Health Care Policy Analysis

From Siloed Projections to System-Wide Planning: How We Built Singapore’s Healthcare Capacity Framework 3 years ago, our healthcare demand projections were done in silos. Today, we have a coherent, system-wide framework that links demand to infrastructure, manpower, and budget planning. Honoured by the recognition on the work done by the team. Here’s the transformation journey. The Challenge We Faced Demand for each care setting is projected independently, using different assumptions and methodologies. 2023: Building the Foundation Introduced more granular inputs: added parameters e.g. functional impairment levels and family support in long-term care projections. Linked patient flows: Connected across settings (e.g. ED visits to acute inpatient to community hospital). 2024: Achieving System Coherence The coordination challenge: Working across 8+ divisions (IPP, HSD, PCC, APO, MP&S, HF) while handling new policy simulations & evolving capacity decisions. The solution: Set up Capacity Planning Committee (CPC) as single decision platform, replacing piecemeal EXCO discussions. The breakthrough: Obtained approval for our projections alignment framework: • Single baseline model across all projections • Common parameters where models intersect • Systematic accounting for care transformation impacts Real impact: Secured approval for new hospital beds through white space activation and new hospital sites. 2025: Advanced System Modelling Healthier SG simulation: Collaborated with Duke-NUS to quantify HSG’s long-term impact on healthcare demand and costs - answering our persistent questions. Disease-based projections: Piloted new method for mental health services, endorsed and used for service planning Tight deadline delivery: Completed baseline and care transformation projections across all settings that should have taken a few years to complete within one year. The Framework That Changed Everything Our Long-Term Capacity Planning Framework now seamlessly connects: • Demand drivers (population aging, functional impairment) • Care settings (from acute to community to home-based care) • Resource planning (manpower, infrastructure, budget) Policy interventions like HSG, right-siting efforts, and palliative care strategies are incorporated. Key Lessons Learned 1. Coordination is as important as methodology - The CPC structure solved more problems than technical improvements alone 2. Resilience matters - When our HSG model wasn’t endorsed initially, we went back to fundamentals and rebuilt stakeholder confidence 3. Granular parameters drive better insights - Moving from broad assumptions to specific factors like family support levels improved accuracy The result? A coherent planning system that helps Singapore prepare for demographic transitions while optimising resource allocation across the entire healthcare continuum. What challenges are you facing in system-wide planning and coordination across multiple stakeholders?

With a new pharmaceutical legislation in the making, Europe finds itself at a crossroads. This is a critical time for the innovation-driven pharmaceutical industry in Europe. Europe’s R&D investments have significantly fallen behind other regions in the world, most notably the United States and China. In today’s era of breakthrough innovation, the question is not if medical progress will happen, but rather where it will happen, given that the global competition for cutting-edge science and new investments is fierce. Since 2014, only 56% of new drug innovations have been approved in the EU, compared to 73% in the US. This means that a quarter of the new medicines approved in the US are not approved in the EU and are thus not available to European patients. With a new European Parliament now elected and an EU legislative framework for medicines currently undergoing its biggest revision in decades, we are at a crossroads. In one direction a continuing - or indeed worsening - of this trend and in the other, a future-proof EU legislation which values, incentivizes, and rewards #innovation, benefiting #patients and ensuring the long-term #competitiveness of the European pharmaceutical industry. The revision of the EU legislative framework for medicines is an effort, which we, as the pharmaceutical industry, fully support. Initiated to increase patient access to medicines and foster an environment conducive to R&D in Europe, the legislative proposal - reducing Regulatory Data Protection from eight to six years for example - unfortunately fell short of addressing the needs for a thriving innovation-based pharmaceutical industry in and for Europe. The amendments that we have seen more recently by the (former) European Parliament are an improvement, but more is needed and there is much we can learn from others. Several governments around the world have made the life sciences a strategic priority, which results in venture capital funding for biotech, in fast clearances to start clinical development, quicker approvals and a market that is willing to pay for innovation. In Europe, by contrast, rather than considering innovation in the life sciences an investment we often viewit solely as a cost.  With a new 5-year term for the European Parliament and the Commission ahead of us, the new cohort of decision makers have the opportunity (and responsibility) to (re)set the direction and shape the future of research, development, and manufacturing for decades to come. And with the right legislation and ecosystem in place, we believe that the potential of medical innovation is limitless.  Together with Lars Fruergaard Jørgensen and David Loew, I remain committed to working with the new European Parliament, the EU Member States, and other stakeholders involved to change the trajectory of Europe for the better and strive for a more competitive, healthier, and stronger Europe.

The longer I work in health, the more I'm concerned how many people live their lives without asking what it’s actually for. What is health for? I’ve been returning to this question a lot more than I ever did. There’s a useful philosophical lens called teleology. It asks a simple but powerful question: what is this for? When applied to health, it reveals three overlapping but sometimes conflicting perspectives. The first is biological. Organs have functions. The heart pumps blood. The lungs exchange gases. When they stop doing what they are built to do, we intervene. This view is practical and measurable. It gives clinicians clear criteria for action. But biology is not interested in your quality of life. Its built-in logic could be reproductive success and survival to reproductive age. Thriving into your 80s, pursuing athletic performance at 50, or preserving cognitive sharpness after retirement—these are human goals layered on top of biology’s defaults, probably not part of the original design. Then there’s the personal telos. This is the version of health that people actually live by, even if they don’t articulate it. For one, health is the energy to build a business. For another, it’s freedom from a family history of disease. For someone else, it’s being able to surf or hike well into old age. These goals give meaning to metrics and shape compliance far more than abstract guidelines. But they also complicate things. What if the pursuit of one goal erodes another? What if a strategy that supports joy in the short term risks pain in the long run? The third lens is public. Health as a shared good. This is where institutions, governments, and policies operate. It is where trade-offs are made at scale. Designing streets for movement, taxing sugar and offering health screenings. Public telos is essential for population outcomes, but it raises ethical tensions. When does the collective good justify limiting individual choice? What happens when personal and public ends collide? So much confusion in health stems from failing to make these goals explicit. Is the aim to restore physiological function? To support someone’s lived experience? To improve the metrics of a community? Each is valid. But each pulls in a slightly different direction. And if we’re not clear which we’re pursuing, we risk building programmes, protocols, and policies that feel precise but miss the point. Clarity of purpose is not a philosophical luxury. It is a practical necessity. It tells us what to measure, what to tolerate, and what to let go of. It protects against goal creep, misaligned incentives, and well-intentioned overreach. It makes room for trade-offs instead of pretending they don’t exist. It allows health to become a tool for life, not a life in service of health. Before we optimise, we need to pause and ask the more difficult question: for whom, and toward what end? Because when that answer is clear, the next steps become a lot easier to take.

I’ve been reflecting this week on conversations about global health at the UN General Assembly two weeks ago. Professor Michael Merson from Duke University reminded me that debates about supporting health systems (the horizontal approach) versus specific disease programmes (the vertical approach) actually go back to the 1970s and 80s.     Dr Halfdan Mahler, WHO’s longest serving director general, was a champion for primary healthcare and the horizontal approach and shaped the Alma Ata Declaration, with the Health for All by Year 2000 vision. However, Mahler concluded that he could not get donors behind such a strategy. This and follow on decisions to prioritize results from vertical programmes shaped global health for decades.    This year at UNGA, it felt like we might move from talk to action. Let me share three observations: - There was a sense of urgency and an understanding of the need for substantial reform – from health ministers, civil society, funders and global health initiatives.   - We saw a strong desire for aid independence. For example, African leaders called for health sovereignty. This means countries themselves taking prime responsibility for the health of their citizens, including mobilising more domestic resources through national budgets.  - There was also a significant emerging consensus from health agencies and organisations to move towards supporting and coordinating around national health plans and budgets instead of working in parallel through many different implementers. This is a seismic shift for global health.    At Wellcome Trust, we’re supportive of such a substantial overhaul of the system. However, there are three conditions we believe need to be met:    - We need to continue investing in health together internationally while giving more ownership and influence for countries to decide their priorities. Investments in health improve lives, create jobs and grow the economy.   - We need strong multilateral organisations, that are a shared resource of intelligence and best practice, like the WHO, and must continue investing in them, and in R&D for global health. Strong regulations and surveillance systems help us tackle common risks like epidemics and climate change.  - Shifting the power to national governments must be combined with strong mechanisms for ensuring that the voice of people, civil society and marginalised groups are being listened to.    The current system has saved millions of lives around the world, and we should be proud of it. However, it's time to build something better – more efficient, more equitable and led by the people it's meant to serve.     Right now, there is political will – from donor countries, from low- and middle-income countries and global initiatives. We must not waste this chance. 

One of the most common refrains in American healthcare is that if we want a better healthcare system, we simply need better incentives. There is truth in that. Incentives matter. They shape behavior. Poorly designed incentives predictably produce bad outcomes. But there is something implicit in the “it’s all about incentives” argument that has always bothered me. It assumes that we are all just rats in a maze. Creatures who inevitably move toward whatever piece of cheese is placed in front of us. Yet that’s not what we actually observe. Under the same payment system, some physicians spend extra time with frightened patients while others rush through the visit to maximize visit volume. Under the same financial pressures, some health plans invest in better care while others invest in finding every last way to make or save a buck (like coding and utilization management). Under the same market conditions, some health systems choose transparency while others choose obfuscation. If incentives were everything, these differences shouldn’t exist. The best example I know of an organization that escaled its own “incentive jail” is CVS Health’s decision to stop selling cigarettes. By every conventional business incentive, it was the wrong decision. CVS voluntarily walked away from roughly $2 billion in annual tobacco sales because it concluded that selling cigarettes was fundamentally incompatible with its mission as a healthcare company. That decision was championed by two leaders who deserve enormous credit: Larry Merlo, who as CEO accepted the financial consequences, and Troyen Brennan, who as Chief Medical Officer articulated the ethical case. Together, they argued that a company committed to improving health could no longer profit from the nation’s leading preventable cause of death. (Brennan recently spoke at SCAN about his new book on primary care and also discussed this seminal decision) Notice what they did not say. They did not argue that the incentives had changed. They argued that their values had. If incentives alone determined behavior, CVS would have continued selling cigarettes until regulators forced it to stop. Walgreens and every other pharmacy chain would have reached the same conclusion at the same time. Instead, one organization chose to lead. The incentives were the same. The leadership was different. The ethics were different. The courage was different. Incentives shape behavior. But they do not eliminate agency. They do not erase character. And they do not absolve leaders of responsibility for the choices they make. Healthcare will not be transformed by better incentives alone. It will be transformed when enough leaders decide that some things matter more than the incentive. That isn’t economics. It’s morality.

Governance and the Results Gap 30 years ago, when I started work at the NZ Ministry of Health, I thought health policy and reform failed because of poor technical design. I was wrong. Most of the failures I have seen up close since then were not technical. The policy was sound, the financing model worked, and the reform was coherent on paper. What broke them was governance — and governance is very hard to see. It runs through relationships, incentives, mandates, and the way institutions actually behave when no evaluation team is in the room. None of that sits neatly on a budget line. Vaccines delivered, you can count. Hospital beds, you can count. Fragmented authority, institutional mistrust, weak coordination, implementation drift — much harder to quantify. So we count what we can count, and treat the rest as background. Which is how the variable doing most of the work often becomes the one nobody really examines. That is not the only reason governance remains underexamined. But it helps explain why technically sound policies and reforms keep failing in familiar ways, country after country, year after year.

The recent executive orders have far-reaching negative implications for healthcare in the U.S., impacting access to care, scientific research, public health communication, and the healthcare workforce. These changes affect every single person in this country, jeopardizing healthcare quality, equity, and progress. Key Concerns: 1. Reduced Access to Care: - Hiring freezes at federal health agencies, including the VA, have led to job losses for newly hired healthcare providers, limiting access to essential services, particularly for veterans. -Hiring freeze affects federally funded health programs, like community health initiatives, rural healthcare services, and public health response teams. This limits the ability to respond to health emergencies, provide preventive care, address public health crises such as infectious disease outbreaks. - The rollback of drug pricing initiatives is expected to increase medication costs, disproportionately affecting vulnerable populations and those on Medicare and Medicaid. 2. Threats to Research and Innovation: - Funding freezes for the National Institutes of Health (NIH) and the National Cancer Institute (NCI) jeopardize critical research initiatives, delaying progress in cancer treatment, chronic disease management, and public health solutions. - Researchers face uncertainty, hindering groundbreaking work that could lead to new treatments and therapies. These cuts weaken the U.S.’s position as a global leader in medical research and reduce opportunities for early-career scientists, particularly women and minorities, who are already underrepresented in research leadership. 3. Public Health Communication Disruptions: - Restrictions on agencies like the CDC and FDA limit the dissemination of vital health information, leading to misinformation and public confusion. Without timely updates on disease outbreaks, food recalls, and health policies, communities may face increased health risks. 4. Global Health Challenges: - Withdrawal from the WHO undermines U.S. participation in global health initiatives, delaying responses to pandemics and limiting international collaboration on pressing health issues. 5. Worsening Health Disparities: Low-income and minority communities will bear the brunt of these policies, with reduced access to preventive care, screenings, and treatment options, further exacerbating existing health inequities. 6. Erosion of Trust in Healthcare Institutions: - Regulatory rollbacks and suppression of scientific information may reduce public confidence in healthcare institutions, leading to lower compliance with critical health initiatives such as vaccinations and cancer screenings. These policy shifts are threatening the health of millions, slowing medical progress, and creating long-term challenges for healthcare systems and communities across the country. Now more than ever, it is crucial to advocate for policies that prioritize accessible, affordable, and evidence-based healthcare for all.

The $50 billion Rural Health Transformation Program represents a historic opportunity to address America's rural healthcare crisis. But workforce isn't just one pillar of this strategy; it's the foundation that makes everything else possible.      With 300+ rural hospitals at risk of closure and nursing shortages set to triple in rural areas by 2027, we need to fundamentally rethink how we train healthcare professionals. The traditional model—requiring students to leave their communities for extended periods—actually works against rural retention.      The solution? Train healthcare professionals where they'll practice. When we develop talent from within the communities they'll serve, retention rates soar. Take Dr. Terrie Becker in Blythe, California, a town of 18,000 in the Sonoran Desert. Blythe had struggled with chronic nursing shortages for years, but as a three-time Chamberlain University graduate from a small town herself, Dr. Becker saw that the route to real, lasting change would be to establish the area’s first nursing program within 100 miles. Nearly a third of the graduates of the program stayed to work in Blythe’s only hospital – ending years of expensive travel nurse dependence.     States competing for RHT funding need to demonstrate not just what they'll build, but who will staff it. The governors who secure competitive funding will be those who show workforce solutions that make the other four pillars achievable.      Through our work at Adtalem Global Education , we've seen how flexible online and hybrid programs can let students gain advanced skills while maintaining community connections. Now we need the vision to scale these proven approaches.      Read my full commentary in Becker's Healthcare: http://bit.ly/3KPzsS9

#Inequality is making pandemics more likely, more deadly, and more costly 👇🏻 This is the powerful conclusion of a major new report released this week just ahead of the G20 Health Ministers’ meetings: Breaking the Inequality-Pandemic Cycle: Building True Health Security in a Global Age. Over the past two years, the Global Council on Inequality, AIDS and Pandemics (convened by UNAIDS and co-chaired by Joseph Stiglitz, Monica Geingos, and Professor Sir Michael Marmot) has gathered evidence from around the world showing that inequality doesn’t just shape who is most affected by pandemics - it helps cause them. The findings are striking: 💡High levels of inequality make outbreaks more likely to become pandemics. 💡Inequality weakens responses and makes pandemics last longer. 💡And in turn, pandemics deepen inequality - creating a vicious cycle that fuels future crises. We saw this with COVID-19, but the same pattern is evident in HIV, Ebola, Influenza, and Mpox. The report also gives hope: when countries take “inequality-informed” action, addressing inequities in health systems, economies, and governance before crises hit, the world becomes far more resilient. True pandemic preparedness must start with tackling inequality itself. This message is deeply important. As debates on health security intensify in a time where multilateralism is under pressure, the Council reminds us that security cannot be built on exclusion. Equity is the foundation of safety. The report offers clear, actionable recommendations from access to affordable medicines to fairer global economic policies and speaks directly to the G20’s 2025 theme: Solidarity, Equality, Sustainability. If we want to prevent the next pandemic, we must first confront the inequalities that make pandemics inevitable. #HealthEquity #PandemicPreparedness #GlobalHealth #SocialDeterminants #Inequality #Solidarity #Sustainability #G20

U.S. job growth is concentrated in one sector: healthcare. A report sharing the latest data on job growth suggests healthcare is in serious distress. --- Recently Eric Pachman published a report with data suggesting the U.S. labor market is riding a narrow line. Over 60% of all new private-sector jobs in the last year came from just two sectors: healthcare and social assistance. However, the report suggests policymakers may be oblivious to the vulnerability of the healthcare sector. --- Here are the three structural issues related to healthcare mentioned in Eric's report: 1. Healthcare jobs are now a primary driver of job growth across the entire economy. BLS data shows healthcare has delivered far more than its “fair share” of job growth across both short-term (1 year) and long-term (30 year) time horizons. The rest of the private sector is barely treading water. 2. Structural pressures in healthcare are increasing. -ADP’s employment data shows a possible contraction in healthcare jobs, even as BLS shows increases. -Medicaid cuts, now law, are projected to remove 10.5 million people from coverage by 2034. -Vertical integration and opaque discount-based contracts (especially in pharmacy) are eroding public trust and are facing regulatory backlash. If these discount-based prices come to an end, it is reasonable to expect profits to decline in the healthcare sector. US healthcare is facing both financial pressure and public resentment at the same time. 3. #Policy tools aren’t aligned with the problem. Monetary policy (the Fed lowering interest rates) can’t fix structural labor issues like those above. If healthcare hiring slows (due to reimbursement cuts, labor shortages, or transparency mandates), the ripple effects could reach every part of the economy. --- Eric recommends a few things for policymakers related to healthcare: -Acknowledge #healthcare as a structural pillar of the labor market. -Consider the labor market impacts of any cost-cutting or transparency reforms (e.g., #Medicaid policy, reimbursement models, and immigration frameworks) to ensure the workforce that delivers care is sustainable. -Since many current threats to the economy broadly and to healthcare employment specifically are structural and therefore cannot be addressed with monetary policy changes, such as interest rate cuts, more focus should move to fiscal/non-monetary policy. With an economy this reliant on healthcare jobs (and immigration) for growth/stability, we may be approaching a point where policy missteps in either arena could strain the entire labor market, not just the healthcare sector. --- Do you agree with the potential effects in this report? Are you worried about the structural impacts to healthcare from coming policy changes?