ABSTRACT
Ensuring timely access to specialist care is an important indicator of the quality of a health service. Demand for cardiology outpatient appointments has grown considerably in the last decade, leading to increased waiting time for cardiology appointments at public hospitals. This paper examines the effectiveness of past and ongoing strategies initiated by the National Heart Centre, many of which were in collaboration with SingHealth Polyclinics, documents the lessons learnt, and provides a framework for approaching this problem. Instead of a simplistic approach where institutions react to long waiting times by growing capacity to meet demand, this paper emphasises the need to focus on the final intended outcome (timely diagnosis and treatment) rather than on a single performance indicator, such as waiting time. A broad systems approach at the national level is advocated, rather than piecemeal, uncoordinated actions by individual hospitals.
There is evidence that shows that the use of healthcare delivered by private providers, particularly procedures and hospital care, depends on supply. For example, in a population-based study of patients with pain that might signal arthritis of the knee, the number of patients in need of surgery (physicians determined following examinations) exceeded the rate of surgery for the corresponding age and sex groups by a factor of more than ten.
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