SuetSuet--Wun LIMWun LIMCEOCEO

National Healthcare Group, SingaporeNational Healthcare Group, SingaporeAnd Tan And Tan TockTock SengSeng Hospital, SingaporeHospital, Singapore

Corporatization of Hospitals “The Singapore Experience”

• Different systems = different “policies & ideology”• => different practice of corporatization• Also implementation variance

Hong Kong’s Outcomes Very Good.

PERFORMANCE ATTAINMENT OF GOALS

MEMBER STATE

Overall health system

performance

On level of health

Health expenditure per capita in international

dollars

Fairness in financial contribution

Singapore 6 14 38 101-102Australia 32 39 17 26-29UK 18 24 26 8-11USA 37 72 1 54-55Switzerland 20 26 2 38-40France 1 4 4 26-29

SINGAPORE IN THE WHO REPORT 2000

Provision

$ 1Co-payment

FinancingSolutions1980\5

Singapore Moved From an Singapore Moved From an ““NHS LikeNHS Like”” SystemSystem

Tax Based

Hospitals MOH Run

Competition & Aging

Buffet Syndrome

Service and Efficiency

Could Not Continue This WayCould Not Continue This Way

MediSave

Copayment20 – 100%

“Restructured”Hospitals

Singapore Government “Organizations”

Hiring (rank & file)

Fees

Policy & Procedures

Management

Government ControlsV V V V V V

NoNoVarying/ Semi-Independant

Yes

NoSome Controls for subsidised

YesYes(Gazetted)

NoSome (Policies only)

Yes(IM)

Yes(IM)

NoNoClose supervision

Yes

Shares in Shares in Listed Listed CompanyCompany

CorporatisedCorporatised(HealthCare)(HealthCare)

Statutory Statutory BoardsBoards

Government Government DepartmentDepartment

Corporatisation Rationale

Other Agenda

Political Distance

Reduce/ manage Expenditure

Autonomy

“External” Perspective

Effectiveness

Other Agenda

Efficiency

Independence

“Internal” Perspective

PrivatisationPrivatisation

HWF Bureau(2004 Leg Co Panel)

Reduction and Prevention

Right to Health Care

Co-payment

Individual Responsibility

Singapore MOH Hong Kong HA

ENVIRONMENT LEADS TO DIFFERENT ENVIRONMENT LEADS TO DIFFERENT POLICY POSITIONS IN HONG KONG POLICY POSITIONS IN HONG KONG

AND SINGAPOREAND SINGAPORE

Not Specific

Not Specific

Clearly Stated

Clearly Stated Not Specific

Low

Not Specific

Not Specific

Clearly Stated

Clearly Stated

Not Specific

Clearly Stated

7 (No Boards)

38 HA Board Governing Committees

Hospitals

2- Registered companies- Non Exec Boards* Cluster CEOs also hospital CEOs

7Provider Clusters

MOH Holdings- Registered Company

Hospital Authority- Statutory Board- Board with 11 Committees

Next Level

MOHHWF BureauGovernmentSingaporeHK

Comparison of Hong Kong and Comparison of Hong Kong and Singapore Organizational StructuresSingapore Organizational Structures

How Was it Implemented ?

• Over time (1985-1990)• With difficulty (too and fro)• With mistakes • Not a magic bullet• Factors like leadership still important

Issues in Implementation

• Public Perceptions are Key• Other Policies and Infrastructure• Other Agenda• Mindset Issue

CorporatizationCorporatization: Degrees of Freedom: Degrees of Freedom

Other Purchasing and Services

Board Appointments

MOH Approval Needed

Capital Purchases

HR

Finance and Pricing

IT

Capabilities and Services

Strategic Plans

Organizational Structure No

Yes

No (Info only)

Medical capabilities list

Subsidised budget Max increase of subsidised charges

New hospitals & major renovations

No

CMIS Information

No

““ We would often be sorry We would often be sorry if our wishes were if our wishes were

gratified.gratified.””

The old man and deathAesop

The Straits Times, Tuesday, September 30, 2003

Competitive PressuresCompetitive Pressures

Class ASubsidy; 0%

Class B1Subsidy; 35%

Class B2Subsidy; 65%

Class CSubsidy 80%

Ward Classes by Choice Ward Classes by Choice

LOS by Ward Classes*, TTSH, Feb-Mar 2006

DRG 261 Chest pain

DRG 130 Dizziness and giddiness(Vestibular neuritis, vertigo)

DRG 037 Stroke withcomplications

0 2 4 6 8 10 12 14

LOS (days)

C B2 B1 A*For no. of patients ≥30

Subvention55% ($244M)

Patient Revenue35% ($156M)

Other Revenue4% ($19M)

Revenue from Patient Related Services to

Third Party6% ($27M)

TTSH FY2005 Revenue(S$446M)

20002000

Institute of Mental Health

National Healthcare GroupNational Healthcare Group’’s Institutionss Institutions

National Skin Centre

Alexandra Hospital Tan Tock Seng HospitalNational University Hospital

Choa Chu Kang Polyclinic

NHG Experience :Organizational Structure

• 8 Member non-executive Board• 4 meetings a year.• No ExCo• HR, Finance, Audit and IT Committees.• Agenda & Minutes confidential (Business Plans)• Copies sent to Ministry of Health• Regular meeting between CEOs and MOH• NHG CEOs meet monthly

NHG Experience: Institutional Autonomy

HO/ MO /CHL Employment

Research approval

Some training(NHG College)

HR Policies

Finance (FSS)

IT

CoordinatedIndependentConsolidated

Operations

Fees

Employment

Quality Programs

Singapore Medicine

Outcome = Cost EffectiveOutcome = Cost Effective

Other Outcomes

ISO ISO 9001:2000 9001:2000 (Quality (Quality

Management Management System)System)

ISO ISO 14001:199614001:1996

(Environmen(Environmental tal

Management Management System)System)

OHSAS OHSAS 18001:199918001:1999(Occupation(Occupational Health & al Health &

Safety Safety Management Management

System)System)

92.0

86.3

93.5

88.8

82.4

88.6

95.7

90.290.1

91.987.3

80.3

70

75

80

85

90

95

100

2001 2002 2003 2004

Perc

enta

ge (%

)

Still Work in ProgressStill Work in Progress

THANK YOU