Unintended Consequences in Singapore by David Chan

Author:David Chan [Chan, David]
Language: eng
Format: epub
ISBN: 9789813231733
Goodreads: 41052809
Publisher: World Scientific
Published: 2018-07-01T00:00:00+00:00

Part III

Chapter 7

Unexpected Outcomes of Healthcare in Singapore

Jeremy Lim

I will briefly cover a few topics on healthcare in Singapore and some of its unintended outcomes so that we have more time for discussion later. Please take the typology or the nomenclature for unintended consequences that David used earlier in his presentation to guide some of the thinking here.

Let me first state that, at its core and highest level, the objectives of a healthcare system are very simple. All healthcare planners aspire to achieve a high quality, affordable and universally accessible healthcare system. That is very straightforward; the challenge is balancing these often conflicting or competing ambitions. Imagine quality, cost and access as the three corners of a triangle. Geometry dictates that as two of these corners move closer together, they necessarily move further away from the third corner, thus elegantly depicting the difficult choices and trade-offs that we have to make in healthcare. How the emphasis placed on quality, cost and access differs across different countries and how these emphases change over time as societies evolve collectively make health policies very dynamic. There are hence stark differences in how healthcare services are designed and delivered in different societies. At its core, the issues are very straightforward, but unintended consequences come about because we try to target some of these issues without a greater appreciation of the magnitude of the impact on the other aspects related to costs, quality, and access.

There are many factors that can affect an individual’s health. Health is a complex adaptive system because the determinants of health are multiple, complex and interelated. A single health issue like obesity would have multiple causal and inter-relating loops, making myriad consequences of a single policy intervention inevitable. The complexity, inter-relations and externalities that drive unintended consequences are quite beyond complete human understanding. Suffice to say that therefore we should approach health as a complex adaptive system, recognising that all we have are theories and we need to figure out how to move forward with our limited understanding. We are also living in a VUCA (volatile, uncertain, complex, ambiguous) world and this is especially so in health with both a longevity dividend and epidemics of chronic diseases. These are unprecedented times with no good models to learn from. This necessitates lots of humility and a healthy dose of what Deng Xiaoping described as “crossing the river by feeling the stones”.

Intellectually, it is not difficult to recognise that health is a complex adaptive system. But emotionally and politically, we want to feel that we are in control, and “quick fixes” and “magic bullets” become attractive. One of the examples that we commonly talked about revolves around bed crunch. It is very common to have letters in the newspaper complaining about waiting time. So the quick fix is to add more hospitals and more beds, and have healthcare workers work even harder. But the solution to the bed crunch is not flogging the workhorses of the Singapore healthcare system even harder. In systems

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