*Health system: a system whose primary intent is to improve or maintain health

Contains the resources, actors and institutions related to the financing, regulation and
provision of health actions
Includes: all actors and institutions who see their primary purpose as contributing to health
The boundaries of a health system do not include educational sectors, as the primary goal
of education is not to improve/maintain health
Primary goal: Better health
Secondary goal: fairness in financial contibution towards the costs of ill-health
Protect vulnerable people from catastrophic costs of health using systematic
measures and mechanisms for sharing risk and providing finacial protection
Tertiary goal: responsiveness to people's expectation
- Individual dignity, autonomy and confidentiality of information (Privacy,HIPPA (US),
National Electronic Health Record (NEHR))
WHO - Functions and objectives of a health system
WHO Health System Framework
Health System vs. Healthcare System
Healthcare System - Hospitals, Doctors, Nurses, etc. (Service Delivery and Health
Workforce)
Primary Care - GP, clinicians
Located in small to medium sized out-patient clinics, usually no in-patient warded states
Gatekeeper for secondary or tertiary care, sinces referrals are provided here
Secondary care - hospitals, physicans located in hospital-based clincis that deal with
hospital patients and referrals
Can be either planned or acute (emergency) issues
Usually hospital-based (both in-patient and out-patient)
Tertiary care - immunologists,, cardiologists, surgeons, subspecialists
Specialised care - usually require referral from primary or secondary care physician or
from inpatient admission episode
Usually hospital-based
*Upside-down pyramid for healthcare hierachy populaton
Small local clinics serve a small unit of people
As severity of symptoms increase, size of region increases as more people are attracted
to larger healthcare centres that host a range of specialists/subspecialists for
secondary/tertiary care
HSA
1 April 2001
ensure technologies are up to standard and evidence to be permissable in the court of law
Integrated Health Information Systems
2008
digitised, connects and analyses Singapore's health ecosystem
PILBOX - no pharmacist/physcian prescriptions for drug refills, streamline drug distribution
compared to pharmacy prescriptions
Health Hub - all-in-one hub for anything health related
National Electronic Health Record (NEHR)
HPB
2001
government organisation committed to promoting healthy living in Singapore
Agency for Integrated Care (AIC)
1992 - Care Liason Services (CLS) under 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 hospital to
community
2008 - Agency for Integrated Care (AIC)
2009 - Established as an indepedent corporate entity under MOH Holdings
2018 - Pioneer Generation Office renamed to Silver Generation Office, joined AIC
Three integrated health clusters in SG
2009 - Creation of Six Regional Health Clusters
2017 - Reorganisation of Three Integrated Health Clusters
National University Health System (NUHS)
National Healthcare Group (NHGS)
North and West
SingHealth
South and East
Regional Health System (RHS)
Consists of Clusters + Partners
Partners - Care Providers, Organisation and Volunteers, Grassroots, Social Agencies
Primary Care
23 Polyclinics (Public) - large Primary care centres
9 More by 2030
About 1800 clinics (Private)
Singleton GP, Group practice, Primary Care Networks (PCNs)
Secondary and Tertiary Care
10 public hospitals
8 general hospitals
1 women's and children's hospital
1 psychiatric hospital
8 private hospitals
Upcoming Hospitals
Woodland Health Campus (under NHG)
New hospital to open around 2030
Intermediate and Long Term Care (ILTC)
presents that the care is transitional, and that there is an end to the care being provided
Residential
Community Hospitals
5 public, 4 non-profit
Nursing Homes
Social Service Agencies (SSAs) / Non-profit
Private
Hospices
provides palliative care, when recovery of the patient is not expected
Community-Based
Centre-Based or Home-Based
end stage illnesses (terminal cancer, dementia, etc.)
old age
a lot of support provided to increase QoL (pain management, symptom management) for
patients, but little to none for treatment of underlying illnesses