Chronic disease management: a Singapore perspective

doi:10.1136/bmj.323.7319.990

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Jason Cheah, adjunct fellow (Jason_Cheah@nhg.com.sg)

Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore 119074

Accepted 5 September 2001

The scope for chronic disease management programmes in Asian countries is tremendous. Rapidly ageing populations, demographic and epidemiological transitions, and changing disease profiles have prompted reviews of healthcare delivery across Asia. This paper provides a brief description of disease management approaches used for chronic illnesses in Singapore and shows that disease management can be successfully implemented in systems very different from that in the United Sates, where it originated.

Summary points

Asian countries have generally not yet tackled the issue of chronic disease management despite their recent epidemiological and demographic changes

Chronic disease management provides an approach that would enable healthcare systems in Asia to take a more holistic view of the care of patients with chronic illnesses

The literature on disease management might confuse Asian healthcare professionals because most comes from the context of managed care in the United States

The approach needs to be adapted to run within a state run and funded healthcare system; the experience of Singapore shows that this is possible

Need for chronic disease management

Chronic diseases have now overtaken infectious diseases as the main cause of mortality and morbidity in developed countries—as well as contributing to escalating healthcare costs. In most developed countries the dual problem of a rising prevalence of chronic disease and escalating costs has caused healthcare policymakers to consider innovative approaches to containing costs and improving the quality of care. An increasing number of reports propose a more holistic and integrated approach for patients with chronic diseases—disease management.1^–8 This approach was first described by the Boston Consulting Group in 1993 and has been gaining popularity in managed care organisations in the United States.4^–6

Most Asian healthcare systems combine state run and financed facilities with private providers. Managed care on a large scale does not exist. Most doctors in the public sector …