Integrated Care Ecosystems in Singapore

Abstract

In this chapter, we describe the development of integrated care ecosystems known as the “Regional Health System(s) (RHS)” in Singapore. Singapore’s challenges associated with rapidly aging population, increasing complexity of needs, demands for healthcare services and fragmentation in the provision of healthcare services were the key factors driving the need to break down the silos and improve integration within and across the Singapore healthcare system. Initially developed in 2012 and re-organized in 2017, the RHS was designed to bring together different actors across disciplines, organizations and sectors to optimize quality, outcomes of care while keeping cost of healthcare affordable. The ecosystem provides the avenue for collaboration between different providers, and integrates different components of the system. In order to better meet future healthcare need while keeping the mandates, the RHS was re-organized from 6 into 3 in 2017. Every RHS ecosystem is led by a major public hospital working in collaboration with health and social care providers within the same geographical region. Together, the RHS ecosystems focus on (i) building partnerships (ii) strengthening primary care and (iii) fostering collaborative learnings to facilitate continual improvements. Four design principles, three overall strategies and three factors enabling ecosystem integration are described as factors facilitating integration. To date, RHS ecosystems have demonstrated good first steps in fostering integrated care in Singapore. In retrospect, it has become clear that the RHS ecosystem model reflects the characteristics of a typical complex adaptive system (CAS), in which relationships and dependencies of actors change with different agendas, working styles and time. The need to increase their adaptive capacity while constantly moving towards greater levels of integrated care is identified as the main ongoing challenge for care delivery innovation.