Medical savings accounts: a core feature of Singapore's health care system.

In 1984 Singapore adopted a system of Medisave accounts, individually owned accounts used to pay for many of the health care expenditures that in Germany would normally be covered by the obligatory or private health insurance. The fact that people are spending their own money rather than that of a third-party insurer has helped to curtail Singapore's health care costs, which were about 2.6% of gross domestic product in 1999 (Germany: 10.5%). Even with these low expenditures, the income of Singapore physicians is about the same in relation to average wages as physician income in Germany or the United States, and patients have easy access to such technology as computerised axial tomography, organ transplants and bypass surgery.

Consultation length and case mix in a general practice clinic.

OBJECTIVE: This study was conducted to determine the mean consultation length in a general practice clinic for all cases as well as for acute and chronic conditions. METHODS: The main diagnosis or reason for encounter in a general practice clinic from 25 April to 15 May 1994 was coded for all consultations using a customized clinic management software. RESULTS: The case mix of the clinic was comparable to the general practice pattern described in the 1993 Morbidity Survey of Outpatients. The overall mean consultation length was 9.3 minutes, the median was 6.0 minutes and the mode was 3.0 minutes. The mean consultation length for representative acute, chronic, and chronic relapsing and remitting conditions were 7.1 minutes (acute upper respiratory tract infection), 7.6 minutes (hypertension), and 9.9 minutes (bronchial asthma), respectively. CONCLUSION: Consultation length for a practice is dependent on the case mix of the practice, which is in turn dependent on the number of tasks required.

Mass screening for diabetic retinopathy--a report on diabetic retinal screening in primary care clinics in Singapore.

INTRODUCTION: Mass screening for diabetic retinopathy is expensive and inaccessible if done by institutional ophthalmalogists. Most diabetics are seen in primary care. Hence it is logical to provide mass screening in primary care clinics. In Singapore, government polyclinics are ideal centres of screening as they are well organised and accessible to the community. SCREENING METHOD: An effective mass screening strategy must provide wide coverage, be low cost and have the ability to assess diabetic eyes accurately and quickly. Non-mydriatic fundal photography was used as the screening method. Mass coverage was achieved by rotating two cameras around six government polyclinics. Cost was reduced by training existing staff and organising the programme to provide a high turnover of screenees. The photographs were read by ophthalmologists in a government-owned hospital. Patients that required referral were referred to specialist eye clinics. RESULTS: A total of 13,296 patients were screened or rescreened during a period of 2 years (25 months). 2,911 patients or 21.8% of the total screened were found to have diabetic retinopathy. About half of these (10.8%) had sight threatening retinopathy. The most common sight threatening retinopathy was maculopathy (8.0%). Twenty-two percent of cases screened were referred. These include referral for other ocular conditions detected during the screening. CONCLUSION: Non-mydriatic fundal photography has proven to be both accessible and effective in screening diabetic eyes in urban Singapore and can be recommended for mass screening of diabetic eyes in the community.

Smoking restrictions in private workplaces in Singapore.

This survey aims to determine the number and profile of private workplaces in Singapore which have a smoking restriction policy. The response rate was 43%. Of the companies which responded, 59% had some form of smoking restriction. Private companies are more likely to have a smoking restriction policy: (a) where smoking poses inherent fire risks, such as those dealing with inflammable chemicals or gases; (b) where smoking poses inherent detrimental effects to the quality of the products, such as those dealing with precision electronic microcomponents, where a smoke-free and dust-free environment is essential; (c) are larger companies; and (d) have strong management support in initiating and enforcing smoking restriction. Future programmes should give more emphasis to the service industries such as construction, insurance, banking and finance, and smaller companies (with fewer than 100 employees). They should involve the management who play an important role in implementing smoking restriction at their workplace.