April 2014 | ISSUE 11
Holy Grail of healthcare: Build a healthcare system for the patient, not the disease





By Nicole Lim
Assistant Director, Communications & External Relations

Integration of healthcare, social and community support services is the holy grail Singapore has to strive towards, according to LKCMedicine Assistant Dean for Integrated Care Associate Professor Chin Jing Jih. “We have to move away from just treating a patient’s illness. We have to treat the person.”

This means enabling patients to access a hub-and-spoke care model, where the care provider nearest to the patient’s home – usually a general practitioner – acts as the hub overseeing the care.

The issue of future healthcare took centre stage recently after the Singapore Budget announcement by Deputy Prime Minister and Minister for Finance Tharman Shanmugaratnam. The debate was further stoked during the tabling of the Ministry of Health’s budget, where Minister for Health Gan Kim Yong mapped out the challenges of future healthcare.

“The generalist is able to have the full picture and know when to send a person to the specialist,” said Assoc Prof Chin, who is also Divisional Chairman for Integrative & Community Care at Tan Tock Seng Hospital and Singapore Medical Association President. This is particularly true for older patients who may suffer from multiple conditions. “A lot of seniors may end up seeing many specialists, but the care has to be coordinated.”

In addition, many older people are supported by frail social structures that may make recovery and adherence to a treatment plan more difficult, or make them prone to injuries. For example, they may forget to take their medication or live with dim or broken light bulbs increasing their risk of a fall. Teasing out these problems is challenging and requires close collaboration between health, social and community care sectors.

“The ultimate holy grail is that we become one system of shared accountability, where more people use primary and community care, and the hospital is used only when the illness is beyond the expertise of primary care,” said Assoc Prof Chin.

By right-siting patients in the community, care will also shift from treatment of disease to prevention. “All this will bring care to the community at an earlier stage and help seniors age in place,” said Assoc Prof Chin.

“Interventions, such as vaccinations, dietary advice and simple exercises can have a significant impact on a patient’s overall health and keep him away from acute illness and a hospital stay,” he added.

With seamless integration of care, doctors will also be able to delegate effectively, relieving segments of the care sector that are currently overused, such as acute hospitals.

“For example, if there can be a system of transferring more stable patients to primary care, then the specialist will have more time to do either research innovation or look at a more acute or challenging group of patients,” said Assoc Prof Chin.

Successful integration of care will not necessarily prolong life, but it can empower people to lead healthier lives longer.

“Medical interventions should be used not only because they may improve the quantity of life but more importantly because they improve the quality of life,” said Assoc Prof Chin.