Dr Jit Seng Tan
Data Driven Individualized Care with Capitation Funding in Singapore
Updated: Apr 8, 2022
Preventive care is better care. Preventing a severe stroke can save a high functioning banker him/herself in millions of dollars in salary potentially made, and continue to generate profits for the company. Previously, in a younger Singapore, chronic diseases and ageing population are not the mainstream medical issues we had collectively. It is possible to have a fire fighting mentality. However, with modern medicine, easy accessibility to medical support (via our ever efficient public ambulance services and a tiny land mass) and ageing population, we are seeing more complications of chronic medical disease. The rules of the game has changed completely.
Preventive care for non-communicable diseases has not been rewarded in the healthcare system here in Singapore. Doctors still make our money seeing people who are sick and not paid when we kept people healthy. Our model has been putting out the fire when it happens, and not finding where potential fires can arises. We were not funded to put in place strategies to prevent the fires, as in the situation of healthcare funding.
Many wise and learned public health colleagues of mine has been proposing new forms of funding for healthcare. Capitation model of funding is one which potentially can factor in preventive care, in which funding into monitoring technology and other Allied health support is possible. For example, to prevent falls in older adults, referrals are made to physiotherapists to do functional exercises and muscular strengthening. By preventing the fall, much suffering are prevented and money is saved. The person does not have to go through fracture of the hip, cost of the surgery, hospitalization and perhaps another 3 months of community hospital rehabilitation. In an even worse case scenario, the fall can result in permanent functional decline, a need to employ a formal caregiver or nursing care home admission, and all other problems resulting from prolonged immobility, like constipation with urinary tract infection leading to sepsis and hospitalization, further functional and cognitive decline and more care needs.
Technology can and should be funded more readily. Remote Patient monitoring of vital signs can result is better control of hypertension, or glucose levels. These services can perhaps prevent a disabling stroke or a diabetic nephropathy needing hemodialysis, resulting in the need for more funding of all these more intensive medical care.
We consume calories from different forms of nutrients, carbohydrates from our rice, protein from our chicken and fats from our nuts and oils. Very much like the food we eat, the house consume energy in various different ways, on waking, we boil water in our kettles to have a cup of hot tea or coffee. We turn off the air conditioning perhaps. We switch on the television or personal computer. All these are activities inside the home, which we can well monitor now.
Perhaps if the older adult has been boiling water at 7 am daily and this activity was missed, can we be alerted? Is there is fall in the toilet for example and the older adult is trapped?
Or the older adult is getting up 8 times a night to go to the toilet, is there an urinary tract infection brewing?
There are many different information that we can obtain and infer from with the consumption of energy in a household. We can be seen as looking at a holistic view of the interaction of the older adult with his or her environment, and how active or sedentary they are throughout the day. Such monitoring is simple now, with an device wired to the power box outside our homes. With different household appliances, equipment or devices having their unique signature in their energy consumption, we can differentiate what is switched on and being use at which timing.
A.I. can help in continuously monitoring and warning of any change in behavior in the older adults interaction with the home. For monitoring of Kodokushi for example, it is just simply monitoring of inactivity in given period.
Technology like this have other uses which I will detail in other articles. But this is a solution that is non invasive, cheap and can be scaled up quickly into the masses, for example, the entire block of senior housing.
There is a recent announcement of healthcare revamp by Ministry of Health, personalized healthcare funded by capitation model ( Your GP: The new gatekeeper of health - https://www.straitstimes.com/singapore/health/your-gp-the-new-gatekeeper-of-health )
Part of the capitated funding can be used for the purpose of home monitoring, using energy based household monitoring. The data can be monitored via A.I. platforms and alerts can be directed to all the stakeholders. It will be another big step towards our goal of having a smart nation!