Integration model: used to provide seamless and effective healthcare for the elderly population in Singapore
Currently Singapore has no model in place that it uses for providing seamless healthcare for the elderly. This paper therefore suggests for the introduction of integration model in Singapore to be used to provide seamless healthcare for its ageing population. The reason why this model is highly recommended in Singapore is because if primarily focuses on geriatric care and as a trained geriatric nurse it is my passion to see that medical care and treatment of old people is done in the best way. The current system being used for geriatric care in Singapore is in service for the elderly. This system does not provide the much needed seamless care. The integrated model has proven to be an important and essential framework that can improve a healthcare system by making it more cost effective besides providing seamless care.
The ageing population in Singapore and its impact
Singapore has a growing trend of ageing population. It is currently an urgent problem that needs to be taken seriously. By 2008, Singapore had over 300000 people who were aged above 65 years. This was 8.7 percent of the national population in Singapore. It is also projected that this figure will increase to about 19 percent of the Singapore national population by the year 2030. The ageing society in Singapore raises concerns because of the nation needs to prepare for this. Policies need to be formulated to come up with ways of taking care of the needs of the elderly.
Singapore is among the unique developed countries that have so far been able to achieve success in the healthcare at low economic cost. The system that the country has adopted to finance healthcare can be attributed for this success. The strategy used for the keeping the cost low emphasizes on making the citizens being responsible for their own health. Also within the public health systems, co payment, deductible, and subsides features were integrated in to the system so as to reduce excessive consumption. The problem is that the low cost of healthcare in Singapore is mainly sustained by a young population. Because of this fact, demand for healthcare has been low or rather restrained in the country.
The concern is that, Singapore has one of the fastest ageing populations in the world. As earlier mentioned, it is projected that by 2030, 30 percent of the national population will be aged 65 years and above. Ageing population in Singapore will therefore impact the national spending on healthcare as demand for healthcare by the elderly will grow. For instance, in 2005, a total of 3.7 percent of the GDP was spent on healthcare. Out of this figure, 25 percent was contributed by the government of Singapore. This contribution represented 0.8 percent of the gross domestic product. With the projection of increasing ageing population and demand for healthcare for the elderly, expenditure on healthcare will definitely increase.
Development of policies on ageing
The Singapore government began realizing that its ageing population is likely to increase as time goes by. It also began realizing that this growing trend will have an impact on the national expenditure on healthcare as well as the society. By 1982, the government of Singapore created a committee on the problems of the aged. This committee was intended to identify anticipated problems associated with the growing ageing population in Singapore. This foresight the government had resulted into formulation of the inter-ministerial population committee in 1984.
In 1988, the issue was taken seriously and lead to the formation of an advisory council that was charged with the responsibility of reviewing the status of the ageing population in the country. This committee came up with recommendations regarding the problem. It proposed formation of the National council on Ageing, a statutory body that is mandated to create policies and programs aimed at meeting the needs of the older people. With regards to retirement age, the council was able to propose that the retirement age be increased from 55 years to 60 years. Employment generally creates a sense of worth and the elderly need to feel worthy members of the society. There was also need to increase programs for public education of the elderly, implementing systems aimed at creation of more opportunities for the elderly to be employed, setting up of homes for the elderly persons, increasing the terms of lease for property especially homes, and providing medical and health services for the elderly who wish to receive the services from their homes.
This development took a complete shift within a period of five years. Currently, there is a national policy on ageing population in Singapore. Healthcare for the elderly is aimed at prevention of diseases and promotion of health so that the elderly people could stay fit and healthy. It strives to ensure that the elderly become proactive within the community as they participate in communal activities. The current healthcare system in the country is multi sectored. It involves the government, the corporate, commercial sector, not for profit organizations, the community, the family, and the individuals. This approach of care charges the community with the responsibility of caring for the elderly even before any institution is established . The ministry of health and the ministry of community development are the two bodies that oversee the entire healthcare system in the country. They therefore play a significant role in the care for the ageing population . Even though the government plays a significant role, it does intend to engage in hands on provision of long term healthcare for the elderly. Specifically, it plays the role of regulating, funding, planning and policy making.
The system provides the elderly with a range of services aimed at ensuring prevention of diseases, and promotion of healthy living. There is education for healthy lifestyle and this involves issues such as dieting, exercise, avoidance of smoking and consumption of alcohol. The system also focuses on detecting diseases early so that they can be managed on time to prevent the further development. There are also community based services
The problem of providing seamless care in Singapore
In Singapore today, the integrated healthcare system is not entirely in use. Even though it has programs that aimed at giving healthcare to the ageing population, the country is still yet to integrate all the elements together in order to address the wider health needs within the community. The country has Voluntary Health Organization that plays a huge role in provision of care for the elderly. These organizations work hand in hand with the government and government hospitals to provide community care for the elderly.
There are also challenges that have met the current healthcare system that can be reduced or mitigated with implementation of an integrated system. For instance, healthcare services for the elderly are basically not provided in a seamless way. This is because of the lack of network development among all the stakeholders or service providers within the country. The other challenge is the need for proper standards for healthcare services aimed at the elderly. These guidelines have to formulated and implemented effectively through the use regulatory means. The final challenge witnessed with the present healthcare system is that there is no proper way of providing quality care that is proportional to reduced cost.
Community hospitals for instance are meant for the elderly who are in need of inpatient care for longer periods but may not be in need of care from the acute hospitals. Within the country, there are only four community hospitals with a total capacity of 427 beds. These community hospitals should have the rehabilitation potential. The country also has chronic sick hospitals, nursing homes and hospice, day care centers and home care. All these institutions are put in place to take care of the needs of the elderly
Integration model of care for the elderly
Integrated healthcare system has attracted the attention of many countries especially in the developed world. It has proven to be an important and essential framework that can improve a healthcare system by making it more cost effective. Integration care has several meaning depending on the country in which it is used. However, in Singapore, the integration care will involve reuniting every aspect of healthcare system into a whole so that they work together. First of all every element involved in the healthcare system will have to be understood comprehensively in order to identify all the ways in which it will relate with all the other elements. Therefore integration system will bond every element together so that they can work together to increase productivity.
Integrated approach to care for the elderly focuses on certain pillars. They include community based services, training services, and network development services. The community based health services is used to provide support to the most frail and weak elderly within the homes. It basically composes of a team of doctors, program coordinators, social workers, and nurses. This will go into the homes of the vulnerable and frail elderly bound in bed and provide medical services, social services, and nursing services.
At a different level, the team of doctors, nurses and social workers would also target fairly frail and vulnerable elderly within the community. These elderly people might be those that receive little healthcare or have inadequate access to quality and proper healthcare. Community based clinics could be set up to provide ease of access to the proper medical and health services that the frail elderly people need. Such clinics will be set up in areas where there are a large proportion of elderly people with low income. Within the clinics, health education, nursing care and geriatric medical care can be provided.
Some of the clinics based within the community might make use of traditional methods of medication. For instance, practices such as acupuncture may still be relevant in some of the communities. The people appreciate these traditional practices since they prove effective. Such clinics that use traditional practices will create an integral system that will make mainstream medical practitioners and traditional practitioners to collaborate. Traditional practices are particularly common with the elderly in Singapore. Within the field of medicine, acupuncture has proven to be very effective in treatment of certain ailments associated with the elderly. For instance, it is effective in treating pain resulting from arthritis. It is also effective in decreasing mobility linked to coronary conditions such as stroke.
Community based healthcare services can also be target senior citizens who are vulnerable and have multiple social and health needs. The services can be provided at the homes of the frail senior Singaporeans. There could be places where community care services might be short. In such areas, the care management services will attempt to link service providers to cooperate and work together to provide a comprehensive coverage of services to the community. Clinical services programs can be expected to complement each other so that there can be a continuum of care for the elderly.
In addition, the integrated approach will emphasize on the issue of training and health education. This is based on the assumption that knowledge and skills are important and essential for community based care and self care. People can know how to take care of themselves once they are given the knowledge, training and skills they require. At the same time, other members of the community can also know how to take care of the health needs of the elderly through proper education and training programs. In effect, the government of Singapore has encouraged initiations of training centers located within the communities to provide training and education to individuals, families, volunteers, professionals and the general public. There people who may intend to volunteer their services to nursing homes for the elderly. These volunteers need to be trained so that they can provide the services effectively.
Training and education is also given to corporate and religious organizations that deal with care for the needs of the elderly. Some of the training programs conducted within the centers are aimed at training trainers. The people expected to train others on the issues of care for the elderly have to be trained so that they can perform their function effectively. Other organizations such as religious based organizations and nonprofit based organization may wish to provide train and provide health education to the general public. Training the trainers program would provide well skilled and effective trainers to such organizations. The training the trainers program has basically led to the multiplier effect through the decentralized care giving training . As a result there has been wide dissemination of skills and knowledge of effective care for the elderly.
Integrated approach should focus on development of network services. This basically implies the notion of inter agency collaboration . Different organizations and agencies can be linked together through policies so that they can join hands and address bigger needs within the communities. The collaboration should also include government hospitals and agencies with nongovernmental organization.
All these training services and medical programs should be designed so that they can be duplicated for use in other regions and communities. This idea of duplication is aimed at increasing development and use of the integrated model in to new areas. To encourage the idea of duplication, the healthcare programs can be developed with training manuals to be used to initiate the programs in new areas.
Implementation of the model
In order to properly implement the integrated healthcare system in Singapore, the there has to be proper means of funding that is cost effective . Funding may involve several aspects such as manpower assistance, financial assistance, allocation of land by the state, exception of certain taxes and charges imposed on vehicles that are used for provision of healthcare, issuance of free medical service to patients who are needy, and providing proper standards for nursing homes and care. The government needs to develop a mixed economic strategy for funding healthcare programs for the elderly. It also needs to target its spending on the low income elderly who may have a problem to adequately access quality healthcare.
The government may not be the sole source of funding for healthcare. It could seek collaboration with other organizations including corporate bodies. Through the use of the integrated approach, the government could find itself reducing cost by having lean and reduced staff running agencies and statutory bodies . Some of the function could easily be shared by other organizations that have stake in the national healthcare system of Singapore. Since nonprofit based organization or charity organization do not attract taxes, the government could easily encourage formation of such organization so as to reduce cost of healthcare for the elderly.
The legal system is also involved in the integrated healthcare system. There is need to have legislations and policies that regulate and govern healthcare of the elderly within the country. Since a lot of decentralization for the dissemination and management of healthcare is encouraged, there will be need to regulate how private hospitals conduct their operations . They have to meet certain standards of measure so that quality is emphasized in the healthcare system. Currently the only piece of law used to spell out standards in nursing homes and private hospitals is the private hospitals and medical clinic Act.
It is indeed not a hard task to achieve full implementation of integration model to provide geriatric care in Singapore. The country itself is has a relatively small population and at the same time it is considered among the developed countries within the Asian Pacific region. Bearing in mind these two facts, implementation of the model will not be entirely difficult as long as long there is political will among the leadership within the country.
Conclusion
This paper has discussed the issue of provision of seamless healthcare for the elderly in Singapore. Being one of the developed countries within the Asian Pacific region, Singapore is faced with a national problem of an increase ageing population. It is projected that with the increasing elderly population, the impact will be felt on the spending on healthcare for the elderly since demand will be on the rise. Through the use of an integrated healthcare model, the country can be able to create a system that will focus on cost reduction and provision of quality healthcare to the elderly. The integrated model is where the different elements within the healthcare systems are bonded together so as to increase the impact of services that caters for the wider need of the community. Based on the discussion provided in this paper, the integration model is therefore the best way in which seamless care can be provided to the elderly people in Singapore.
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