Population ageing is arguably humanity's greatest challenge in the 21st century. The
magnitude of this phenomenon, compounded by the increasing burden of chronic illnesses
and the question of longevity and quality of life, will undoubtedly create health,
economic and social demands on all developed and developing countries [1]. In Singapore,
the government has created a multi-agency effort, led by a senior statesman, comprising
of different public and non-governmental agencies representing social welfare, health,
transport, housing, and infrastructure. This is a concerted effort to coordinate amongst
various parties to manage what has been aptly termed as the ‘silver tsunami’. Singapore
is the second most rapidly ageing population in the world today, due mainly to two
key factors—the rapidly declining total fertility rate, and the increasing life expectancy
at birth. While the population is still generally young now (8.5% are over 65 years
old), the proportion of elderly is set to almost triple within the next 25 years.
The impending silver tsunami has forced our healthcare system to reorganise how we
deliver care. With the ageing profile, increasing acuity and greater frailty of our
patients, more will require a longer period of care to recover. Many will need continued
rehabilitation, some will need some level of transitional care support at home and
others may need convalescence in nursing homes and other aged care facilities. Hence,
our care delivery system is undergoing a massive restructuring, moving from ‘silo
or compartmentalised episodic care’ to a more integrated approach by forming regional
health systems, whereby an acute general hospital is linked to a community rehabilitation
hospital supported by a network of primary care providers, community home care teams
and day rehabilitation centers as partners. The importance for close coordination
and effective collaboration between the acute hospitals and their clinical partners
in the community becomes more urgent so that patients can transition seamlessly from
one provider and setting to another. Underpinning the restructuring is an electronic
health record system that is being developed nationally. This virtual and longitudinal
health record will be accessible to all authorised medical practitioners at our hospitals
and primary care centres, and eventually extending to the community care sector. It
will allow for more effective treatment and monitoring of patients, who may receive
a spectrum of healthcare services from different providers. The notion of integrated
regional health systems is certainly not a new concept nor model, but few countries
or health systems have managed to successfully implement this. Some of the examples
that have been often mentioned in the literature (e.g. Jonkoping in Sweden, Geisinger
and Kaiser Permanente in the US, etc.) are exceptions rather than the rule. A key
consideration is the political and social milieu within which the health care system
operates, the financing system and the presence of real leadership to drive the change
and integration that is necessary.
Singapore has the advantage of being a very small nation of some 5 million residents.
It also has the advantage of having a relatively high penetration of the use of technology
by individuals and in the homes. Such infrastructure has played a key role in fostering
integration of care at a faster pace. In addition, Singapore's healthcare system is
underpinned on a unique philosophy of individual responsibility, coupled with a national
system of individual health savings accounts and co-payment. In this regard, health
policy has managed to influence individual behaviour towards maintaining healthy and
avoiding unnecessary healthcare utilisation. Today, Singapore's healthcare expenditure
as a percentage of GDP is 4.5% [2]. Despite this, however, the challenge still remains
as the population ages and chronic diseases such as diabetes, hypertension and stroke
increase in prevalence. In 2009, the Singapore's Ministry of Health gave the mandate
to the Agency for Integrated Care (AIC) [3] to oversee, coordinate and facilitate
all efforts in care integration. It is recognized that in order to continue providing
affordable, quality healthcare, health systems have to be restructured in such a manner
that enhance efficiency and reduce fragmentation, with integration as a key reform
driver [4]. AIC is now tasked with performing the role of a ‘national care integrator’.
Part of AICs strategic thrusts is to develop the capacity and quality of primary care
and community care, and connecting the various healthcare providers for better health
outcomes. As part of our strategic effort in integration, the AIC will also be implementing
a new national care assessment framework for more accurate and consistent identification
of individual needs for community and continuing care. This will be fully implemented
by the end of 2011.
As our healthcare system evolves and becomes more integrated in the coming years,
a great deal still remains to be done to improve the cost-effectiveness and efficiency
of delivering care and to improve the overall health of the population. A number of
ambitious frameworks have since been developed which are worth studying—one of which
is the Institute for Healthcare Improvement (IHI) Triple Aim—which provides working
models and principles for better and more efficient care, keeping costs affordable
and keeping populations healthy. This is a model which the Singapore healthcare system
is working towards.
As many more integration initiatives will take off in the next few years across many
countries, we are pleased to organise the Inaugural Asian Conference on Integrated
Care in Singapore from 25 to 26 February 2011. This is a collaboration between AIC
and the International Network of Integrated Care (INIC), and participants can expect
to hear from prominent experts from the USA, Europe and Australia, as well as our
fellow colleagues from the Asia Pacific Region involved in care integration initiatives.
We hope to welcome you in Singapore in February next year!