Healthcare system in Singapore

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Healthcare system in Singapore by Mind Map: Healthcare system in Singapore


1.1. Healthcare systems

1.1.1. - Governance - Health workforce - health informatics Components of health system Service Health workforce information medical technologies leadership / govemance financing Health workforce Professional


2.1. Revenue collection

2.1.1. Ways of revenue collection Revenue collection is the process by which the health system receives money from individuals. Figure 1 shows the 5 main ways by which revenue is collected for purchasing healthcare services, and their characteristics/fairness.

2.2. Risk Pooling

2.2.1. Individuals with higher health risks are more likely to utilize more healthcare and therefore more exposed to financial risk . Pooling is the accumulation and management of revenues in such a way as to ensure that the risk of having to pay for health care is borne by all the members of the pool and not by each contributor individually. Its main purpose is to spread the financial risk associated with health interventions for which the need is uncertain.

2.3. Cross-subsidy

2.3.1. Definition Cross-subsidy is mainly achieved first through general taxation, which is usually progressive, followed by government spending on healthcare subsidy for all citizens.

2.3.2. Re-distribution of income Individuals who have lower income and higher health risks (usually the sick elderly) would pay less tax but consume more services, and therefore benefit more from cross subsidy from the those with higher income and lower risk (usually the young and healthy).

2.4. Fairness of Risk Pooling and cross-subsidy

2.4.1. Risk pooling and cross-subsidy in healthcare financing are desirable to some but undesirable to others.

2.5. Health services purchasing

2.5.1. Purchasing is the process by which pooled funds are used to pay for healthcare for a population.

2.6. Mechanisms of payment to healthcare providers

2.6.1. -Free-for-service -Global budget -Line item Budgets -Capitation -Diagnostic-related payment

2.7. Payment mechanisms influence provider's behaviour

2.7.1. Payment mechanisms is an essential part of the purchaser–provider interaction.

2.8. Healthcare financing system

2.8.1. Structure Financing mix of Singapore health system

2.9. Pros and Cons of individually medical savings account

2.9.1. -Pros A form of pre-payment which provides greater certainty and ability to pay for services when one is sick. -Cons Not all can have an account e.g. housewife, those sick and elderly who cannot work.

2.10. Fairness and Financial Risk Protection

2.10.1. A combination of government subsidy, community support, and individual responsibility;  Medisave, Medishield etc. ensure that monetary concerns are minimal;  Most Singaporeans are taken care of in the event of any illness


2.11.1. IS IT SUCCESSFUL? Yes, all rounding we covered many flaws that is very difficult therefore we are very successful

2.12. Managed care

2.12.1. Benefits Access to new patients  Able to “upsell” various health services such as vaccinations or health screening if not covered by MCO plans; and workplace health initiatives  Provide a steady stream of cash flow for potential investment in services, technology or new clinic locations  Possibility to value-add by helping to manage chronic conditions

2.12.2. different managed care plans indemnity plan HMO The HMO doesn’t have an in-network provider for the specialty service a patient need. This is rare. But, if it happens, pre-arrange the out-of-network specialty care with the HMO—keep the HMO in the loop. PPO Stands for preferred provider organization, a type of managed care health insurance plan like their distant cousins, HMOs. PPOs got this name because they have lists of health care providers they prefer in which patients can receive their health care from. If a patient receive health care from these preferred providers, they pay less. EPO The PPO provides an incentive for the patient to get their care from its network of providers by charging the patient higher co-pays or co-insurance when they get their care out-of-network. POS In an EPO health plan, the patient can only get health care services from in-network providers. If the patient get care out-of-network, the EPO won’t pay for it. HDHP No hassle with bills and claim forms as the in-network health care provider bills the EPO health plan directly for the care a patient receive. The patient will only be responsible for paying their deductible, co-payment, and co-insurance. Corporate fee-for-service system Fee caps system Agent system Benefits of a Corporate Human Resource Standpoint in Singapore Considerations

2.12.3. How are enrolled patients being affected? Limited Range of treatment options Limit on the total cost of drugs dispensed per consultation Exclusion of certain kind of drugs Limited number of specialists on referral list May not be advised on advantageous treatment options due to restrictions under MCO scheme Treatment may be delayed due to the need for prior approvals for some treatments or if cost is exceeded If referral is required to A&E and MCO scheme do not cover, patient has to make a decision on his/her willingness to pay out of pocket Prioritisation Being placed on a lower priority as compared to full-paying patients Shorter consultation time number of days of sick leave Over servicing Depending on MCO schemes, some service provider may tend to ‘over service’ by recommending additional investigative tests, surgeries or high-value screening packages Breach of confidentiality There may be situations of sensitive diagnoses that may prevent coverage under MCO scheme. Patient has to decide if he/she is willing to pay as a private patient Doctor-patient relationship Managed care limits patients’ ability to establish a relationship with the doctor of their choice Termination of doctor-patient relationship can also occur when the company shift from one health plan to another healthcare provider

3. LESSON 10

3.1. roles and functions of various key components of healthcare system.

3.1.1. Consequences of under-staffing for patient care  Patient safety would be compromised and potentially could lead to increase in patient mortality  Satisfaction level will decrease Key interventions by MOH  Increase pay of healthcare professionals  Increase the local intake of healthcare professionals including doctors, nurses, allied health professionals, pharmacists and dentists.  Tap on foreign-trained professionals - both Singaporeans and foreigners - are needed to supplement the workforce

3.2. factors contributing to healthcare manpower crunch

3.2.1. Singapore has rolled out a national electronic health record (NEHR) system that is accessible to all medical practitioners.  The idea is for each patient to have just one set of medical records, which will list all his treatments, medication and allergies.  This way, any doctor treating a patient, whether in a hospital or as an outpatient, and in both public and private sectors, would have access to the patient’s medical history.  This is an important move that will benefit patients and for this case, Madam Su.

3.3. MOH Manpower Development Plan

3.3.1. Singapore believes that welfarism is not viable as it breeds dependency on the government. It has adopted a policy of co-payment to encourage people to assume personal responsibility of their own welfare, though the government does provide subsidies in vital areas like housing, health and education.

3.4. Health Informatics development impacts healthcare services

3.4.1.  Access to new patients  Able to “upsell” various health services such as vaccinations or health screening if not covered by MCO plans; and workplace health initiatives  Provide a steady stream of cash flow for potential investment in services, technology or new clinic locations  Possibility to value-add by helping to manage chronic conditions

3.5. roles of the individual, government and community in Singapore’s healthcare financing framework

3.5.1. A combination of government subsidy, community support, and individual responsibility;  Medisave, Medishield etc. ensure that monetary concerns are minimal;  Most Singaporeans are taken care of in the event of any illness

4. LESSON 11

4.1. Preamble

4.1.1. Ageing, urbanization, and globalization combine to change the pattern and cause of diseases and deaths globally.

4.1.2. There is a shift in distribution of diseases and deaths from infectious and birth-related causes to chronic diseases.

4.1.3. Traffic accident rates will increase;

4.1.4. Threat of global epidemic of communicable diseases is increasing.

4.2. Population pyramid

4.2.1. In 1950, the population pyramids were triangular with broader bases. Over time the shapes became less triangular and the upper part becomes broader and the base smaller

4.2.2. This means that over time, the proportion of younger people in the population decreases, and the proportion of older people increases.

4.2.3. Singapore is a rapidly ageing country and by 2030 the pyramid seems to be inverting, i.e. more older people than younger people.

4.3. Global burden of disease

4.3.1. Populations of lower income countries tend to die at a younger age than populations of higher income countries.

4.3.2. The leading causes of death in high income countries tend to be non-communicable diseases, especially chronic diseases such as cancer and stroke. Chronic diseases mostly affect older people. In countries of higher income, people live in better hygiene conditions and have better access to medical treatment, and therefore live longer. With a relatively larger proportion of elderly people in the population, the major causes of death tend to be chronic diseases (long term diseases).

5. LESSON 12

5.1. Integrated care pathways

5.1.1. Allow patient to flow seamlessly through care providers to achieve the best outcomes

5.1.2. Prevent patients from getting lost as they move through the system

5.1.3. Enable patients to be cared at most appropriate care setting

5.1.4. TO PATIENTS Does not need to repeat history when the next care provider is taking over know where to go Being well taken care of

5.1.5. TO PROVIDERS take care of patients after they were being discharged

5.1.6. TO HEALTHCARE SYSTEM system efficiency system better use and allocation of resources (manpower and cost) better patient outcomes less complaints

5.2. Level of integration

5.2.1. Micro - Seek to improve care coordination for individual patients and users - Utilizes care planning and technology to enhance individual’s experience of the care that is being delivered

5.2.2. Macro Provider and purchaser of care seek to deliver integrated care to the population they serve

5.2.3. Meso Integration focuses on the needs of specific groups of patients Example: patients with chronic conditions and their care needs are expected to span

5.3. Why choose care pathway?

5.3.1. Cares for specific types of illness pinpointed for ICP Stretches across different disciplines and healthcare organisations Establishes consensus among clinical group

5.3.2. Reduces variations in individual professional practices Every professional involved in the caring of the patient will have a common understanding of the management plan

5.3.3. Concentration on particular disease and model of care - based on clinical research and best practices

5.3.4. Specific type of illness picked out for ICP and homogeneous patient group Treatment plan and outcomes are similar

5.4. Care Integration

5.4.1. A coherent set of methods and models on: - funding - administration - organisational - service delivery - clinical levels

5.4.2. designed to create - connectivity - alignment - collaboration

5.4.3. Aims to enhance - quality of care - quality of life - consumer satisfaction - system efficiency (cost-effectiveness of care) Patients with: - complex or chronic conditions - there is a need to span across multiple services, provider, healthcare settings

5.4.4. Types of integration Organisational organisations brought together formally by mergers or through “collectives” and/or virtually through coordinated provider networks or via contracts between separate organisations brokered by a purchaser functional non-clinical support and back-office functions are integrated, such as electronic patient records service different clinical services provided are integrated at an organisational level, such as through teams of multidisciplinary professionals clinical care by professionals and providers to patients is integrated into a single or coherent process within and/or across professions, such as through use of shared guidelines and protocols normative where an ethos of shared values and commitment to coordinating work enables trust and collaboration in delivering healthcare systemic there is coherence of rules and policies at all organisational levels. Sometimes called ‘Integrated delivery system Horizontal two or more organisations or services delivering care at a similar level come together Vertical two or more organisations or services delivering care at different levels come together Real entails mergers between organisations Virtual takes the form of alliances, partnerships and networks created by a number of organisations

5.4.5. Advantages - Ensure patients receive appropriate care at appropriate sites - Ensure smooth transition of care from one healthcare provider to another - Helps patients navigate the healthcare system effectively - Decrease healthcare costs


6.1. Continuum of care

6.1.1. Types of healthcare Provides at each level of care

6.1.2. Health promoting organization eg. health promotion board Prevention is better than cure. Singapore's healthcare management is based on the philosophy of building a healthy population through preventive healthcare programs and promoting a healthy lifestyle. E.g Health Promotion Board (HPB) is the leading national agency advocating healthy lifestyle ad driving various national health promotion and illness prevention programs.

6.1.3. Primary Care eg. GP clinic Generally refers to the first point of consultation can be provided by a general practitioner or family physician or other healthcare professionals eg. nurse or pharmacist. Depending on the nature of the health condition, patients may be referred for secondary or tertiary care. Involves the widest scope of health care, including all ages of patients, and patients with any acute and chronic physical and mental conditions, and patients with non medical needs eg family planning, vaccination. Accident & Emergency Department (A&E or EMD) Inpatient services Ambulatory or Outpatient services (e.g. Specialist Outpatient Clinics, Day Surgery Centre) Surgical Departments Medical Departments Operating Theatres Intensive or Critical Care Units (ICU / CCU) Allied Health Departments Diagnostic Department Pharmacy What can be deduced? Imbalance distribution of doctors across public and private hospital sectors More doctors and less patients Lower bed to ratio in private sector, so doctors would prefer to work in Public sector doctors are most likely to be overworked or underpaid, or both Factors affecting: Patients wait for hours in A&E for admission Bed occupancy over 90% Beds in corridor Cancellation of non-urgent surgeries and planned admissions ‘Overflow’ of patients to private hospitals Patients’ choice but have to pay more ‘Overflow’/Transfer of stable patients to community hospitals

6.1.4. Secondary/ Tertiary Care It is provided by medical specialists and other health professionals, in hospitals, both private and public. It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. it also includes skilled attendance during childbirth, intensive care, and medical imaging services. "secondary care" is sometimes used synonymously with "Hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists or physiotherapists and some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a refferral before they can access secondary care.

6.1.5. Intermediate And long term care Many types of health care are delivered outside of health facilities. they also include the services of professionals in home and community settings in support of self-care, home care (nursing, medical, rehabilitation, hospice), centre based rehabilitation, palliative care and other types of health and social care services.

6.1.6. How Public Healthcare evloved Ministry of Health Singapore -> Acute Care Public Hospital -> 1. Private Hospital, 2. Community Hospital, 3. Nursing Home, 4. Family Doctor, 5. Home (1. Nursing Home & 2. Home) -> Acute Care Public Hospital Home -> Family Doctor <- Nursing Home

6.1.7. The need of evolution for healthare One of Singapore's visions is to have an integrated healthcare system to better integrate all care services under one roof so as to ensure continuity in care. Aging population => Increase in chronic disease and hospital re-admissions Episodic care model is not appropriate to provide quality and cost effective.

6.1.8. Explain the benefits and barriers of continuity of care Benefits: 1. Lower all-cause mortality 2. Better access to care 3. Less re-hospitalization 4. Fewer consultations with specialists 5 Less use of emergency services 6. Better detection of adverse effects of medical interventions Barriers: Access to information. Continuity of care depends on ensuring continuity of information. Missing information is a common cause of delayed care and uptake of unnecessary services. Out-of-pocket payment if the patient cannot afford. Treatment schedules requiring frequent clinic attendance that carry a heavy cost in time, travel expenses or lost wages. Patients may get lost in the complicated institutional environment of referral hospitals or social services. Lack of efforts from health workers in negotiating the modalities of the treatment schedule with the patients so as to maximize the chances that it can be completed; keeping registries of clients with chronic conditions; and creating communication channels through home visits, liaison with community workers, telephonic reminders and text messages to re-establish interrupted continuity. Lack of clarity to patient and caregiver as to how and by whom follow-up care will be organized. Copyright © 2017 Republic.


7.1. Primary care

7.1.1. First point of consultation for patients

7.1.2. involves widest scope of healthcare including all ages of patients, with any acute and chronic physical and mental conditions

7.1.3. continuity patients prefer consulting the same practitioner for treatment, preventive care and health promotion services

7.1.4. clinicians important role in assuring that patients are adhering to medications and deviated from planned recovery are managed in a timely way to prevent unnecessary re-admissions or complications

7.1.5. DEVELOPMENT Expanding the roles of private GPs, e.g. treating patients with mental health, or need palliative care Enhancing support for private practitioners - diagnostic and allied health services, e.g. setting up of new Community Health Centres (CHCs) - continuing medical education Growing capacity in the primary care sector - Collaboration between public and private sectors, e.g. Family Medicine Clinics (FMCs) - Flowing of more subsidies from public to private primary care

7.1.6. Re-deveoping We have been redeveloping our polyclinics, making them paperless, fully computerised, film-less with tele-radiology services, with e-prescription capability. (IT capability) Patients with chronic diseases are given clinic appointments for their regular follow-ups. This has cut down their waiting time. We will continue to upgrade the other polyclinics. Ang Mo Kio, Bedok, Geylang, Tampines and Yishun. Polyclinics will benefit from this Polyclinic Redevelopment Programme. For the rapidly expanding population in Punggol, we are also planning a new polyclinic in that town.

7.2. Become center of excellence for chronic care management

7.3. comparison between polyclinic and private

7.3.1. POLYCLINIC - General medical / dental - Nursing - Diagnostic - Pharmaceutical - Health Screening - Vaccinations - Medical Social Work - Dietetics - Physiotherapy - Psychologist - Subsidized services - One-stop center for various services - Referral to specialists with subsidy Become more effective in treating patients (spend more time with each patient for more thorough examination) rather than more efficient (trying to see all the patients who turn up)

7.3.2. PRIVATE - Convenience, near home Shorter waiting time - Can see the same doctor each time - Some operate 24-hr - If the patient is eligible for certain government subsidy scheme, and the GP is participating in the scheme - General Medical /Dental outpatient services - Vaccination - Drug dispensing Receive more patients from the crowded polyclinic, especially those who need chronic disease management Be trained in other specialized areas and receive patients who need specialized care e.g. mental illness, palliative care.

7.4. Community health assist scheme [CHAS]

7.4.1. provide needy elderly and/or disabled Singaporeans with better access to primary healthcare by bringing affordable services closer to such residents. Applicants must be Singaporeans and - For households with income, the household monthly income per person must be $1,800 and below. - For households with no income, the Annual Value (AV) of home must be $21,000 and below.

7.4.2. What does CHAS cover? Common medical illnesses e.g. cold/cough/fever 19 chronic conditions under the Chronic Disease Management Programme (CDMP) Selected dental services, e.g. dentures, root canal treatments and crowning. Recommended health screening by Health Promotion Board (HPB) Anxiety Asthma Benign Prostatic Hyperplasia (Enlargement of Prostate Gland) Bipolar Disorder Chronic Obstructive Pulmonary Disease (COPD) Dementia Diabetes Epilepsy Hypertension (High Blood Pressure) Lipid Disorders (e.g. High Cholesterol) Major Depression Nephritis / Nephrosis (Chronic Kidney Disease) Osteoarthritis (Degenerative Joint Disease) Osteoporosis Parkinson’s Disease Psoriasis Rheumatoid Arthritis Schizophrenia StrokeMajor Depression Nephritis / Nephrosis (Chronic Kidney Disease) Osteoarthritis (Degenerative Joint Disease) Osteoporosis Parkinson’s Disease Psoriasis Rheumatoid Arthritis Schizophrenia Stroke

7.4.3. A scheme that enables middle to lower income Singaporeans, and all Pioneers, to receive subsidized primary care at participating GP and dental clinics near their homes.


8.1. Community Hospitals & Nursing

8.1.1. Singapore has 63 nursing homes with 9,236 beds, but inadequate to meet demand. VWO nursing homes are running at close to full occupancy. Private nursing homes with portable subsidy are also running at > 90% occupancy.

8.1.2. intermediate care facilities. They cater to patients who are fit for discharge from acute hospitals but require inpatient rehabilitative and sub-acute care (average stay about All CHs (total about 800 beds) in Singapore owned and run by VWos Future 2 CHs will co-locate with KTPH and Jurong General Hospital

8.2. Nursing Homes

8.3. Day Care Centres

8.3.1. Provide vocational and psychosocial rehabilitation. Aim is to re-integrate clients into society, their normal work settings and enable them to return to stay with their families Clients are trained to do a variety of tasks in a work-stimulated environment, domestic and cleaning activities, and social and recreational activities.

8.4. Home Care

8.4.1. The service can be provided by a doctor, nurse or therapist, or as a team, to provides holistic care to the patient and also caregiver training. The team can also coordinate non-medical or social services eg. meal delivery, home help, be friender and financial assistance. Home Hospice care is provided by specialised palliative nurse and/or doctors

8.5. Hospice and Palliative Care

8.5.1. Hospice is a specialised form of care designed to provide palliative care, comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.

8.5.2. This service responds to the unique needs of the terminally ill by providing physical and emotional care to the dying persons and their families. The underlying belief is that this form of care will help prepare patients and their families to attain a degree of mental and spiritual acceptance of death that is meaningful. Hospice and palliative care can be provided in an inpatient hospice, at day centre or in the patient’s home

8.6. Assisted Living

8.7. Case Management

8.7.1. Case management is a procedure to plan, seek, and monitor services for different social agencies and staff on behalf of a client. Usually one agency takes primary responsibility for the client and assigns a case manager, who coordinates services, advocates for the client, and sometimes controls resources and purchases services for the client.

8.7.2. Assistance may include the administration or supervision of medication, or personal care services provided by a trained staff person. In Singapore there has yet been any full assisted living facility available thus far. A similar type of living arrangement is provided by VWOs such as AWWA Community Home for Senior Citizens , where they rent out some HDB flats in Ang Mo Kio to needy elderly people. For shelter. AWWA runs a day care centre in that same HDB block for the elderly to socialise in the day. Assistance may include the administration or supervision of medication, or personal care services provided by a trained staff person.


9.1. Identify and discuss the issues and challenges faced by the levels of healthcare services

9.1.1. The inflexibility, rules and regulations in the public hospitals restrict the private practice;  Care capacity / resources of the public hospitals are limited. Private practice is built at the expense of subsidised patients. o Increases waiting time and possibly delays the consultation / treatment for subsidised patients; o Worsens bed crunch issue; o Reduces time for supervising / coaching of junior doctors.

9.2. Elaborate how the issues and challenges impact the integrated care

9.2.1. To retain medical talent as it is a key to build strong institutions in terms of providing best patient care, teaching, and research.  A need to hold the regional medical hub status trough producing of top clinicians who keep Singapore Medicine competitive

9.3. Examine the development and evolution of levels of healthcare services.

9.3.1. 1. Health Promoting, 2. Primary Care, 3. Secondary/Tertiary Care, 4. Intermediate & Long Term Care

10. LESSON 5

10.1. Mortality rate

10.1.1. measure of the number of deaths due to a specific cause (or in general) in a population, scaled to the size of that population, per unit time. Singapore, deaths due to HIV/AIDS is <5 (per 100 000 population per year)

10.2. morbidity rate

10.2.1. Prevalence rate: the number of individuals in poor health during a given `time period in Singapore, prevalence of HIV among adults aged >=15 years is 158 (per 100 000 population) Incidence rate: the number of newly appearing cases of the disease per unit of time. Incidence of HIV is not available in WHO database

10.3. common outcome indicator

10.3.1. life expectancy (LE) LE is the average number of years that a newborn is expected to live if current mortality rates continue to apply.

10.3.2. Healthy life expectancy (HALE) HALE is the average number of years that a person can expect to live in “full health” by taking into account years lived in disease and/or disability.

10.4. Health system performance

10.4.1. Function : The system has components that serve important functions - delivering health services; raising, pooling and allocating the revenues to purchase those services; investing in people, buildings and equipment; and acting as the overall stewards of the resources, powers and expectations entrusted to them.

10.4.2. Objective: Can be based on various health based DALE

10.4.3. Good health not always satisfactory to protect or improve the average health of the population, if at the same time inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health.

10.4.4. Responsiveness: Prompt healthcare attention, quility of amenities and choice of provider

10.4.5. Fair financial contribution Fair distribution of financial burden among individuals

10.5. Overall health system attainments

10.5.1. Distribution (equality) of health within the population. Overall level of health system responsiveness. Distribution (equality) of responsiveness within the population.

11. LESSON 6

11.1. Performance measurement/Monitoring

11.1.1. “Ways in which the performance of whole organizations, such as profit centres, cost centres, divisions, departments, and sections, and the managers responsible for theses parts of the business, are measured” “Using quantitative, qualitative, or financial measures” A function of performance management

11.2. KPI

11.2.1. “Key measures of the performance of an organization, which are monitored and assessed to ensure its long term success” Help to single out organization’s strengths and weaknesses Typically classified into Strategic Operational, etc

11.3. Balance score card

11.3.1. The balanced scorecard is a strategic planning and management system that is used to: clarify vision and strategy improve internal and external communications, translate strategy into action monitor organization performance for continuous improvement

11.4. Joint Commission International (JCI)

11.4.1. Functions Hospital Primary care Ambulatory care Clinical care program certification Clinical Laboratory Medical Transport Care Continuum

11.4.2. American leader in standard setting and accrediting body in healthcare that evaluates Healthcare Organizations Focuses on patient safety and quality care

11.5. Silver Industry standards committee

11.5.1. Desired Characteristics of Silver Environment: 1. Strong Families and Cohesive Community, 2. Vibrant & Productive Workforce, 3. High Quality living environment Collaboration with Key Stakeholders for Silver Industry: 1. Aging Planning Office, 2. Silver Infocomm Initiatives, 3. MSF, 4. Promotes active aging, 5. Health promotion Board, 6. AiC, 7. Building of Construction Authority, 8. Implementation of Code on Barrier-Free Accessibility, 8. SG Enable

11.6. Research and development

11.6.1. improving health systems performance

11.6.2. INNOVATION: PRODUCT introduction of a good or service that is new or significantly improved with respect to its characteristics or intended uses. This includes significant improvements in technical specifications, components and materials, incorporated software, user friendliness or other functional characteristics. PROCESS implementation of a new or significantly improved production or delivery method. This includes significant changes in techniques, equipment and/or software. The customer does not usually pay directly for process, but the process is required to deliver a product or service and to manage the relationship with the various stakeholders. MARKETING implementation of a new marketing method involving significant changes in product design or packaging, product placement, product promotion or pricing. ORGANISATIONAL implementation of a new organizational method in the firm’s business practices, workplace organization or external relations. HEALTHCARE Healthcare innovation can be defined as the introduction of a new concept, idea, service, process, or product aimed at improving treatment, diagnosis, education, outreach, prevention and research, and with the long term goals of improving quality, safety, outcomes, efficiency and costs.