corporatization of hospitals “the singapore experience” · 2006-05-23 · suet-wun lim ceo...
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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
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