Singapore's health-care system:key features, challenges, and shifts

Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds—namely, beyond health care to health, beyond hospital to community, and beyond quality to value

Secondary Household Transmission of SARS, Singapore

Secondary household transmission of severe acute respiratory syndrome (SARS) was studied in 114 households involving 417 contacts. The attack rate was low (6.2%). Occupation of the index case was the factor that most influenced household transmission (adjusted hazard ratio for healthcare workers 0.157; 95% confidence interval 0.042 to 0.588)

REGULATION OF ERYTHROPOIETIN MESSENGER RNA

Ph.DDOCTOR OF PHILOSOPH

Staying healthy in the Asian Century

We are now in what is widely known as the Asian Century. Within this context, the transformation of healthcare is one of Asia’s greatest challenges but also one of its greatest opportunities. However Asia is a vast heterogeneous region, and includes countries with varying systems of politics and governance, and at different phases of economic development – with per capita GDP ranging from, say, Laos at US$1,320 to Japan at US$45,903. Health spending per capita shows a similar wide variation – US$39 for Laos to US$3,754 for Japan. Hence health priorities and needs, and capacity to deliver good healthcare, differ markedly. Even within huge Asian countries such as China and India, regional health indices may vary greatly. This means there cannot be a “one-size-fits-all” set of healthcare approaches or solutions. And with rapid economic growth driving massive change, approaches to health issues must go far beyond the normal ambit of national health departments and involve multi-sectoral, cross-agency and transnational approaches and cooperation. There are several salient trends shaping the health landscape of Asia in the coming decades. The first is urbanisation, which is happening at an unprecedented pace and scale. Rapid economic growth has resulted in rapid social changes – in lifestyles, diet, education and family structures – and created widening income gaps and inequalities which hinder access of some segments of the population to medical services. It is also often associated with environmental degradation and pollution, as well as higher accident rates and exposure of workers to occupational diseases, with attendant health problems.PROFESSOR TAN CHORH CHUAN is president of the National University of Singapore and deputy chairman of Singapore’s Agency for Science, Technology & Research. This essay is adapted from his recent John Yu oration for the George Institute in Sydney

THE USE OF DES-ASPARTATE-ANGIOTENSIN I AS AN AGENT FOR THE TREATMENT AND PREVENTION OF GLOMERULOSCLEROSIS AND RENAL FAILURE

WO2001078759A1Published Applicatio

Use of des-Aspartate-angiotensin I as an agent for the treatment and prevention of glomerulosclerosis and renal failure

US20030086920A1Published Applicatio

Public Health in East and Southeast Asia: Challenges and Opportunities in the Twenty-First Century

“This volume is unique in its comprehensive investigation of the changing face of public health in East and Southeast Asia. The region’s countries have experienced major challenges resulting from colonialism, conflicts, economic and technological development, varying levels of government stability, widening disparities between social classes, uneven distribution of wealth, emerging epidemics, chronic diseases, occupational hazards, and changing health services. All of these issues are ably addressed by the authors, firsthand experts in their respective countries and fields. With its useful summaries and wealth of international sources, it will be an excellent resource for scholars and practitioners seeking an introduction to the region’s complex context and development.” Chitr Sitthi-amorn, former president, International Epidemiological AssociationPublic Health in East and Southeast Asia presents an overview of the state of public health across this vast region and considers the challenges and prospects for its future advancement. It pays particular attention to how rapid economic progress has brought accelerated change, both demographic and epidemiological, to an area already marked by great heterogeneity in health status and public health systems. In comparative and thematically oriented chapters, leading scholars consider such issues as changes in values and lifestyles, infectious diseases, nutrition, tobacco, chronic diseases, accidents and injury, environmental health, occupational health, the effect of globalization, and health services.Roger Detels is Distinguished Professor of Epidemiology and Infectious Diseases and Chair of Epidemiology at the University of California, Los Angeles. He is the former president of the International Epidemiological Association. Sheena G. Sullivan is an epidemiologist at the WHO Collaborating Centre for Reference and Research on Influenza and was previously with the Chinese Center for Disease Control and Prevention. Chorh Chuan Tan is President of the National University of Singapore and was previously the Director of Medical Services in Singapore’s Ministry of Health, in which capacity he was responsible for the medical response to the SARS epidemic in 2003.Contributors: Rajesh Bhatia, Chien-Jen Chen, Wen-Ta Chiu, Roger Detels, Binh Y. Goldstein, Anthony J. Hedley, Ling-I Hsu, Elizabeth A. Jahncke, Sunbaunat Ka, David Koh, Ee Heok Kua, Tai Hing Lam, William Lavely, Ting Heung Leung, Sarah M. McGhee, Jai P. Narain, Lu Pai, Donald Maxwell Parkin, Saumik Paul, Samlee Plianbangchang, Ramkishen S. Rajan, Adeline Seow, Judy Sng, Sheena G. Sullivan, Chorh Chuan Tan, U Than Sein, Kraisid Tontisirin, Shin-Han Tsai, Thomas Tsang, Kumnuan Ungchusak, Lilian W. C. Wan, Pattanee Winichagoon, Zuo-Feng Zhan

Public Health in East and Southeast Asia: Challenges and Opportunities in the Twenty-First Century

“This volume is unique in its comprehensive investigation of the changing face of public health in East and Southeast Asia. The region’s countries have experienced major challenges resulting from colonialism, conflicts, economic and technological development, varying levels of government stability, widening disparities between social classes, uneven distribution of wealth, emerging epidemics, chronic diseases, occupational hazards, and changing health services. All of these issues are ably addressed by the authors, firsthand experts in their respective countries and fields. With its useful summaries and wealth of international sources, it will be an excellent resource for scholars and practitioners seeking an introduction to the region’s complex context and development.” Chitr Sitthi-amorn, former president, International Epidemiological AssociationPublic Health in East and Southeast Asia presents an overview of the state of public health across this vast region and considers the challenges and prospects for its future advancement. It pays particular attention to how rapid economic progress has brought accelerated change, both demographic and epidemiological, to an area already marked by great heterogeneity in health status and public health systems. In comparative and thematically oriented chapters, leading scholars consider such issues as changes in values and lifestyles, infectious diseases, nutrition, tobacco, chronic diseases, accidents and injury, environmental health, occupational health, the effect of globalization, and health services.Roger Detels is Distinguished Professor of Epidemiology and Infectious Diseases and Chair of Epidemiology at the University of California, Los Angeles. He is the former president of the International Epidemiological Association. Sheena G. Sullivan is an epidemiologist at the WHO Collaborating Centre for Reference and Research on Influenza and was previously with the Chinese Center for Disease Control and Prevention. Chorh Chuan Tan is President of the National University of Singapore and was previously the Director of Medical Services in Singapore’s Ministry of Health, in which capacity he was responsible for the medical response to the SARS epidemic in 2003.Contributors: Rajesh Bhatia, Chien-Jen Chen, Wen-Ta Chiu, Roger Detels, Binh Y. Goldstein, Anthony J. Hedley, Ling-I Hsu, Elizabeth A. Jahncke, Sunbaunat Ka, David Koh, Ee Heok Kua, Tai Hing Lam, William Lavely, Ting Heung Leung, Sarah M. McGhee, Jai P. Narain, Lu Pai, Donald Maxwell Parkin, Saumik Paul, Samlee Plianbangchang, Ramkishen S. Rajan, Adeline Seow, Judy Sng, Sheena G. Sullivan, Chorh Chuan Tan, U Than Sein, Kraisid Tontisirin, Shin-Han Tsai, Thomas Tsang, Kumnuan Ungchusak, Lilian W. C. Wan, Pattanee Winichagoon, Zuo-Feng Zhan

Improving Asia-Pacific science collaboration

President's OfficeNon UBCUnreviewedFacultyOthe