Insights into Singapore's national strategy for primary care reform: physician attitudes, facilitators and barriers to healthier SG.

BACKGROUND

Healthier SG (HSG), introduced in July 2023 by Singapore's Ministry of Health as a nationwide primary care reform initiative, aims to enhance preventive care within the primary care sector, strengthen patient-physician relationships, and integrate health and social care. It incorporates a transition to capitation-based payment models and introduces structured "health plans" within consultations. Given the significant role of primary care physicians in implementing HSG, understanding their perspectives - including their attitudes, as well as the facilitators and barriers they encounter - is critical for addressing operational challenges and ensuring the initiative's success.

METHODS

A qualitative study was conducted using semi-structured interviews with 15 primary care physicians from both public and private sectors directly involved in HSG. Participants were purposively sampled, and data were analysed using thematic analysis, guided by Braun and Clarke's framework, to identify key attitudes, facilitators, and barriers.

RESULTS

Participants were unanimously supportive of HSG's objectives, particularly its emphasis on preventive care and potential to address long-term healthcare challenges. However, participants also expressed frustration with various implementation issues. Facilitators included heightened patient engagement in preventive health, a structured framework to prioritise preventive care during consultations, and subsidies that increased patient uptake of recommended vaccinations and screenings. However, there were barriers including increased administrative workload, challenges in integrating HSG tasks into existing clinical workflows, and concerns about financial sustainability, particularly in private practices. Participants also noted significant gaps in patient understanding of HSG, which disrupted consultations and workflows.

CONCLUSION

While the objectives of HSG were supported by physicians, its implementation posed substantial operational and financial challenges. Addressing these barriers requires improved administrative processes, enhanced system integration, and targeted public education efforts. Policymakers should consider tailored strategies for public and private healthcare providers to ensure the programme's long-term success. These findings provide valuable insights for optimising HSG and can inform similar healthcare reforms in other contexts.