who are on the register of Family Physicians and those who are not.
Adoption and implementation
Private GPs practicing in ambulatory care clinics will be recruited to sign up with MOH to set up good chronic disease management programmes for their patients. The programmes will affect
about one million Singaporeans or one quarter of the total population.
MOH will provide the clinical protocols and also mount a campaign to advice patients with any of these chronic diseases to register with these doctors, who will presumably assume the role of being
their family physicians. Success of the programme will depend on good compliance by patients and adherence to clinical practice guidelines by their doctors. Hospital specialists will be enlisted
to give professional advice and assistance. Government outpatient polyclinics, which are already familiar with the disease management approach, will expand their existing coverage to benefit
more patients.
MOH will monitor and publish meaningful data regularly on its website reflecting the performance, cost and effectiveness of these disease management programmes so that patients can make informed
choices when selecting their healthcare providers. Patients enrolled in the programmes will also have easy access to hospital nurses for help. In addition, there will also be a financial incentive,
in the form of allowing Medisave to be used for disease management programmes (Medisave was designed primarily to pay for inpatient care).
Details of the scheme are being worked out. The scheme will be implemented by year's end.
Expected outcome
Over the next few months, MOH will consult doctors, patients and other relevant parties on the implementation details. The intention is to implement the scheme before end-2006. It is also expected that the larger group practices will do better as they will have better resources for monitoring and follow-up of patients. The coming years may therefore see a consolidation pattern taking place in the general practice scene.
References
Sources of Information
www.moh.gov.sg/corp/about/newsroom/pressreleases/details.do?id=36962319
Reform formerly reported in
| Upgrading family medicine Process Stages: Policy Paper |
Author/s and/or contributors to this survey
Lim Meng Kin