L11 Quality Healthcare Flashcards
Define “healthcare”.
The maintenance or improvement of health via the diagnosis, treatment, prevention of disease, illness, injury, and other physical and mental impairments in human beings.
State the 6 dimensions that constitute quality in healthcare as defined by WHO and US Institute of Medicine (IOM).
1) Safe
2) Effective
3) Patient-centred
4) Accessible
5) Efficient
6) Equitable
Discuss the 6 dimensions that constitute quality in healthcare as defined by WHO and US Institute of Medicine (IOM).
1) Safe:
- Minimise risk & avoid injuries to service users from the care that is intended to help them
2) Effective:
- Provide healthcare that is adherent to an evidence base and results in improved health outcomes for individuals and communities, based on need/indication
- Tension w/ efficiency
3) Patient-centred:
- Provide care that is respectful of and responsible to individual patient preferences, needs and values, and ensure that patient values guide all clinical decision
- To consider cultures of their communities as well, as part of shared decision-making
4) Accessible:
- Ensure timeliness, reducing waits and sometimes harmful delays
- Ensure care is provided in the right setting where skills and resources are appropriate to medical needs
5) Efficient:
- Maximise resource use, avoids waste, including waste of equipment, supplies, ideas and energy
- More applicable in RCT settings
6) Equitable:
- Providing care that does not vary inequality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
What is the gist of “quality healthcare”?
- Meets the needs of patients/community in a timely manner; to balance timeliness w/ efficiency via optimisation
- Most effective based on best evidence & provide the best outcomes
- Minimise risk
- Optimise use of resources
What are some barriers to quality healthcare?
Provision of quality healthcare is not easy as patient/public hold the government accountable for quality healthcare.
1) Rapid changes:
- Medical science and technology have advanced at unprecedented rate during the past half-century
2) Growing complexity of healthcare
- More to know, more to do, more to manage, more to watch, and more people involved
3) Changes in public health needs
- Aging population, people living with chronic diseases in the community
4) Healthcare delivery is disorganised, complex & uncoordinated
- Especially at transition of care, institutions working in silo
Briefly describe Singapore’s healthcare philosophy.
1) Achieve better health for all
- Promote healthy living
- Promote preventive health programmes
2) Ensure quality & affordable basic medical services
- At public hospitals, polyclinics & GP clinics
3) Anchored on individual responsibility
- Co-payment prevents overconsumption of healthcare services
- Pay more for higher level of service
What core issues & key pain points drive the need for healthcare transformation in Singapore?
Core issues:
1) Quickly aging population/society
2) More people with chronic diseases
Key pain points:
1) Increased out-of-pocket cost, esp. when pt. resort to private HCPs instead
2) Increased bed occupancy rates
3) Decreased ILTC capacity
What are some key strategical thrusts Singapore has planned to put in place toward ensuring quality healthcare in Singapore, based on Healthcare 2020?
Healthcare 2020: Improving Accessibility, Quality & Affordability
1) Accessibility:
- Expand capacity
- Build more healthcare infrastructure
- Expand healthcare workforce
2) Affordability
- Assurance for healthcare bills
- Strengthen collective responsibility as a society
- Continued personal responsibility for our own health
3) Quality
What are some key strategical thrusts Singapore has planned to put in place toward ensuring quality healthcare in Singapore, based on Beyond Healthcare 2020?
Beyond Healthcare 2020:
1) Move beyond hospital to community
- Via establishing GPs network in the Primary Care Netowrk (PCN) & networking between retail, community & acute settings.
- To allow Singaporeans to receive care in the community & nearer to home since hospital costs are expensive!
2) Move beyond quality to value
- e.g. Reorganisation of 6 -> 3 healthcare clusters & establishing Agency for Care Effectiveness (ACE)
- To give every Singaporean best value, while keeping our system sustainable
3) Move beyond healthcare to health
- e.g. Healthhub by HPB as primary mode of communication to public
- To help & support Singaporeans to lead healthier lives
Name the healthcare clusters currently available in Singapore.
1) NUHS (West)
2) SingHealth (East & South)
3) NHG (North & Central)
Reorganised from 6 to 3 clusters in 2017 to better optimise resources & capabilities, and provide more comprehensive, integrated and patient-centred care.
Explain the financing strategies Singapore has placed to promote quality healthcare.
Financing system anchored on twin philosophies of individual responsibility & affordable healthcare for all
- Mixed financing system adopted based on use of market-based mechanisms to promote competition & transparency
1) S + 3Ms
- Subsidies: Up to 80% at public healthcare institutions to ensure affordable healthcare
- Medisave: Compulsory personal savings to pay for smaller healthcare bills
- Medishield Life (and other insurances): Basic health insurance to help with larger hospital & healthcare bills
- Medifund: Safety net to provide help to needy Singaporeans; from interest earned by government endowment fund
2) CHAS scheme
- Green tier: ALL can apply w/o restrictions for chronic subsidies
- Orange tier: Subsidies for common illnesses, enhanced for complex chronic subsidies & dental subsidies
- Blue tier: Even greater subsidies than orange tier w/ complex chronic subsidies further enhanced; for lowest GDP families to receive highest level of subsidies subjected to audit by MOH
- Merdaka generation & Pioneer generation (more than Merdaka)
3) Drug subsidies & schemes
- Standard Drug List (SDL): Tagged to drug & NOT disease dependent
- SDL I: Max $1.40/week of drug: Very essential drugs w/ highest subsidy (e.g. atenolol, risperidone & rifampicin)
- SDL II: Less subsidy of max ~50%
- Medication Assistance Fund (MAF): Tagged to specific clinical conditions/diseases & need to undergo means-testing to determine level of subsidies applied
What are some legislative frameworks Singapore has put in place to ensure quality healthcare in Singapore, with respect to hospitals & clinics?
1) Private Hospitals & Medical Clinics Act (PHMC Act)
2) Mandatory to have quality assurance committees
3) Empower MOH officials to inspect premises & ensure compliance with minimum standards
4) Mandatory monitoring of services and clinical indications as quality indicators, which include:
- Waiting time
- In-patient mortality
- Unscheduled return to operating theatres
- Unscheduled readmission within 15 days
- Unscheduled admission following ambulatory procedures
- Inpatient admission following unscheduled returns to A&E department
- Device utilisation and device-associated infection in the ICU
- Review of Mortalities and Morbidities (M&M) and Serious Reportable Events (SRE)
What are some legislative frameworks Singapore has put in place to ensure quality healthcare in Singapore, with respect to professional registration & conduct?
1) Licensed HCP: medical, nursing, pharmacy, dental & allied HCPs
- Medical Registration Act
- Dental Registration Act
- Nurses and Midwives Act
- Pharmacists Registration Act 2007
- Optometrists and Opticians Act
2) Empower respective professional Councils & Boards to uphold professional standards and investigate complaints of professional misconduct
3) Empower the professional Councils/Boards to remove those deemed unfit to practice from the Register
4) Mandates continuing professional education for license (practising certificate) renewal
- e.g. clocking 50 CE points every even year via medical journals etc.
What are some legislative frameworks Singapore has put in place to ensure quality healthcare in Singapore, with respect to medical products, procedures and diseases?
1) Spell out what medical profession can & cannot do in relation to specific situations
2) Rigorous regulation of health products by Health Products Act, Medicines Act, Medicines (Advertisement & Sale) Act etc.
3) Other legislation with regards to medical procedures & diseases include: Termination of Pregnancy Act, Infectious Diseases Act, Human Organ Transplant Act
What are some non-legislative frameworks Singapore has put in place to ensure quality healthcare in Singapore?
1) Introducing evidence-based clinical practice guidelines & practice standards
- e.g. Agency for Care Effectiveness (ACE) set up in 2015 by MOH as the national health technology assessment agency to drive better decision-making about clinically and cost-effective means.
- MOH facilitates sharing of best practices from institution’s investigation of root causes that contributed to Serious Reportable Events, to ensure learning & gap closure.
2) Monitoring patient satisfaction
- First national survey done in 2000, to gather feedback from patients recently discharged from restructured hospitals
- Now done yearly at restructured hospitals, speciality centres and polyclinics
- Includes questions on e.g. overall satisfaction level, meeting expectations, value for money etc.
3) Market-based mechanisms to promote competition and transparency
- Comparison of performance index, fee benchmark, & bill amount information available
- e.g. length of stay, prices from Pharmaceutical Society of Singapore, cost of procedures
4) Voluntary accreditation for Quality and Safety Standards
- e.g. Singapore Quality Class, Joint Commission International, ISO 9000
