Thursday, 22 September 2022

Healthier SG: Residents aged 60 and above can enrol in one resident, one doctor scheme from second half of 2023

Singapore Government releases White Paper on Healthier SG on 21 September 2022
By Joyce Teo, Senior Health Correspondent, The Straits Times, 21 Sep 2022

Singapore's ambitious plan to have one family physician and one health plan for each and every one of its residents will start with those aged 60 and above in the second half of 2023.

The Healthier SG Programme will also offer cheaper drugs for chronic diseases at general practitioner (GP) clinics, among other benefits. With it, MOH aims to shift its focus from "sick care" to preventive care so as to eventually help every resident stay on the path to better health.

Eligible residents will be invited to enrol in the programme with a primary care clinic of their choice via SMS. Those in the 40 to 59 age group will be invited to enrol in the following two years, the Ministry of Health (MOH) said in a White Paper that was submitted to Parliament on Wednesday. The White Paper will be debated in Parliament in October.

Since March, the ministry has engaged more than 6,000 residents and other stakeholders for their views on the strategy.


Under the Healthier SG Programme, residents will develop a relationship with a primary care doctor who will holistically manage their health.

At the first visit, which will be free, the doctor will work out a health plan that can include diet adjustments, an exercise regimen and regular health screenings and vaccinations.

Health Minister Ong Ye Kung told the media at the MOH headquarters in College Road on Wednesday that the plan has social prescriptions like "how you eat, how you sleep, how you cut down on salt and sugar, quit smoking, exercise, so on and so forth".

Community partners will be roped in to help manage residents' health, as the idea is to move healthcare away from acute hospitals to the community to help keep people healthy. Residents will be able to join free programmes to keep fit, for instance.


A key change that MOH will introduce to get residents on the programme is to make drug prices at participating GP clinics more comparable with those at polyclinics through a combination of enhanced drug subsidies and drug price limits. This will be done for drugs used to manage common chronic diseases.

With this, people will no longer have to end their relationship with their long-time GPs when they develop diabetes or hypertension just because the drugs for these conditions are cheaper at polyclinics.

MOH will announce the details for this at a later date.


The ministry also said that it will fully subsidise nationally recommended screenings and vaccinations for Singapore citizens, and waive the need for residents to co-pay 15 per cent of their bills in cash when using MediSave for the treatment of common chronic conditions under the Chronic Disease Management Programme.

"We are shifting away from co-payment for this basic preventive care to fully support residents (in) preventive care," said Mr Ong.

There will be a health points reward system to get people to take action, such as to enrol and complete their first consultation, and engage in health activities.

However, to get Healthier SG off the ground, MOH will first have to mobilise family doctors in private practice.

MOH will offer GPs an annual service fee for each enrolled resident, which will vary according to the risk profile, scope of care and the progress made, as well as a tech support grant.

These doctors will need to join a so-called Primary Care Network, partner a healthcare cluster, and be digitally enabled. The Primary Care Networks, which hire nurses and coordinators for chronic disease management and other shared tasks, will support the GPs in their work. There are currently 23 polyclinics and about 1,800 GP clinics, of which 670 clinics have formed such networks.

To ensure the level of care is consistent across GPs, MOH is developing a set of care protocols with primary care leaders to guide family doctors on how to manage key chronic conditions.


Healthier SG will start with the care protocols of three of the most common chronic conditions: diabetes, hypertension and lipid disorders. In the future, the protocols will expand to cover more conditions and areas such as mental health.

"Everyone involved, including healthcare providers, the Government and residents, will need to do things differently," MOH said in the White Paper.

"Healthier SG is probably the most significant change to the health system since Independence. We have had six decades where we emphasised reactive sick care rather than health promotion," said Associate Professor Jeremy Lim, director of the Leadership Institute for Global Health Transformation at the National University of Singapore's Saw Swee Hock School of Public Health.

The incentives under Healthier SG are created to promote health, rather than healthcare and, for the residents, inertia will be the biggest enemy, he said.

It will take years for such a major transformation of the healthcare system to take off and experts said the start will inevitably be challenging before the results show.

"Healthcare expenditure may rise initially and even more rapidly as we discover more people who have medical problems," said Dr Wong Chiang Yin, a public health specialist in the private sector.

"We must have the tenacity to stomach this and stay the course before the benefits of Healthier SG kick in at a later stage," he added.


Additional reporting by Lee Li Ying













How will being paired with a GP under the Healthier SG programme benefit me?
By Lee Li Ying, The Straits Times, 21 Sep 2022

From the second half of 2023, residents aged 60 and above will be able to discuss their health goals and medical history with a dedicated family physician when they enrol in the Healthier SG programme.

The programme will be extended to those in the 40 to 59 age group in the following two years.

This comes as Singapore strives to shift its healthcare model towards preventing individuals from falling ill, instead of reactively caring for those who are already sick.

Since March 2022, the Ministry of Health (MOH) has consulted more than 6,000 residents and stakeholders such as general practitioners (GPs), employers and community partners.

A White Paper on Healthier SG – listing the key features and recommendations of the programme – was submitted to Parliament on Wednesday, and will be debated in October.


The Straits Times looks at how the programme aims to prevent or delay the onset of chronic diseases and ill health.

Q: What can residents expect when they enrol in the Healthier SG programme?

A: When enrolment starts, MOH will send eligible residents an SMS text message to invite them to choose their preferred clinics. During the first consultation, which will be free, the doctor will assess the resident's medical history, health needs and concerns.

For those with no chronic conditions, the doctor will advise them on appropriate preventive measures, such as health screenings and vaccinations, and the Government will fully subsidise the nationally recommended ones.

For those with chronic conditions, the doctor will work with them on follow-up management.

Everyone enrolled in the programme will have a personalised health plan.

To monitor a resident's progress, the GP will check on him remotely, such as over the phone, or when he sees the doctor for other checks. This brief annual check will be subsidised by the Government.

Those with chronic conditions would likely require two to four follow-up consultations annually, and prevailing subsidies will apply for their visits and treatments.




Q: What does a health plan look like?

A: A health plan is an overview of the resident's key health parameters, which include a set of health goals, such as weight loss or improvement in chronic conditions.

The plan would also include follow-ups such as health screenings, diet adjustments and an exercise regimen.

The conversation between the doctor and patient on the desired health outcomes, action plans and care preferences will be based on the health plan.


Q: How can I be sure the level of care is consistent given that different family doctors may have different approaches?

A: To ensure a consistent level of care, MOH is developing 12 care protocols on managing key chronic conditions.

For a start, the care protocols will cover three of the most common chronic conditions: diabetes, hypertension and lipid disorders.

The protocols will lay out recommended health screenings, medication, lifestyle adjustments and when specialist attention or acute care is required.

About a year after the initial launch, MOH will broaden care protocols to cover other common chronic conditions as well as specific screenings required for seniors.

Subsequently, the Government will progressively cover other complex chronic conditions, such as mental health and end-of-life care.


Q: Will all GP clinics be on board this scheme?

A: To participate in the Healthier SG programme, clinics will have to meet a few criteria.

Each GP clinic must have at least one family doctor registered as a family physician within seven years of the launch of the programme's enrolment.

Family doctors must also participate in core government schemes, such as the Chronic Disease Management Programme, Community Health Assist Scheme, and the Screen for Life and national vaccination programmes.

Other requirements include partnering a healthcare cluster and using a compatible clinic management system within a year of the programme's launch.


Q: Will I be allowed to switch doctors?

A: In the first two years after the initial enrolment, residents will be allowed to switch doctors up to four times. This allows residents more time to find a clinic they are comfortable with.

After that, MOH will allow one change a year to accommodate personal preferences and change in life circumstances, such as families who move house.


Q: What about those with employer medical benefits?

A: The Government is urging employers to encourage their panel doctors to participate in the Healthier SG programme so their employees can see the same doctor to enjoy both employer and Healthier SG benefits.

Alternatively, residents can still choose to see a company panel doctor for episodic care, while enrolling with a family doctor for preventive and chronic consultations.


Q: What other incentives are there to encourage residents to lead healthier lifestyles?

A: Today, under the National Steps Challenge by the Health Promotion Board, residents who are active can earn health points, which can be used to exchange for vouchers from merchants such as supermarket chain FairPrice. Residents need to download the Healthy 365 app to accumulate points.

To encourage residents to exercise more, MOH will enhance health points for those on the programme. Beyond just counting of steps, health points will also be awarded for a range of physical activities and even for adherence to diet plans. Details of these are not available yet.

























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