Affordable Excellence: The Singapore Healthcare Story

Design and Infrastructure

Design and Infrastructure  CHAPTER 6 Design and Infrastructure  Primary Healthcare Private General Practitioners Primary care, where ill patients make first contact with care professionals, is largely issued by private rather than public care providers. There are approximately 2,000 private general practitioners in Singapore, located mainly in housing estates, and they deliver 80 percent of primary care.1 Several private general practitioner chains serve the public, including Raffles Medical (with more than 70 clinics), Parkway Shenton (over 40 clinics), and Frontier Healthcare Group (with nine clinics). The idea behind allowing the private sector to handle much of this care stems from the philosophy that people must take responsibility for their own health. It follows that patients should pay for minor episodic ailments on their own and not rely on government subsidies to defray the cost. Ailments that the general practitioners treat include the cough, cold, flu, diarrhea, abdominal pain, urinary tract infection, simple skin problems, menstrual problems, muscle, bone and joint pain, and many other common medical concerns. Private general practitioners generally provide more services than the public polyclinics (discussed below). For example, they make certain vaccines and aesthetic services available that the public clinics do not. Raffles Medical Group, a major private healthcare company in Singapore, offers a range of services in its clinics, including family medical care, travel health, emergency services, minor surgery, statutory medical check ups, health screenings, x-ray services, and various specialty services, such as obstetrics and gynecology services.2 According to the Ministry of Health, there is no data available comparing the costs of services at the private clinics to the public clinics. Affordable Excellence combined t93 93 3/21/2013 7:13:07 PM  Affordable Excellence Polyclinics The public side of primary care is represented by “polyclinics,” which provide 20 percent of primary level services and are highly-subsidized for patients. At this writing, there are 18 government polyclinics. An older version of the polyclinic existed well before Singapore became self-governing. By the 1920s, primary healthcare services which were provided by outpatient clinics, infant welfare clinics and traveling dispensaries.3 These outpatient clinics have since then been consolidated into the present-day, modern polyclinics. They provide outpatient medical care, immunization services, health screening, health education, investigative facilities, pharmacy services, and follow-up of patients discharged from hospitals. Some offer dental services as well. The average outpatient consultation fee at a polyclinic is about S$10 (see Table 6.1). This represents a subsidy of 50 percent. Senior citizens aged above 65 years, children younger than 18, and students in school and junior colleges enjoy up to 75 percent subsidy for consultation and treatment.4 The polyclinics are meant to cater to lower-income Singaporeans who are unable to afford the consultation fees of private general practitioners. These generally have a longer waiting time for consultation, although they do accept walk-ins. With the recent deployment of technology, and with government efforts to revamp and upgrade the polyclinics, services are becoming much faster and more efficient. Polyclinics are most frequently located near amenities and public transportation, but, as there are only 18 polyclinics, they may be further away from patients than the more numerous general practitioner clinics.5 A general practitioner treats patients at a polyclinic, but several other kinds of care are available. Family Physician Clinics at the polyclinics offer consultations with doctors with qualifications in family medicine. At these Clinics, the consultations are by appointment and more time is spent with the patient. Patients with complex or multiple chronic diseases can enroll in these clinics. A Nurse Clinician Service is also available at the polyclinics. There, senior nurses, managed by doctors, see patients whose chronic diseases are well under control.6 Polyclinics offer basic diagnostic services, and the standard basic medication dispensed at the polyclinic pharmacies is subsidized. They also provide advice on preventive healthcare. They offer regular health talks and workshops for patient education, with the goal of increasing their level of health awareness. Supporting the polyclinics are numerous imaging centers, laboratories (most located within the polyclinics), and mobile services.7 Specialist Affordable Excellence combined t94 94 3/21/2013 7:13:07 PM Design and Infrastructure  Table 6.1 Affordable Excellence combined t95 95 3/21/2013 7:13:07 PM  Affordable Excellence Outpatient Clinics, located at public hospitals, provide subsidized care on referral, either by a polyclinic or by an accident and emergency department. These clinics...