evolving healthcare landscape

Question 1

what are the key pain points and drivers of stress of SG’s healthcare landscape

Answer 1

1. decreased ILTC capacity
   - fewer caregovers
   - more reliance on voluntary welfare and organisations
   - less capacity of voluntary welfare and organisations
   - more health related services and ILTC needs
   - more ILTC use
2. increased out of pocket costs
   - higher total hospital costs
   - higher primary care costs
   - more primary care needs
   - higher OOP gradient for private vs public which drives more primary care use
3. increased bed occupancy rates
   - longer duration of acute hospital stay
   - higher hospital rates
   - less primary care capacity
   - more unmet and complex non-communicable disease needs

Question 2

how are the pain points addressed

Answer 2

• shift of care from hospital to community
• subsidies to ensure it remains affordable for most of singapore
• blurring of public, private, VWO lines in primary care and ILTC esp with healthier sg

Question 3

list the subsidies for specialist OP clinic and MAF

Answer 3

specialist OP clinic
- if PCHI = 0, determine annual value (gross annual rent of a property)
AV ≤13k: 70%
13<AV≤21k: 50%
AV>21k: 30%
- 0<PCHI≤1200: 70%
- 1200<PCHI≤2000: 60%
- 2000<PCHI≤3300: 50%
- 3300<PCHI≤6500: 40%
- PCHI>6500: 30%

MAF
- 0<PCHI<2000: 75%
- 2000<PCHI≤3300: 50%
- 3300<PCHI≤6500: 40%
- PCHI>6500: 0%

Question 4

what are the three key shifts for a future ready SG by MOH in 2017

Answer 4

1. beyond hospital to community
2. beyond quality to value
3. beyond healthcare to health

Question 5

what are the key components in the healthcare 2020 masterplan

Answer 5

1. easier access
   - increase in capacity by having more nursing homes, community and home care services
2. better quality
   - improve primary care services (community health centers CHC, family medicine clinics FMC, more support for community and home care)
3. more affordable
   - cheaper OP services and drugs at public with more government subsidies
   - lower cash payments with more uses for medisave
   - medishield life – lifetime coverage, enhanced benefits, premium subsidies for lower to middle income, pioneer generation
4. promote healthy living and active aging
   - singapore healthcare system clusters (NHG, singhealth NUHS)
   - capitation funding where each cluster gets a predetermined fee for each resident living in the region

Question 6

what are other types of funding systems

Answer 6

1. pay per service
2. pay per day
3. pay per event
4. pay per beneficiary

Question 7

what are the five thrusts under the national pharmacy strategy and the relevant initiatives under each thrust

Answer 7

1. pharmaceutical care excellence
   - establish role of pharmacy in community care setting
   - improve drug stewardship in non-acute
   - establish collaborative models of care
   - implement clinical governance framework for medication management
   - promote pharmacists as part of collaborative workforce
2. confident pharmacy workforce
   - advanced practice framework
   - pre-reg training
   - pharmacy residency
   - develop and train pharm technicians
   - build up manpower capabilities for community care setting
3. re-design supply cain
   - centralized procurement, packaging, compounding and distribution
4. information enablement
   - common platform to stimulate
   - consumer and patient access to information and education
   - NDF containing standardized and safe use supported by best clinical practices
5. technology enablement
   - telepharmacy
   - standardize drug terminology and code structures for seamless communication and accurate transfer of information
   - common pharmacy system for harmonized medication dispensing and to stream line billing process

Question 8

what is pharmforce and the various workstreams under it

Answer 8

the objective of pharmforce is to establish a healthy, motivated and resilient pharmacy workforce to deliver value-added services to meet our population needs

workstreams
1. leadership development
2. role and scope of practice (scope of practice, value of pharmacy services)
3. manpower development and recognition (competency frameworks, career pathway and recognition)
4. workload and work environment
5. communication and engagement

Question 9

what are the key challenges confronting pharmacy today

Answer 9

1. workload and staff shortages
   - high staff turnover
2. managing complexity
3. adapting to pt-centered care models
   - require shift in mindset and practice to emphasize pt counseling, education and chronic disease management
4. adapting to team-based care/ interprofessional collaboration
   - differences in practice cultures, communication barriers, time constraints
5. keeping up with rapid technological changes
   - to continually update their skills and knowledge
6. navigating regulatory and policy changes
7. integrating advancements into practice
   - may have lack of standardized guidelines, limited insurance coverage, and the need for additional training
8. managing financial pressures
   - decreasing drug margins, high cost of medications
   - to address health disparities to ensure equitable access