Competition in the Healthcare Sector in Singapore - An Explorative Case Study

Gideon, Andrea

doi:10.2139/ssrn.2853888

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…However, it is not the case for Singapore. The country’s small land area, availability of numerous healthcare facilities island-wide, a highly efficient inter-connected transportation system and historical preference of patients seeking primary care services with a provider of their choice could be reasons for not having a mandated gatekeeping role for GPs [ 63 , 64 ]. On the other hand, studies have shown that patients develop relational discontinuity with their GPs when care continuity is enforced via gatekeeping.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

Foo

Surendran

Jiménez

et al. 2021

IJERPH

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The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

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Section: Discussionmentioning

confidence: 99%

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

Foo

Surendran

Jiménez

et al. 2021

IJERPH

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“…However, specialists are able to access important lab test results done at the polyclinics and some participating private general practitioners through a national electronic medical record. Public sector provides 80% of the secondary and tertiary healthcare services in Singapore 26…”

Section: Introductionmentioning

confidence: 99%

Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study

et al. 2019

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ObjectiveTo measure the extent of multispecialty care fragmentation among outpatients receiving specialist care and identify associated risk factors for fragmented care.DesignA retrospective cross-sectional study.SettingSpecialist outpatient clinics (SOCs) in a Singapore regional hospital.ParticipantsA total of 40 333 patients aged 21 and above with at least two SOC visits in the year 2016. Data for 146 792 physician consultation visits were used in the analysis and visits for allied health services and medical procedures were excluded.Outcome measuresThe Fragmentation of Care Index (FCI) was used to measure care fragmentation for specialist outpatients. Log-linear regression with stepwise selection was used to investigate the association between FCI and patient age, gender, race and Most Frequently Visited Specialty (MFVS), controlling for number of different specialities seen.ResultsAbout 36% experienced fragmented care (FCI >0) and their mean FCI was 0.70 (SD=0.20). FCI was found to be positively associated with age (p<0.001). Patients who most frequently visited Haematology, Endocrinology and Anaesthesiology specialities were associated with more fragmented care while those who most frequently visited Medical Oncology, Ophthalmology and Orthopaedics Surgery specialities were associated with less fragmented care.ConclusionMultispecialty care fragmentation was found to be moderately high in the outpatient specialist clinics and was found to be associated with patients’ age and certain medical specialties. With an ageing population and a rising prevalence of multimorbidity, healthcare providers should seek to eliminate unnecessary referrals to reduce the extent of care fragmentation.

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Competition in the Healthcare Sector in Singapore - An Explorative Case Study

Cited by 2 publications

References 29 publications

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study

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