Plan for changing existing healthcare policies

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It is important for the overall workplace health program to contain a combination of individual and organizational level strategies and interventions to influence health, including: Health-related Policies — are formal or informal written statements that are designed to protect or promote employee health. Supportive workplace health policies affect large groups of workers simultaneously and make adopting healthy behaviors much easier.

They can also create and foster a company culture of health Examples of health-related policies include: Policies prohibiting tobacco and alcohol use at the workplace Policies requiring healthy foods to be served at company meetings and events Policies allowing for flextime to exercise or attend health programs Policies that are not specifically health-related may have health impacts on employees.

Regardless of which interventions are selected, the program should strive to: Use multiple interventions, such as combining a policy and a health benefit intervention, for a single health issue. Combinations are more effective than any one intervention alone Use interventions that address multiple health issues at the same time, which is more effective than addressing each single health issue separately. Secondly, some academics contend that Singapore's combination of favourable health indicators with the low proportion of GDP spent on health expenditure owes more to socioeconomic factors than to the NHP.

The suggestion is that the nation's diet, lifestyle, strong family and community ties, and overall social culture play a large part in keeping the population healthy. In particular, comparisons are made with Hong Kong and Taiwan, countries with similar socioeconomic cultures, environments and challenges. In the 35 years since the introduction of the NHP, Singapore's healthcare system is not only thriving but also keeping Singaporeans healthier for significantly less expenditure relative to GDP than any other nation.

While it is debatable whether this can be attributed entirely to the NHP, the objectives of the NHP have nevertheless led to Singapore retaining an active and healthy population - which is primarily responsible for the costs of its own healthcare.

From the outset, the MOH consulted with the stakeholders involved in the development of the NHP, receiving a number of suggestions none of which were incorporated into the NHP to any significant extent.

Nevertheless, the NHP was implemented smoothly with no notable opposition, and all stakeholders played their part, including the public, medical bodies, hospital administrators, medical professionals, and government officials.

When development of the NHP began in , several activities were initiated to gather ideas, especially from academics and key players in the healthcare system. These include eminent members of the medical and dental profession, knowledgeable journalists and community leaders from the Citizens' Consultative Committees and the Residents' Committees.

During the consultation period, the NHP was also tabled before parliament, following discussions and consultation not only with officials from the MOH but also with numerous representatives from the medical profession and professional bodies.

None of the comments, criticisms and suggestions made of the Blue Paper led to any significant alterations to the NHP before it was enacted. Arguably, the voices of the stakeholders in the public consultation were disregarded, although the stakeholders still supported the implementation of the NHP and its radical reforms, all of which were introduced without opposition. Political support from the ruling People's Action Party PAP was almost unanimous, with only a handful of concerns expressed in parliament and only 2 dissenting voices out of 75 MPs.

Governing all but unopposed meant that the MOH faced no political hurdles in enacting the NHP as it saw fit, and that any scrutiny or criticisms of the NHP were merely suggestions that required neither action nor consideration. The Medisave scheme was presented to parliament for debate and approval in a two-day debate on 30 and 31 August Fourteen MPs gave their views and while some reservations were expressed, support was unanimous with only two exceptions.

Toh Chin Chye abstained from voting on the grounds of his conviction that the government should inherently assume the task of healthcare.

Chye, who was formerly the minister for health, argued that healthcare was primarily the government's responsibility. It was therefore the government's duty to find ways of using taxpayers' money to fulfil its different objectives, rather than implementing a CPF savings scheme.

Receiving In the run-up to the general election, some opposition candidates had been making calls for either free or less expensive healthcare. Chye touched upon the PAP's position on healthcare at a rally ahead of the general election.

In the general election, following the implementation of the NHP, the PAP lost ground slightly, receiving just Nevertheless, this continued an astounding, if now not quite complete, majority and represented significant and continued public confidence and support for the party.

Once again, healthcare was not a key issue or platform in this election. The NHP set out a range of objectives to be achieved over the following two decades, including both quantitative targets and qualitative policies. Firstly, the financial burden of healthcare was to be shifted from the government to individuals and employers, through a mandatory MSA called Medisave, and secondly, all government hospitals were to be corporatised rather than privatised.

Build a healthy, vigorous, active and physically fit population. Build up individual financial resources so that those who fall sick would have the means to pay their healthcare[ 2 ]. Divert the public health sector's energy and resources into preventative medicine and health education. Encourage the private health sector to take on greater responsibility of providing care at reasonable cost.

Coordinate the planning and development of both sectors to achieve a better distribution of services, avoid wasteful duplication, stimulate healthy competition, and enhance efficiency. In addition to policy objectives, the NHP Blue Paper also set out clear, quantitatively measurable targets for numbers of hospital beds and outpatient consultations needed by the year , based on their projections of demand. They set targets of 13, beds and 20 million consultations per annum, which implied a predicted increase in demand from of 3, beds and 16 million consultations per annum.

Targets for numbers of doctors, nurses and dentists were also identified. Developing primary healthcare services to provide frontline preventative and curative healthcare. Encouraging the community to care for the old and chronically sick. Moving towards outpatient treatment for non-acute psychiatric illness.

While extensive consultations with relevant professionals, experts and academics in the healthcare field were undertaken in the development of the NHP, it is unclear what evidence the policy's approach was based on. The MOH explained that the Medisave scheme was designed after studies of countries with prepaid healthcare systems.

These systems were primarily financed through general taxes or compulsory health insurance instead of fees at the point of consumption. Personal accountability became key to Singapore's future healthcare planning.

Whatever the reason for rejecting a prepaid healthcare system, there would have been little evidence available to evaluate the efficacy of an MSA-based system, particularly on the scale that Singapore would be applying.

Quantitative projections of future healthcare supply and demand were made by extrapolating directly from relevant data from the preceding decade's records. In some respects, the Medicare scheme was to be its own pilot scheme. Initially, Medisave withdrawals were limited to the amounts charged for treatment in a public hospital's Class C ward.

The MOH was cautious about the figures they had imposed for Medisave, ensuring that the scheme would be feasible. In Medisave's first year, the scheme collected SGD million - more than double the running costs of the entire public health system. Only 30 percent of the fund for that year was paid out, a figure that was predicted to rise as the population aged.

As part of the NHP, admissions targets for relevant medical training institutions were put in place to help create the supply of manpower needed to meet the predicted targets of practitioner numbers for the population. Singaporeans and their employers were already mandatorily paying into the CPF for pensions and the Public Housing Scheme. The administrative institution that was needed to manage and operate the Medisave scheme was already established and operational, and the population was familiar with the concept of mandatory personal savings schemes.

These factors made the introduction of Medisave and MSAs a feasible and practical overhaul of the public healthcare infrastructure. Central to the NHP was the idea of corporatising hospitals. Hospitals that were previously free public institutions were granted a high degree of autonomy.

The structure allowed the MOH to continue exercising its authority in larger, strategic decision-making and macro healthcare system management. On the finance side of the NHP, Medisave was to be managed by the existing CPF, a national agency that was well established, having been formed almost 30 years earlier in There were no specific mechanisms in place nor were there any reporting targets that were made public.

Market forces came into play within the corporatised hospitals system, with any underperforming management or administrators of individual hospitals being held accountable by the MOH-controlled HCOS board to which they reported. Measuring the public impact of the NHP is a difficult task to undertake because the MOH does not often make healthcare data publicly available.

Some metrics were identified in the NHP Blue Paper, which can be tracked and measured, notably numbers of hospital beds and the ratios of medical practitioners to the population. Whether these figures are specifically tracked by the MOH is unclear, and they are certainly not announced routinely.

Nevertheless, significant changes have been made in the implementation of the NHP since it came into effect, most notably in extending the MSA system's offering from Medisave alone to include a voluntary insurance scheme Medishield and an endowment fund to assist those facing financial difficulties in paying their medical bills Medifund. Integrated Shield Plans IPs were introduced in , combining Medishield coverage with private coverage and allowing payment of premiums from MSA funds.

IPs were intended to lower OOP spending on healthcare and ensure universal coverage, demonstrating that the MOH is still monitoring associated data and issues. These adaptive changes to the NHP provide a strong indication that the MOH is measuring and monitoring the public impact and effect of the NHP in order to make adjustments and improvements, but choosing not to make the measurements public. The NHP was launched without addressing criticisms made by stakeholders about the treatment of chronic illnesses, care for the elderly, and pressures on the financially destitute.

Further down the line, however, these concerns were directly addressed and the stakeholders brought further into alignment with the introduction of Medishield and the Medifund. The corporatisation of hospitals attempted to combine free market forces with government control and intervention.

That the MOH felt it needed to step in is a direct result of the natural misalignment between the interests of patients, private hospitals, and the government. Upon admission, for instance, a hospital is required to provide a patient in Singapore with not only an estimate of their bill but also an estimate of the average bill at other hospitals. Despite the naturally conflicting requirements of patients wanting cheap, subsidised healthcare, private hospitals and professionals wanting to make as much profit as possible, and the government wanting a comprehensive, affordable healthcare system, the NHP was introduced smoothly without public protests or objections.

Let's copy Singapore's health care miracle, Sean M. This case study has been assessed using the Public Impact Fundamentals, a simple framework and practical tool to help you assess your public policies and ensure the three fundamentals - Legitimacy, Policy and Action are embedded in them.

Learn more about the Fundamentals and how you can use them to access your own policies and initiatives. Home - Centre for public impact.

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For nurses and health administrators, understanding and following policies can help ensure that you deliver the best care to patients while using your knowledge to help inform future policies. On a broader level, when patients take the time to understand healthcare policy, they learn more about their rights.

To be able to maintain quality care for patients, organizations must set policies to address the following aspects of their operations. Patient care policies cover protocols and workflow for treatment procedures, outlining how healthcare professionals should respond to specific medical situations. Of course, policies must be tailored to the care your facility provides. For example, a cancer center would create different patient care policies than would a center for rehabilitative medicine , because their treatment protocols are so different.

The health of employees is a crucial component of running an effective facility, as staff must be able to care for patients safely, while maintaining their own well-being. Examples of policies designed to protect and promote employee health include rules around the consumption of alcohol and tobacco in the workplace, wearing masks and gloves to minimize the risk of exposure to illnesses and chemicals, and wellness policies such as time off and healthy eating.

Drug policies outline procedures around the handling and administering of pharmaceuticals, whether the medication is over-the-counter, controlled, or non-controlled. This can include protocols for recording, handling, and delivering each medication. Security policies clearly outline how employees should handle situations that pose a security threat in their facility.

This can include situations like abuse towards medical staff, patient abductions or elopements, theft, and active shooters. Aside from physical security, data privacy and technology security policies and procedures are extremely important in any healthcare facility. The HIPAA Privacy Rule protects patient information from release to the public, while permitting the exchange of this information if needed between medical professionals and in certain other situations.

Alex M. The more that technology becomes an integral component in how healthcare facilities operate, the greater the chance that data leaks and privacy breaches can occur. In , there were healthcare breaches, a 55 percent increase from For many families, healthcare takes up a huge portion of their budget. There is an ongoing debate over who has access to coverage and why the costs of care are so high in the United States, which is why some policymakers are trying to find solutions to improve access to affordable and quality care for all.

Below, we explore a few major health policy issues impacting Americans today. In , 92 percent of Americans had some form of healthcare coverage—whether employer-provided coverage, Medicare or Medicaid, or private health insurance.

Katherine Keisler-Starkey and Lisa N. The Affordable Care Act, implemented in , played a major role in increasing the number of insured Americans. Although the percentage of uninsured individuals has decreased, policymakers have diverging viewpoints around this issue. Some policymakers are pushing for higher participation in employer-provided coverage, while others are advocating for Medicare for all.

Even with health insurance, many individuals still face overwhelmingly high out-of-pocket healthcare costs. In the wake of the COVID pandemic, it has become even more imperative for lawmakers to find an affordable solution for Americans. To address these high costs, policymakers have discussed finding a way to lower prices without compromising the quality of the services and care provided.

Some solutions include significantly reducing prescription drug prices or allowing policymakers to regulate healthcare prices. And competing with the public option could pressure private insurers to lower their costs. This includes access to healthy food, affordable housing, transportation, childcare services, education, and more.

A healthy population leads to better outcomes and more affordable care for all. Healthcare policy analysts play a huge role in making effective changes to our healthcare systems. And certainly for Ferris asked panelists what they see as the role of technology in addressing policy changes and how technology will make an impact beyond the ACA — to consumers, providers, health plans, payers, and hospitals.

That model is tough to scale and so clinicians are best focused on high clinical acuity and complex care. And that includes leveraging remote patient monitoring capability, wearables, Etc. And so right now for a commercial line of business, you can do, for example, digital coaching and get reimbursed for it. So, I think, as it becomes more commonplace in the commercial market in evolution it will be more common in government programs. I think technology is going to reinvent the shopping experience in healthcare for both obtaining health insurance as well as care delivery.

If we wonder what technology should do, we have to realize that Amazon is a technology company that brought the store to the house. And Netflix is a technology solution.

And Uber is a technology solution. I think technology is already revolutionizing care delivery so that much of it can be provided in the home if people want it there, or in the cloud. The participant went on to share additional insight on technologies likely impact on shopping, care delivery, and drug development.

One attendee commented about the need for ubiquitous access to healthcare services in all locations — urban, suburban, and rural — and the growing acceptance of technology-related glitches by healthcare consumers:. He stressed the importance of focusing digital solutions on what providers and patients need — not on supporting the economics of the healthcare model. For more insight and information on the challenges, issues, and opportunities facing healthcare leaders, subscribe to our newsletter and connect with us on Twitter and LinkedIn.

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