Corporatization of Hospitals The Singapore Experience. Suet-Wun LIM CEO National Healthcare Group, Singapore And Tan Tock Seng Hospital, Singapore

Transcription

1 Corporatization of Hospitals The Singapore Experience Suet-Wun LIM CEO National Healthcare Group, Singapore And Tan Tock Seng Hospital, Singapore

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3 Different systems = different policies & ideology => different practice of corporatization Also implementation variance

4 Hong Kong s Outcomes Very Good.

5 MEMBER STATE SINGAPORE IN THE WHO REPORT 2000 PERFORMANCE Overall health system performance On level of health Health expenditure per capita in international dollars ATTAINMENT OF GOALS Fairness in financial contribution Singapore Australia UK USA Switzerland France

6 Singapore Moved From an NHS Like System Financing Co-payment Provision 1980\5 Tax Based Competition & Aging $ 1 Buffet Syndrome Hospitals MOH Run Service and Efficiency Solutions MediSave Copayment % Restructured Hospitals Could Not Continue This Way

7 Singapore Government Organizations Government Controls V V V V V V Government Department Statutory Boards Corporatised (HealthCare) Shares in Listed Company Management Yes Close supervision No No Policy & Procedures Yes (IM) Yes (IM) Some (Policies only) No Fees Yes (Gazetted) Yes Some Controls for subsidised No Hiring (rank & file) Yes Varying/ Semi- Independant No No

8 Corporatisation Rationale External Perspective Internal Perspective Autonomy Independence Reduce/ manage Expenditure Efficiency Political Distance Effectiveness Other Agenda Other Agenda

9 Privatisation

10 ENVIRONMENT LEADS TO DIFFERENT POLICY POSITIONS IN HONG KONG AND SINGAPORE HWF Bureau (2004 Leg Co Panel) Hong Kong HA Singapore MOH Individual Responsibility Clearly Stated Not Specific Clearly Stated Co-payment Not Specific Low Clearly Stated Right to Health Care Not Specific Not Specific Not Specific Reduction and Prevention Clearly Stated Not Specific Clearly Stated

11 Comparison of Hong Kong and Singapore Organizational Structures Government HK HWF Bureau MOH Singapore Next Level Provider Clusters Hospitals Hospital Authority - Statutory Board - Board with 11 Committees 7 38 HA Board Governing Committees MOH Holdings - Registered Company (No Boards) 2 - Registered companies - Non Exec Boards * Cluster CEOs also hospital CEOs 7

12 How Was it Implemented? Over time ( ) With difficulty (too and fro) With mistakes Not a magic bullet Factors like leadership still important

13 Issues in Implementation Public Perceptions are Key Other Policies and Infrastructure Other Agenda Mindset Issue

14 Corporatization: : Degrees of Freedom MOH Approval Needed Organizational Structure Board Appointments Strategic Plans Capabilities and Services Finance and Pricing Capital Purchases Other Purchasing and Services HR IT No Yes No (Info only) Medical capabilities list Subsidised budget Max increase of subsidised charges New hospitals & major renovations No No CMIS Information

15 We would often be sorry if our wishes were gratified. The old man and death Aesop

16 Competitive Pressures The Straits Times, Tuesday, September 30, 2003

17 Ward Classes by Choice Class A Subsidy; 0% Class B1 Subsidy; 35% Class B2 Subsidy; 65% Class C Subsidy 80%

18 LOS by Ward Classes*, TTSH, Feb-Mar 2006 DRG 037 Stroke with complications DRG 130 Dizziness and giddiness (Vestibular neuritis, vertigo) DRG 261 Chest pain LOS (days) *For no. of patients 30 C B2 B1 A

19 TTSH FY2005 Revenue (S$446M) Patient Revenue 35% ($156M) Revenue from Patient Related Services to Third Party 6% ($27M) Other Revenue 4% ($19M) Subvention 55% ($244M)

20 2000

21 National Healthcare Group s s Institutions Alexandra Hospital National University Hospital Tan Tock Seng Hospital National Skin Centre Choa Chu Kang Polyclinic Institute of Mental Health

22 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

23 NHG Experience: Institutional Autonomy Consolidated IT Finance (FSS) HR Policies HO/ MO /CHL Employment Some training (NHG College) Research approval Independent Operations Fees Employment Coordinated Quality Programs Singapore Medicine

24 Outcome = Cost Effective

25 Other Outcomes ISO 9001:2000 (Quality Management System) ISO 14001:1996 (Environmen tal Management System) OHSAS 18001:1999 (Occupation al Health & Safety Management System) 100 Percentage (% )

26 Still Work in Progress

27 THANK YOU