What This Means
This research suggests that reorganizing primary care clinics in Singapore into small, coordinated teams — each consisting of two family doctors, one nurse, and one care coordinator — led to meaningful improvements in how patients with chronic diseases like diabetes, high blood pressure, and high cholesterol received care. Over a five-year period, patients enrolled in these 'teamlet' teams were more likely to complete important preventive screenings, such as foot and eye exams for diabetes, compared to patients receiving the usual standard of care. Clinical improvements in blood sugar, blood pressure, and cholesterol were modest but present.
One of the most striking findings was the impact on health care costs and where patients sought care. Patients in the teamlet model used fewer hospital inpatient services, visited specialist clinics less often, and had fewer emergency department visits. While their use of primary care clinics (polyclinics) increased slightly in cost, the savings from avoided hospitalizations and specialist visits far outweighed this increase, resulting in an overall saving of approximately SGD $2,186 per patient over five years. The largest single source of savings came from reduced hospital admissions, which saved an average of SGD $2,432 per person.
This research suggests that structuring primary care around small, collaborative teams can shift care away from expensive hospital-based settings toward more affordable community-based primary care, while also improving adherence to recommended health screenings. These findings may be relevant for health systems in other countries looking for ways to manage growing numbers of patients with chronic diseases more efficiently and cost-effectively.