By Dr Tan Cheng Bock

The current system is curative (hospital) care and is expensive but most diseases can be managed at cheaper outpatient level.

Diseases like cancer, high blood pressure, heart attacks, diabetes can be managed outpatient. This is what we must do. Manage these ailments well and there will be fewer admissions and cheaper cost. The Straitstimes report on 2013-03-22 that last year patients paid around 271,000 visits to public specialist clinics, a marked increase on the 74,000 visits in 1994. Either this increase is due to population increase or our community preventive management needs a review.

The day the hospitals see less cases of amputations of limbs, kidney failure, blindness and heart attacks will be a testimony of good health care programs for our diabetic and heart patients at community level. Costs will come down as Singaporeans with proper cholesterol control will have less heart stents and fewer bypass heart surgery, for example.

Primary health is not just building outpatient clinics or community hospitals or nursing homes etc, .These are important and essential health commodity assets .But they should not exist by itself. They are part of a very structured health care delivery program with other allied health care institutions involving nurses, doctors from public and private sectors , dental surgeons, allied health care givers and community at large. Ministry of Health (MOH) must play a pivotal role in getting these health workers at the ground to work and cooperate effectively. Thus MOH should encourage private, public doctors cooperation through sharing of facilities to avoid duplication of equipment and services to effect cost savings.

Primary health care is frontline medicine. The manner in which the health workers control the spread of disease at the community is of paramount importance as to its eventual outcome, for example, the changing pattern of practice among our General Practitioners (GP) will affect future control of infectious diseases SARs as, as many as 30% of GPs are involved in aesthetics. The current high rentals gave many young doctors not much choice. They will be ill prepared to fight infectious dideases. So it is vital that MOH pay more attention to this area. How will this trend affect control as we are a travel hub and with frequent people movement between other countries and Singapore, our people are exposed to imported illnesses.

Primary health care also involve in easing the pain of illness disruption to families through the provision of better nursing, old age homes etc .Usually following discharge, the patient’s family will be frantically looking for an affordable place to put the patient. The lack of such step down health care institutions for our sick and frail Singaporeans show that over the years this area has been given less priority.MOH must address this quickly as demand for such facilities increases with an aging population. Do not just leave to the non-government organizations (NGO) or some charitable organisations to run such homes. Many are spending time simply on fund raising to meet the expenses alone therefore MOH must take the initiatives to build more such homes.

At present there are good primary care programs to control and manage diabetes, high blood pressure, high cholesterol,obesity and asthma, to name a few. Singaporeans should take advantage of these programs, some, supported by medisave. Prevent early admissions to hospitals through these programs will save Singaporeans huge hospital bills.

There should be a review the building of new huge hospitals, What type of role will the new hospitals play?. Currently most of the hospitals are tertiary type. Maybe the new ones should be secondary like Alexandra. Keep it simple so that hospitals remain a place for the ill with no no elaborate foodcourts to keep rodents and cockroaches off limits I have brought up many issues, challenged some existing ones, re-hashed my old arguments when l was in parliament. This is to let my readers think and even challenge my views.

At the end of the day, we must take responsibility of our own health by leading a healthy lifestyle like not smoking, watching your weight and regular workout.

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