Presentation (CTI)

OBJECTIVES: Despite a well-developed health system, Singapore historically experienced suboptimal asthma outcomes, including high mortality, hospitalization rates, rescue-medication reliance, impaired quality of life, productivity losses, and an estimated annual societal cost of SG$2.09 billion. This study describes a national, value-based asthma care transformation aimed at reducing mortality and acute-care utilization, improving patient-centered outcomes, and strengthening system-wide integration
METHODS: We conducted a descriptive evaluation of a 20-year, whole-of-system asthma strategy implemented through iterative stakeholder engagement, service redesign, and continuous quality improvement. Core interventions included the Singapore National Asthma Program, promotion of inhaled preventer use with primary-care monitoring of preventer: reliever prescribing ratios, a zero-tolerance approach to asthma deaths, public education, risk stratification of high-risk patients, integration across primary and tertiary care, medication subsidies, and deployment of asthma nurses and case managers
RESULTS: Over two decades, national asthma mortality declined nine-fold and disability-adjusted life years fell by 50%. Outcomes were benchmarked against Sweden and Australia, two countries recognized for advanced asthma care systems. At Tan Tock Seng Hospital, one of the busiest hospitals, emergency department attendances decreased by 56% and asthma hospitalizations by 30% between 2009 and 2023. Mean length of stay increased from 2.9 to 5.0 days, consistent with a changing inpatient case mix as lower-risk patients were increasingly managed outside the acute hospital setting and admitted patients were older and more clinically complex
CONCLUSIONS: A sustained, integrated, value-based population health approach was associated with major improvements in asthma outcomes at national and hospital levels. Singapore’s experience suggests that alignment of policy, financing, workforce, service delivery, and longitudinal outcome measurement can reduce mortality and morbidity while supporting more appropriate use of acute-care services. Further work should strengthen routine measurement of patient-reported outcomes and total cost of care to better quantify value