Friday, March 1, 2013

TMI: Health sector needs to radically innovate now — by Jeremy Lim

Health sector needs to radically innovate now — Jeremy Lim

TMI: March 01, 2013
MARCH 1 — Singapore is short of healthcare resources. We need 32,000 additional healthcare professionals by the year 2030 to care for our rapidly ageing society, a 70 per cent increase over today’s workforce. We currently have about two hospital beds (both acute and extended care) per 1,000 population, which pales in comparison to the Organisation for Economic Co-operation and Development average of five beds per 1,000 population.

What can we do then? We cannot lower our standards or compromise the health of our citizens, and must raise our productivity.

We know we face, and will continue to face, severe manpower and infrastructure shortages. If we do not radically innovate and enable Singapore healthcare providers to do more with less people, fewer beds and so on, we will pay a price in human life.

To avert this, the generous monies provided for the Ministry of Health in this year’s Budget, to the tune of S$5.7 billion (RM14.3 billion) (an 18-per-cent increase from last year), must be well spent.
The often-quoted labour saving efforts, such as mechanical patient lifters in nursing homes reducing the number of attendants needed, or a pharmacy packing robot, are really only incremental innovations. Can we do better?

A pivotal insight is that healthcare providers offer “healthcare” but what patients really want is “health”. How can we have more “health” even if this actually means less “healthcare”?
Productivity cast in this perspective cannot be about squeezing more patients into an already overbooked clinic session, or pharmacists being able to dispense medicines to 25 patients when they were previously able to only do 15. It has to be about achieving the same objective, “health”, and being agnostic about the means.

Here are some examples from around the world to stimulate our imagination:

● Chronic Disease Management
Does a stable and well-controlled hypertensive patient need to physically consult her doctor every two or three months? Would a virtual consult or even a computer-augmented self-management regime suffice in between annual visits to her physician?

Years ago, I had the privilege to visit Kaiser Permanente, a world-renowned Californian integrated care provider.

I asked my host: “How often does a well-controlled hypertensive patient need to physically consult?” His response: “Never, we can do everything remotely through the Internet or over the phone.”
He added that during the annual in-person general preventive health screening consultation, high blood pressure control could be discussed. Almost a quarter of the Singapore adult population has high blood pressure. Imagine how many physician visits could be obviated.

● Minor Ailments
The average person is afflicted with “flu-like” symptoms maybe four to six times a year with the vast majority being minor and self-limiting. How do we know which ones are “minor”?

England has a remote care service called NHS Direct where members of the public can consult over the telephone or online and as necessary, decide whether an in-person consultation is warranted. Do patients want “impersonal” remote care? Well, yes, four million calls and 10 million online consults a year are made for all kinds of symptoms.

The ecosystem has to exist to support this, and by ecosystem, I mean pharmacies where members of the public can purchase medicines for treatment of common ailments without a prescription, and a societal model where workers can call in sick without the need for medical certification at least some of the time.

Singapore has more than 3.36 million persons in the workforce; multiply this by, say, five minor illnesses a year, and that is almost 17 million consultations per year. Can patients self-manage select conditions with some help and minimise the strain on our healthcare system?

● Specialist Referrals
Certain specialties such as dermatology are highly visual. Can a dermatologist provide advice remotely to a family physician instead of having the patient moving back and forth, creating additional visits? Sure. In the University of California Davis, dermatologists treat patients from 32 remote sites in California via “live interactive” teledermatology.

In Singapore, 5 per cent of all GP visits are for skin-related ailments. How many progress to specialist referrals, and of these, how many could have been avoided by enlisting teledermatology?

Technology adoption does not occur in a vacuum. Premium cars will struggle if roads are rudimentary and signage is absent. In the same way, while technology (and especially tele-health) has tremendous potential to revolutionise the way we deliver healthcare and enable Singapore to mitigate our infrastructure shortfalls, the government has a key role in building the roads and organising street signs.

What is needed, and quickly, is a national tele-health strategy that establishes standards for appropriate remote practice; enables viable business models so that private enterprise can bring its creative energy into the fray; and empowers patients and healthcare professionals to do the right thing for themselves, and for the country.

The government has announced it will “build infrastructure well ahead of demand”. Infrastructure is not just beds or buildings; it also includes the policy and legal frameworks necessary to realise productivity and innovation. Let us start doing things differently — we have to. — Today

* Dr Jeremy Lim has held senior executive positions in both public and private healthcare sectors. He is currently writing a book on the Singapore health system.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.

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