Abstract for: Integrating SD, VSM, and DPG to Address Health Financing & Governance Challenges in Singapore

The “Healthier SG” initiative covers the transition from a fee-for-service payment model to capitation funding, which has been formally implemented since 1 April 2023. However, key challenges can be expected regarding the local health financing reform, including but limited to, financial risks for providers such as small clinics, and effective governance structure for risk management and care coordination. Our research proposes an integrated methodological framework combining the Viable System Model (VSM), System Dynamics (SD), and Dynamic Performance Governance (DPG) to design, analyze, and govern the capitation payment reform effectively under the “Healthier SG” initiative in Singapore. By leveraging these approaches, this study aims to provide a comprehensive toolkit and viable governance blueprint for policymakers to optimize healthcare resource allocation, improve primary care delivery, and ensure whole system viability. It is found that the coordination and collaboration between private GPs and public healthcare clusters are essential for the success of capitation payment model when delivering care services to residents. Moreover, MOH ought to play a role of facilitator and promoter at the top level of health system governance. A sustainable capitation model should also attach importance to the potential financial risks borne by small primary care providers. As far as the methodology is concerned, our study has enriched the fundamental research method by combing SD, VSM, & DPG system methods into an integrated workflow. Besides, our study also provides a nuanced understanding of the potential pitfalls and governance challenges associated with the capitated payment reform in Singapore.