Week 2 Introduction to Health Systems PDF

Restricted, Non-Sensitive GEC1015 / GEH1049 PUBLIC HEALTH IN ACTION: Introduction to Health Systems AY2024/2025 Sem 1 Assistant Professor Ian Ang [email protected]...

Restricted, Non-Sensitive GEC1015 / GEH1049 PUBLIC HEALTH IN ACTION: Introduction to Health Systems AY2024/2025 Sem 1 Assistant Professor Ian Ang [email protected] 1  Restricted, Non-Sensitive Please log in with your NUS student account. https://www.pollev.com/ianang 2 Restricted, Non-Sensitive 3  Restricted, Non-Sensitive Overview 1. Defining a “Health System” 2. Components of a Healthcare System 3. The Singapore Health System 4  Restricted, Non-Sensitive Defining a “Health System” 5  Restricted, Non-Sensitive What is a Health System? WHO (2010): “A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health.” World Health Organization. (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf. 6  Restricted, Non-Sensitive Boundaries of a Health System Murray & Frenk (2000): A health system includes the resources, actors and institutions related to the financing, regulation and provision of health actions. A health action is defined to be any set of activities whose primary intent is to improve or maintain health. Includes: all actors and institutions who see their primary purpose as contributing to health. Murray, C. J., & Frenk, J. (2000). A framework for assessing the performance of health systems. Bulletin of the world Health Organization, 78, 717-731. 7  Restricted, Non-Sensitive Goals of the Health System The World Health Report 2000: Better health is unquestionably the primary goal of a health system. A second goal of health systems is therefore fairness in financial contribution toward the costs of ill-health. Because health care can be catastrophically costly and the need for it unpredictable, mechanisms for sharing risk and providing financial protection are important. A third goal – responsiveness to people’s expectations in regard to non-health matters – reflects the importance of respecting people’s dignity, autonomy and the confidentiality of information. World Health Organization. (2000). The world health report 2000: health systems: improving performance. World Health Organization. https://www.who.int/whr/2000/en/whr00_en.pdf?ua=1 8  Restricted, Non-Sensitive Functions and Objectives of a Health System World Health Organization. (2000). The world health report 2000: health systems: improving performance. World Health Organization. https://www.who.int/whr/2000/en/whr00_en.pdf?ua=1 9  Restricted, Non-Sensitive The WHO Health System Framework World Health Organization. (2007). Everybody's business--strengthening health systems to improve health outcomes: WHO's framework for action. http://www.who.int/healthsystems/strategy/everybodys_business.pdf 10  Restricted, Non-Sensitive Health System vs. Healthcare System Arah et al. (2006) for the Organization for Economic Cooperation and Development (OECD) Health Care Quality Indicator (HCQI) Project: “By ‘health care’ we mean the combined functioning of public health and personal health care services.” Arah, O. A., Westert, G. P., Hurst, J., & Klazinga, N. S. (2006). A conceptual framework for the OECD health care quality indicators project. International Journal for Quality in Health Care, 18(suppl_1), 5-13. 11  Restricted, Non-Sensitive Components of a Healthcare System 12  Restricted, Non-Sensitive Bodenheimer, T., & Grumbach, K. (2016). 5: How Health Care Is Organized—I: Primary, Secondary, and Tertiary Care. In Understanding health policy: A clinical approach, 7th edition. McGraw-Hill Companies, Inc. http://accessmedicine.mhmedical.com.libproxy1.nus.edu.sg/content.aspx?bookid=1790&sectionid=121191474. 13  Restricted, Non-Sensitive Primary Care Involves common health problems and preventive measures that account for 80% to 90% of visits to a physician or other caregiver. Virtually the exclusive domain of general practitioners (GPs), who practice in small- to medium-sized groups and whose main responsibility is ambulatory (outpatient) care. Bodenheimer, T., & Grumbach, K. (2016). 5: How Health Care Is Organized—I: Primary, Secondary, and Tertiary Care. In Understanding health policy: A clinical approach, 7th edition. McGraw-Hill Companies, Inc. Retrieved from http://accessmedicine.mhmedical.com.libproxy1.nus.edu.sg/content.aspx?bookid=1790&sectionid=121191474. 14  Restricted, Non-Sensitive Primary Care Intended usual first contact with patients Provide referrals to secondary or tertiary care Serving as gatekeeper 15  Restricted, Non-Sensitive Secondary Care Secondary care involves problems that require more specialised clinical expertise such as hospital care. Physicians are located at hospital-based clinics and serve as consultants for outpatient referrals from GPs, in turn routing most patients back to GPs for ongoing care needs. Physicians also provide care to hospitalised inpatients. Bodenheimer, T., & Grumbach, K. (2016). 5: How Health Care Is Organized—I: Primary, Secondary, and Tertiary Care. In Understanding health policy: A clinical approach, 7th edition. McGraw-Hill Companies, Inc. http://accessmedicine.mhmedical.com.libproxy1.nus.edu.sg/content.aspx?bookid=1790&sectionid=121191474. 16  Restricted, Non-Sensitive Secondary Care Includes acute care For brief but serious issues Often provided in emergency departments Can also include planned elective care e.g. childbirth, cataract surgery, advanced medical imaging Usually hospital-based Can be both inpatient and outpatient 17  Restricted, Non-Sensitive Tertiary Care Involves the management of rare disorders. Tertiary care subspecialists such as cardiac surgeons, immunologists, and pediatric hematologists are located at a few tertiary care medical centres. Bodenheimer, T., & Grumbach, K. (2016). 5: How Health Care Is Organized—I: Primary, Secondary, and Tertiary Care. In Understanding health policy: A clinical approach, 7th edition. McGraw-Hill Companies, Inc. http://accessmedicine.mhmedical.com.libproxy1.nus.edu.sg/content.aspx?bookid=1790&sectionid=121191474 18  Restricted, Non-Sensitive Tertiary Care Specialised care Usually requiring referral from primary care physician or from inpatient admission episode. Usually hospital-based Can be both inpatient and outpatient. 19  Restricted, Non-Sensitive Bodenheimer, T., & Grumbach, K. (2016). 5: How Health Care Is Organized—I: Primary, Secondary, and Tertiary Care. In Understanding health policy: A clinical approach, 7th edition. McGraw-Hill Companies, Inc. http://accessmedicine.mhmedical.com.libproxy1.nus.edu.sg/content.aspx?bookid=1790&sectionid=121191474. 20  Restricted, Non-Sensitive Long Term Care Involves a variety of services designed to meet a person's health or personal care needs during a moderate or long period of time. Help people live as independently and safely as possible when they can no longer perform everyday activities on their own. Most common type is personal care Help with everyday activities, also called "activities of daily living”. National Institute of Aging. (2017). What Is Long-Term Care? Retrieved from https://www.nia.nih.gov/health/what-long-term-care. 21  Restricted, Non-Sensitive Please log in with your NUS student account. https://www.pollev.com/ianang 22 Restricted, Non-Sensitive 23  Restricted, Non-Sensitive The Singapore Health System 24  Restricted, Non-Sensitive Health System Relationships Ong, S. E., Tyagi, S., Lim, J. M., Chia, K. S., & Legido-Quigley, H. (2018). Health systems reforms in Singapore: A qualitative study of key stakeholders. Health Policy, 122(4), 431-443. 25  Restricted, Non-Sensitive Key Public Institutions for Health in Singapore National Ministry Agencies and Statutory Boards Integrated Healthcare Clusters 26  Restricted, Non-Sensitive Ministry of Health Director-General of Health DS (Services) Yoong, J., Lim, W. Y., & Lin, L. (2018). Chapter 8. Singapore. In Legido-Quigley, H., & Asgari-Jirhandeh, N. (Eds.), Resilient and people-centred health systems: Progress, challenges and future directions in Asia (pp. 292-317). World Health Organization, Regional Office for South-East Asia. Government of Singapore. (2019). Ministry of Health Singapore: Senior Management. https://www.moh.gov.sg/about-moh/senior-management 27  Restricted, Non-Sensitive YouTube – MothershipSG (2021). Covid-19 in SG: Full Press Conference by the Multi-Ministry Task Force on May 18, 2021. https://www.youtube.com/watch?v=a93llQBYBOg 28  Restricted, Non-Sensitive Ministry of Health Holdings MOH Holdings Pte Ltd (MOHH) is the holding company of Singapore’s public health clusters: MOH Holdings Pte Ltd. (2019). MOHH: What we do. http://www.mohh.com.sg/about-us/what-we-do 29  Restricted, Non-Sensitive Health Sciences Authority The Health Sciences Authority (HSA) was established as a statutory board under the Ministry of Health on 1 April 2001 with the integration of five of its former national agencies: Centre for Drug Evaluation Institute of Science and Forensic Medicine National Pharmaceutical Administration Product Regulation Department Singapore Blood Transfusion Service 30  Restricted, Non-Sensitive Health Sciences Authority Role of HSA: Serve the administration of justice with the use of forensic medicine, forensic science and analytical chemistry testing. Secure the nation’s blood supply by ensuring a safe and adequate blood supply for public and private hospitals. Regulate health products to meet standards of safety, quality and efficacy. Government of Singapore. (2019). About HSA. https://www.hsa.gov.sg/about-us 31  Restricted, Non-Sensitive Synapxe Synapxe is the health technology agency for the public healthcare sector. Formerly known as Integrated Health Information Systems (IHiS), which was formed in 2008. Purpose is to connect people and systems to power a healthier Singapore and improve the health of millions of people every day, everywhere. Synapxe. (2023). Our Role. https://www.synapxe.sg/about-synapxe/our-role 32  Restricted, Non-Sensitive Synapxe Some Key Initiatives of Synapxe Mobile app for patient use Electronic medical record system for clinician use Consolidated health records system at national-level Synapxe. (2023). National Programmes. https://www.synapxe.sg/healthtech/national-programmes/ 33  Restricted, Non-Sensitive Health Promotion Board Established in 2001, the Health Promotion Board (HPB) is a government organisation committed to promoting healthy living in Singapore. Health Promotion Board. (2019). Health Promotion Board: About Us. https://www.hpb.gov.sg/about/about-us 34  Restricted, Non-Sensitive Health Promotion Board Wide range of health promotion and disease prevention programmes: Health Promotion Board. (2021). Schools. https://www.hpb.gov.sg/schools Health Promotion Board. (2021). Workplace. https://www.hpb.gov.sg/workplace 35  Restricted, Non-Sensitive Agency for Integrated Care 1992: Care Liaison Services (CLS) under Ministry of Health (MOH) Coordinate and facilitate the placement of elderly sick to nursing homes and chronic sick units. 2001: Integrated Care Services (ICS) Greater role in discharge planning and facilitate the transition of patients from hospitals to the community. 2008: Agency for Integrated Care (AIC) 2009: Established as an independent corporate entity under MOH Holdings. 2018: The Pioneer Generation Office was renamed the Silver Generation Office and joined AIC. Agency for Integrated Care Singapore. (2019). Agency for Integrated Care Singapore: About Us. https://www.aic.sg/Resources/What%20We%20Do 36  Restricted, Non-Sensitive Agency for Integrated Care AIC Singapore. (2019). Agency for Integrated Care (AIC) Corporate Video - 90s. https://www.youtube.com/watch?v=tsllCqISb3c 37  Restricted, Non-Sensitive Integrated Health Clusters MOH Holdings Pte Ltd. (2020). About the public healthcare family. https://brightsparks.com.sg/profile/mohh/about-us.php 38  Restricted, Non-Sensitive 2000: Grouping of Two Healthcare Clusters SingHealth Polyclinics. (2016). Real Time Research in a Singapore Public Primary Care Institution. https://www.slideshare.net/RespiratoryEffectivenessGroup/real-time-research-in-a- singapore-public-primary-care-institution 39  Restricted, Non-Sensitive 2009: Creation of Six Regional Health Clusters Ministry of Health Holdings. (2014). Singapore’s Public Healthcare Sector. http://sghardtruth.com/wp-content/uploads/2014/06/mohh-map.jpg 40  Restricted, Non-Sensitive 2017: Reorganisation of Three Integrated Health Clusters MOH Holdings Pte Ltd. (2020). About the public healthcare family. https://brightsparks.com.sg/profile/mohh/about-us.php 41  Restricted, Non-Sensitive Regional Health System (RHS) RHS = Cluster + Partners RHS Organisation Health Cluster Polyclinics and Volunteers Community Partners Care Hospitals Providers (e.g. primary care, ILTC) National Social Centres Agencies Academic Grassroots Centres Slide courtesy of NUHS Regional Health System Office. 42  Restricted, Non-Sensitive NUHS Structure Primary Care and Acute Hospitals National Centres Community Hospital Schools Outpatient Centres 43  Restricted, Non-Sensitive Primary Care 26 polyclinics (public) About 1,800 private clinics Singleton General Practitioners (GPs) http://www.frontierhealthcare.com.sg/images/stories/frontier%20fmc%20logo%20low%20res1.jpg Group practices Primary Care Networks (PCNs) 44  Restricted, Non-Sensitive 6 More New Polyclinics by 2030 25 26 21 24 –– 6 23 22 26 25 21 23 24 22 Government of Singapore (2021). Quiz: How many hospitals and polyclinics do we have on this little sunny island? https://www.gov.sg/article/quiz-how-many-hospitals-and- polyclinics-do-we-have 45  Restricted, Non-Sensitive Secondary and Tertiary Care 11 public hospitals 9 general hospitals 1 women's and children's hospital 1 psychiatric hospital 9 private hospitals 46  Restricted, Non-Sensitive Upcoming Hospitals / Health Campuses Channel News Asia (2021). New hospital at Bedok North to open 'around 2030': MOH. https://www.channelnewsasia.com/news/singapore/bedok-north-hospital-ready-around-2030-13535906 Channel News Asia (2024). Singapore to build new hospital in Tengah, expand home care initiatives to meet ageing population needs. https://www.channelnewsasia.com/singapore/new-hospital-tengah- home-care-ageing-population-healthiersg-moh-4172146 47  Restricted, Non-Sensitive Intermediate and Long-Term Care (ILTC) Residential Community Hospitals 5 public community hospitals 4 non-profit community hospitals 48  Restricted, Non-Sensitive Intermediate and Long-Term Care (ILTC) Residential Nursing Homes Social Service Agencies (SSAs) / Non-profit Private Hospices 49  Restricted, Non-Sensitive Intermediate and Long-Term Care (ILTC) Community-Based Centre-Based Community rehabilitation Day care Home-Based Home medical or nursing care Home palliative care Meal delivery Medical escort and transport 50  Restricted, Non-Sensitive Health System Relationships Ong, S. E., Tyagi, S., Lim, J. M., Chia, K. S., & Legido-Quigley, H. (2018). Health systems reforms in Singapore: A qualitative study of key stakeholders. Health Policy, 122(4), 431-443. 51  Restricted, Non-Sensitive Public Institutions in Health System World Health Organization. (2007). Everybody's business--strengthening health systems to improve health outcomes: WHO's framework for action. http://www.who.int/healthsystems/strategy/everybodys_business.pdf 52  Restricted, Non-Sensitive Please log in with your NUS student account. https://www.pollev.com/ianang 53 Restricted, Non-Sensitive 54  Restricted, Non-Sensitive Thank you. 55