Excellent, affordable healthcare is dependent on several elements. Defined delivery systems and a prevailing ethos of cooperation are two of such elements. These are reflected in BG Lee Hsien Loong’s address on the occasion of the opening of the Changi General Hospital. The text of his address forms the lead article in this issue of the Newsletter.

We have over the years developed a good healthcare infrastructure. This is however, not enough. There is a need for regional hospitals, tertiary hospitals and national centres to co-operate closely to handle referrals smoothly. Each must do what one is good at and appropriate for his level of care. For this to happen, we need a change of mindset. There is a need of a mental revolution to value working with one another. The credo of institutions have to change to what is their role in patient care, research and professional development of doctors. The organisation of seminars for GPs and public talks should not be for more market share. They should be aimed at reinforcing the notion of working together for good, affordable medical care.

Two other areas of cooperation are necessary towards excellent, affordable healthcare. One is the patient. BG Lee has also alluded to this. The patient needs to be discerning and to use the various elements of the health care delivery system appropriately. He or she should make use of the regional hospitals instead of tertiary hospitals where appropriate. Similarly, if the patient would make use of his primary care doctor, then the workload in the A & E and hospital walk-in clinic will be much reduced. The queue will be shorter and the service will be faster. All it needs is for every citizen to use it only for real emergencies.

The other area of cooperation is between the hospital and the primary care clinics. Doctors in the government polyclinics and private clinics can play a bigger role if their services are put to optimal use. The primary care doctor should be linked to the regional hospital of his district in more than one sense. He should be linked through patient care, through referrals and also in his professional development. He must have the confidence he will get his patient whom he has referred back to him again. He must have a meaningful role in the patient management. He must know enough doctors in that hospital to be able to receive help and support professionally at the time he needs that.

Many hospitals have seen the merits of developing the doctors in their drainage areas. Perhaps, more primary care doctors should avail themselves of such linkages. Notwithstanding these linkages, there are still problems in the shared care programmes. Many patients in the shared care programmes return to hospital care because the primary care doctor can never provide the medicines at the cost that the hospital can. The hospital is able to get cheaper medicines because of quantity purchase. Perhaps, this advantage could be shared with the participating primary care doctors.