Similar to other countries, the population in Singapore is ageing, and it is paramount that the quality of care (QoC) provided to patients be maintained if not improved.

“There's increasing evidence that shows the positive effects on health care outcomes when patients' nonmedical needs are addressed,” said lead author and Dartmouth Institute Research Scientist Dr Taressa Fraze.

“But up until now, we haven't known if, and to what extent, healthcare organisations operating under new payment models are addressing them."

Addressing non medical needs for holistic healthcare

It has been estimated that approximately 40% to 90% of health outcomes are linked to non-medical needs such as social, behavioural, and economic factors, amongst others, and has been agreed by health care policy makers that addressing such matters can improve health outcomes and lower medical costs.

A study of chronically homeless adults and struggling with alcohol addiction in America revealed that medical costs could be reduced by as much as 53% if a roof is provided over their heads.

The Social and Family Development Ministry (MSF) in Singapore reported over 900 displaced individuals and families between 2013 and 2015 nationwide, whom were then placed in transitional shelters and or in temporary accommodation where meals, medical help and job referrals are provided.

The government’s efforts in providing shelter for the homeless reflects in a better overall quality of healthcare amongst Singapore nationals in comparison to citizens from other countries who struggle to find a home and fall out due to behavioural or addiction-related issues.

Barriers remain due to inadequate resources

Based on a study by researchers from The Dartmouth Institute for Health Policy and Clinical Practice and the School of Public Health at UC Berkeley, 50% of accountable care organisations (ACOs), a form of value-based payment models, addressed patients’ non-medical needs, of which the most commonly addressed, were related to housing stability, transportation and food insecurity.

"The intersection between patients' medical outcomes and social service programs is complex, but it's very important we study it further to determine which activities are effective at addressing patients' needs while reducing costs and improving the quality of care," said Fraze.

However, efforts by most ACOs remained inadequate and neither services nor organisations were well integrated.

The study also identified multiple issues faced by ACOs with program scalability, where a general need was identified, but constraint attributed to insufficient resources, lack of expertise as well as competing clinical priorities collectively formed barriers towards developing effective formal programs.

One such example was a nutrition assistance program that was developed for patients with specific medical conditions. While the ACO recognised that the program had greater potential for many others to benefit from; the organisation lacked the resources to widen the scope of the program to accommodate to others.

Singapore to improve QoC by addressing community care sector

According to Singapore’s Health Minister Gan Kim Yong, the country would require more healthcare workers with the expansion of primary and community care. In order to achieve a stronger local core in the healthcare field, expansion of training and recruitment is necessary to enable all who are interested to become involved with work in healthcare.

The Centre for Healthcare Innovation Co-Learning Network was introduced with aims to connect both local and overseas institutions to address the challenges caused by the country’s ageing population and slowing growth of labour force.

According to the Minister of State for Health and Communications and Information Chee Hong Tat, the focus would be on training healthcare workers such that they are able to support the transition from a hospital to community care, and look into how robotics can be utilised to allow healthcare workers to focus on the patients’ needs.

Through the Senior Management Associate Scheme (SMAS), the Agency for Integrated Care (AIC) helps coordinate healthcare services for senior citizens and aids mid-career professionals in their transition to new jobs in the community care sector.

"The programme is meant to prepare and assimilate them into their new jobs," said Teo Sio Hoon, chief of intermediate- and long-term care at the AIC’s manpower development and resourcing division.

"In a corporation, the bottom line is the key thing, but in community care, while we are conscious of cost, the welfare of patients is more important in making decisions.” MIMS

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