Back to the Hospital for Chronic Care: a Hybrid Generalist Model
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and Yee Wei Lim, PhD1,2
Yong Loo Lin School of Medicine, National University of Singapore Singapore, Singapore; 2Medical Affairs – Research, Innovation & Enterprise, Alexandra Hospital, National University Health System 378 Alexandra Road, Singapore, Singapore; 3Department of Health Sciences, University of York, York, UK.
1
Singapore, like many countries, is attempting to meet the growing healthcare needs of an ageing population with a high burden of chronic diseases. Despite efforts to integrate and increase healthcare capacity, longstanding challenges remain difficult to overcome. Recently, policymakers have considered a new approach to building chronic and eldercare capacity—the Integrated General Hospital (IGH). The development of the IGH model is motivated by a combination of factors: the limit to which the primary care system can manage patients with increasingly complex chronic diseases, a longstanding preference of patients for hospital-based specialty services and patients experiencing fragmented care delivery. The IGH model links hospital care teams and community-based care providers, to facilitate the management of patients throughout the care continuum in a single integrated site. It is hoped that this hospital-led model for chronic care can meet patients’ needs and preferences and reduce fragmentation of care. J Gen Intern Med DOI: 10.1007/s11606-020-06271-6 © Society of General Internal Medicine 2020
BACKGROUND
Singapore, like many countries, has a rapidly ageing population with a growing chronic disease burden.1 To meet the growing demand for chronic disease-related healthcare services, Singapore has attempted to provide better coordinated and patient-centred services. Recent initiatives include the development of three integrated health clusters, organised to improve the distribution of facilities, capabilities and services across primary, secondary and community levels.2 Another example is the primary care network (PCN), established to enhance primary care through resource sharing, the setting-up of chronic disease clinics and a disease registry.3 Despite efforts to integrate healthcare services and improve the capacity of primary care to manage an ageing population, longstanding barriers remain. Primary care in Singapore is largely privatised. As of 2019, 1700 private practices (80% of primary care) and 20 Received May 11, 2020 Accepted September 25, 2020
polyclinics (publicly funded primary care clinics) were in operation.4 While polyclinics offer subsidised care, they are heavily subscribed. In the hospital setting, the reverse is true; approximately 70% of hospitals are public institutions that offer subsidised care.5 Consequently, patients routinely seek subsidised chronic disease care from specialists based in hospitals. Singaporeans’ perceive that hospital specialists provide a better quality of care, a perception also true in South Korea, Hong Kong and Japan.6–12 The combination of a favourable perception of specialty care and the lower cost of subsidised public hospital services has
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