Free health screenings, vaccinations among plans for those enrolled under Healthier SG initiative

SINGAPORE: As part of a new strategy to drive preventive healthcare for Singapore citizens, those who enrol with a family doctor could get fully subsidised recommended health screenings and vaccinations. 

The Ministry of Health (MOH) submitted a White Paper on the Healthier SG strategy to Parliament on Wednesday (Sep 21) following a public engagement with residents, healthcare professionals, community partners, insurers and other stakeholders over the past six months. The White Paper will be debated in Parliament in October. 

The Healthier SG initiative, which aims to have citizens take charge of their own healthcare, involves having residents enrol with a single doctor, either a general practitioner (GP) or a polyclinic doctor, who will support residents in their health needs throughout their lives. 

Under the plan, residents who enrol in Healthier SG - which is voluntary - can schedule a face-to-face onboarding health consultation, which will be paid for by the Government. Residents will then develop health plans with their doctors, who will continue to monitor the resident's progress via follow-ups.

Health plans will include an overview of the resident's health status, medical needs and health goals and will be followed by an action plan, such as lifestyle adjustments or weight management.

On Wednesday Health Minister Ong Ye Kung told reporters the ministry had consulted thousands of people and taken into consideration feedback from GPs and residents to design the initiative.

Announced during MOH's Committee of Supply Debate 2022 in March, Healthier SG will be open to those 60 and above - roughly 1 million people - to enrol in the second half of 2023. It will gradually be made available to those between 40 and 59 years old in the next two years. 

The strategy is part of the Government's effort to tackle two main challenges - an ageing population and the rising impact of chronic disease - through preventive care. 

By 2030, one in four citizens is expected to be 65 and above, up from one in six today. Chronic diseases, such as hypertension and hyperlipidaemia, have risen to high levels, at 32 per cent and 37 per cent of the population respectively, said MOH.

The ministry noted that while people who visit a regular family doctor are generally healthier and have fewer visits to emergency departments and hospitals, only three in five Singaporeans have a regular family doctor. 

"We invite residents to go to a GP of your choice. You can choose one near your home. Choose one which is part of your panel of doctors in your company. And then commit to a one-resident, one-doctor or one-clinic relationship," said Mr Ong.

He added that a lasting resident-doctor relationship was necessary for preventive care to work.

"Then the doctor will really know your conditions well, and better still know the conditions of your family well, and can do the necessary counselling, persuasion, nagging to help you keep to your health plan."

RESIDENTS' CONCERNS

According to MOH, two in three of the 6,000 residents consulted for Healthier SG were in support of anchoring with one doctor. Three in four supported having a health plan.

During its engagement with residents, one of the main concerns raised was the cost of regular screenings. 

The Government is addressing this by fully subsidising nationally recommended screenings and vaccinations for Singaporeans. 

As part of the push, MOH is also proposing to waive the requirement for residents to co-pay part of their bills in cash when using MediSave for chronic care management.

Residents suffering from chronic diseases may also get their drugs from the GP clinics they enrol with at prices comparable to polyclinics, as the Government will introduce a new Community Health Assist Scheme (CHAS) drug subsidy tier for a whitelist of chronic disease management drugs. 

Residents will be allowed to choose a family doctor. They can also switch doctors up to four times in the first two years of enrolment and once a year after that. 

Existing mobile applications HealthHub and Healthy 365 will be enhanced to support the initiative. Through HealthHub, residents will be able to track their health outcomes and key points of discussion with their doctors, while Healthy 365 will be able to track physical activities and diets, as well as support access to community activities. 

Those who complete their first consultation under Healthier SG will receive Healthpoints upon completion. 

As part of the resident's overall health plan, family doctors may refer their residents to community partners that have activities to encourage a healthier lifestyle. 

MOH will provide more services and additional support for seniors through Eldercare Centres by expanding the number from the current 119 to 220 by 2025.

HEALTHCARE PROFESSIONALS' CONCERNS

The 1,000 healthcare professionals consulted cited a need for a viable business model to manage the scope of care of patients under them. They were also concerned about the administrative workload and the cost of IT support. 

As part of the proposed plan, family doctors in private practice will receive annual service fees for Healthier SG enrollees based on their health risk profile and the scope of care they need.

The Government will also provide a one-off grant to family doctors to offset the costs of IT adoption to facilitate the sharing of clinical notes, data and the monitoring of patient outcomes. 

Singapore's three healthcare clusters - National Healthcare Group, National University Health System and SingHealth - will support GPs in their region. Clusters will get a pre-determined fee for every resident assigned to them.

This form of payment on a capitation basis - for each enrolled resident rather than for each healthcare service rendered - simplifies funding and allows Healthier SG to be implemented at scale, said Mr Ong.

"Because it is one bundled standard payment, it inherently balances between the GP providing what is needed for the residents, and at the same time, observing cost discipline," he said.

MOH said it is working with primary care leaders to develop 12 care protocols to guide the approach to screening, vaccination and managing key chronic conditions, with more to come over time.

Mr Ong said that GPs' recruitment into the initiative has been "encouraging" so far. He added that MOH will beef up Singapore's nursing manpower to cater to the increasing demand for healthcare services.