Assessing the Impact of Enhanced Primary Care on Population Health and Health Services Utilization in Singapore: A Modified Delphi Study
Background: Rapid population aging and increasing chronic disease prevalence underscore the need to strengthen primary care systems globally. The Primary Care Assessment Tool (PCAT) provides a structured framework for evaluating how well primary care systems meet population health needs. In Singapore, primary care is delivered through the main sectors: public polyclinics and private general practitioner (GP) clinics. Method: A modified Delphi study was conducted with expert representatives from the primary care sector. Five primary care group practices in Singapore were recruited to form the expert panel. The study employed the short form of the PCAT-PS to assess and compare typical and enhanced models of primary care delivery, evaluating key dimensions including first-contact accessibility, service continuity, coordination, and comprehensiveness. Results: With a maximum possible PCAT score of 24, typical GP clinics scored 19.09, typical polyclinics scored 18.88, enhanced polyclinics scored 20.90, and improved GP clinics achieved the highest score of 21.24. Experts estimated that patients receiving care in enhanced primary care settings would be less likely to experience deterioration in their health than those in typical settings. Enhancements were also associated with reduced hospitalizations and specialist outpatient visits, as well as increased use of primary care services. Conclusion: Findings from this expert panel suggest that plausible enhancements to Singapore's public and private primary care systems could significantly improve population health outcomes, reduce reliance on high-cost specialist and hospital services, and strengthen primary care's role as the first point of contact within the healthcare system.
