Primary Care has become the core strategy of the Singaporean government's response to population aging, increased burden on chronic diseases, and rising medical expenditure.

Singapore's grass -roots medical fields are mainly led by general doctors, and they are responsible for 80%of the country's primary medical treatment.In the public domain, a large number of subsidies for primary medical services and drugs for primary medical care and drugs are provided.Because the cost of self -payment is much lower, many chronic patients who need long -term medication will be more inclined to go to the comprehensive clinic.Starting in July 2023, major reforms called the "Health SG Plan" will be implemented in the next few years.Health SG plans to create a better healthy ecosystem through cooperation with grassroots medical systems and community partners.At the current stage, its main feature is to allow each resident to choose a general clinic to formulate a personalized health plan for them.

The registration of residents and general doctors aims to strengthen the close doctor -patient relationship, which is more conducive to allowing doctors to encourage residents to receive preventive care, such as physical examination, vaccination, and subsequent continuous care.Doctors will also associate them with community partners in response to the health and social needs of residents.It is voluntary to join the health SG plan for residents and general doctors, and residents can still choose to take a clinic for general clinics.

With the gradual launch of the health SG program, we believe that this reform is to be successful, there are three key elements.

1. Consider the needs of the general clinic and doctors

Although local general clinics traditionally focused on providing acute and short -term primary medical care, the health SG plan will expand their scope of duties, including Social Prescriping, preventive care, administrative requirements, and moreComplex drug inventory management (because the government will provide a series of drug subsidies).

Because most general clinics are operated by individual doctors, they may feel overwhelmed and cannot assume these new work arrangements outside of existing heavy duties.Although the Ministry of Health will compensate the clinic based on the completion of the population (number of participants), specific clinical and process indicators, some general doctors are concerned because the remuneration is not enough to make up for the extra time and resources required for these new responsibilities.The Ministry of Health shall re -review the payment model to ensure that the general clinic will be compensated fairly for the tasks they will bear.In addition, it is necessary to provide a detailed admission process for the general clinic to explain clinical requirements and how to apply for funds.

These concerns may be reflected in the ratio of the general clinic of the health SG plan.As of April this year, only 712 of the 1,800 general clinics have joined the Health SG plan.As the health SG plan continues to implement, we need to take more measures to encourage more general clinics to join.

In addition to administrative issues, general doctors may also have another concern, that is, they are not ready to provide new types of care such as social prescriptions.Due to the diversity of social services and referral procedures, doctors may not know the useful service, which provider is the most suitable, or the process of referring to the patient.In addition, the use of motivation interview skills are essential for guiding personal values and persuading them to cultivate health behaviors, and linked them with suitable community partners.These skills require training and strong functional relationships with community services.Although the Ministry of Health plans to implement at least one family medical expert in each general clinic in the next seven years (doctors who have completed a graduate course of family medical), clinical and management training is necessaryThe front line of the health SG plan.

2. Promote digital solution

Singapore has used digital health innovation to promote medical reform.The health SG plan will use the "Health 365" application (Healthy 365) to encourage residents to participate in the Health SG plan and reward a healthy lifestyle choice.The application and the wearable fitness tracker provided for residents for free can track parameters such as dietary intake, physical exercise and sleep mode.At the same time, the GP Clinic Management System is being upgraded to be compatible with the health SG plan.In addition to allowing doctors to register for residents, record health programs, referring and submit data to the government, it will also be combined with the National Electronic Health Records information system compatible with the health SG plan.

This is a major improvement that will enable medical providers in the public and private sector to seamlessly check the health records of patients.Residents can also check their health records and physical test results through Healthhub to make them know and be responsible for their health.The initial focus of these efforts is to support the formulation and documentation of health plans; whether the information technology (IT) capabilities are fully exerted, it will depend on the effective transmission of comprehensive data systems, allowing medical providers to, Share healthy data.

Three, cultivate trust

Trust is essential for effective primary medical care, which involves understanding the relationship between responsible and responsible, and the value of emergency and long -term nursing needs in life.In addition, the unfavorable financial gradient between the general clinic and the comprehensive clinic may hinder this relationship, because many patients who need long -term medication are more inclined to seek medical treatment at the integrated clinic, because they can get highly subsidized medical and drugsEssenceIn the past, residents mainly used the general clinic for smaller acute diseases, mainly based on trading models. Now they need to change their thinking to recognize the role of general doctors in preventive and promoting medical care.

To grow the seeds of trust, they should also show their full support to the residents through the general doctor to show their full support for the new types of nursing provided by the health SG plan.

In addition to providing financial incentives to the residents who joined the health SG plan (the first health plan consultation, free points rewards are stored in Healthy 365, and free nationwide recommended physical examination and vaccination), whether the health SG plan can make residents realize negative negativeThe value of long -term medical relations of responsibility is also crucial.This not only involves community education, but also requires the continuous positive experience of individuals, families, friends and neighbors.

The feasibility of the

Health SG plan depends on the trust between the provider and the government.It significantly expands the government's participation in the field of grassroots medical care.The general clinic will have to work closely with the government in a new way, including responsibility for performance standards.But trust must be two -way, because the general clinics will lose a lot of traditional independence.The general doctors need to be convinced that the government will also take care of their interests, and through governance structure, they can maximize their autonomy and independence to solve various challenges in the process of implementing the health SG plan.

The

Health SG program represents a useful change. It re -balances the medical system and optimizes the health and well -being of Singaporeans.During the popularity of coronary disease, Singapore's general clinics actively actively actively actively met the demand for vaccination, testing and case management.The unity and determination displayed during the period of popularity makes us very confident that the grass -roots medical field can achieve the goals of the health SG plan.In order to fully realize the potential of the health SG plan, we must understand and consider the needs and operating processes of general clinics and doctors, to maximize the digital solution, and between residents and medical providers, as well as medical providers and governments,Cultivate trust.

Author Xie Huizheng and Fu Chuande are researchers at the Singapore National University Su Ruifu Public Health College

Xie Huizheng Translation