Browsing by Author "Ansah, JP"
Now showing 1 - 8 of 8
Results Per Page
Sort Options
Item Open Access Estimating costs and benefits of stroke management: A population-based simulation model(Journal of the Operational Research Society, 2020-01-01) Bayer, S; Eom, K; Sivapragasam, N; Silva, DAD; Choon, G; Koh, H; Tan, KB; Ansah, JP; Matchar, DBThe paper demonstrates how a system dynamics approach can support strategic planning of health care services and can in particular help to balance cost-effectiveness considerations with budget impact considerations when assessing a comprehensive package of stroke care interventions in Singapore. A population-level system dynamics model is used to investigate 12 intervention scenarios based on six stroke interventions (a public information campaign, thrombolysis, endovascular therapy, acute stroke unit (ASU), out-of-hospital rehabilitation, and secondary prevention). Primary outcomes included cumulative discounted costs and quality-adjusted life years (QALYs) gained, as well as cumulative net monetary benefit by 2030. All intervention scenarios result in an increase in net monetary benefit by 2030; much of these gains were realized through improved post-acute care. Findings highlight the importance of coordination of care, and affirms the economic value of current stroke interventions.Item Open Access Impact of the COVID-19 pandemic on a tertiary care public hospital in Singapore: resources and economic costs.(The Journal of hospital infection, 2021-12-11) Cai, Y; Kwek, S; Tang, SSL; Saffari, SE; Lum, E; Yoon, S; Ansah, JP; Matchar, DB; Kwa, AL; Ang, KA; Thumboo, J; Ong, MEH; Graves, NBackground
The COVID-19 pandemic has prompted hospitals to respond with stringent measures. Accurate estimates of costs and resources used in outbreaks can guide evaluations of responses. We report on the financial expenditure associated with COVID-19, the bed-days used for COVID-19 patients and hospital services displaced due to COVID-19 in a Singapore tertiary hospital.Methods
We conducted a retrospective cost analysis from January to December 2020 in the largest public hospital in Singapore. Costs were estimated from the hospital perspective. We examined financial expenditures made in direct response to COVID-19; hospital admissions data related to COVID-19 inpatients; and the number of outpatient and emergency department visits, non-emergency surgeries, inpatient days in 2020, compared with preceding years of 2018 and 2019. Bayesian time-series was used to estimate the magnitude of displaced services.Results
USD $41.96 million was incurred in the hospital for COVID-19-related expenses. Facilities set-up and capital assets accounted for 51.6% of the expenditure; patient-care supplies comprised 35.1%. Of the 19,611 inpatients tested for COVID-19 in 2020, 727 (3.7%) had COVID-19. The total inpatient- and intensive care unit (ICU)-days for COVID-19 patients in 2020 were 8009 and 8 days, respectively. A decline in all hospital services was observed from February following a raised disease outbreak alert level; most services quickly resumed when the lockdown was lifted in June.Conclusion
COVID-19 led to an increase in healthcare expenses and a displacement in hospital services. Our findings are useful for informing economic evaluations of COVID-19 response and provide some information about the expected costs of future outbreaks.Item Open Access Mapping the Dynamic Complexity of Chronic Disease Care in Singapore: Using Group Model Building in Knowledge Elicitation(Systems Research and Behavioral Science, 2018-11-01) Ansah, JP; Matchar, DB; Koh, V; Schoenenberger, LThis study describes a group model building exercise that aims to develop a deeper understanding of the dynamic complexity of chronic disease care delivery within a primary care setting in Singapore, leveraging on the insights of stakeholders with personal and institutional knowledge of the health care system. A group model building exercise, which included 50 stakeholders, was used to develop the qualitative model. The qualitative model helped to bring a feedback perspective to understanding the dynamic complexity of chronic disease care delivery. The feedback perspective helped in identifying the systemic issues within chronic disease care delivery, which has the potential to inform system-wide interventions and policies to improve health. Enhancing chronic care in Singapore will require an enhancement of both the capacity and capability of the primary care sector. © 2018 John Wiley & Sons, Ltd.Item Open Access Modeling manpower requirement for a changing population health needs: The case of ophthalmic nurses and allied health ophthalmic professionals(Health Policy and Technology, 2019-09-01) Ansah, JP; Koh, V; De Korne, D; Jayabaskar, T; Matchar, DB; Quek, DBackground: Prevalence of chronic eye conditions has been shown to increase with age. As the global population continues to age rapidly, the demand for eye care services is expected to increase significantly in the near future, requiring effective health workforce planning in order to provide for the needs of the population. The aim of this paper is to synthesize data from a variety of sources to develop a simulation model based on the systems modelling methodology of system dynamics that links population health needs to workforce requirements to generate evidence-based projections for ophthalmic nurses, and allied health ophthalmic professionals in Singapore. Methods: A system dynamics simulation model was developed with active engagement of key stakeholders—such as ophthalmologists, senior nurses, healthcare planners and managers, and senior technicians—to verify the model structure and assumptions. The model project the future requirement of ophthalmic nurses, technicians and patient service assistants. Results: The number of Singaporeans with eye diseases is projected to more than double by 2040. As a result, the demand for eye care services and eye care workforce is expected to increase significantly under all the plausible scenarios. The increase in eye disease burden is due mainly to population aging—given that the prevalence of eye disease increases with age. Conclusion: This research provides a future demand outlook for ophthalmic nurses, technicians and patient service assistants in Singapore and has implications for recruitment and training of ophthalmic nurses and allied health professionals in Singapore.Item Open Access Modeling to inform long-term care policy and planning for an aging society(2017-01-01) Ansah, JP; Koh, V; Qureshi, MA; Matchar, DBDemographic changes such as increasing longevity, declining family sizes, and increasing female participation in the labor market have implications for long-term care (LTC) planning for the elderly. As the population in both developed and developing world ages, the prevalence of health conditions such as chronic diseases and disabilities increases. Consequently, the proportion of elderly adults who require assistance with their daily activities rises. Further, the potential decrease in family members available as caregivers implies an increase in the demand for alternative LTC arrangements. Planning of LTC services is fraught with dynamic complexities. Various issues, such as projecting future need, cost, capacity, and quality of care and caregivers—formal and informal—can influence the effectiveness and efficiency of LTC services. The trends outlined point to the need for a comprehensive LTC planning that accounts for all these dynamics changes. This chapter aims to demonstrate the use of simulation modeling as a communication tool that allows for the LTC complexity to be reduced to its essential elements to inform policy for an aging society. The forms of simulation techniques used in the planning of LTC policy and services and real-world applications across different institutional contexts are discussed. Of particular focus is the application of the system dynamics methodology in LTC planning. Three LTC projects using system dynamics methodology are presented. Specifically, these LTC projects comprise the methodological process in the projection of the number of disabled elderly in Singapore accounting for changing educational attainment, the impact of various LTC policies on informal eldercare hours and labor force participation of informal caregivers, and the impact of LTC capacity expansion policies on acute care.Item Open Access Projecting the Number of Elderly with Cognitive Impairment in China Using a Multi-State Dynamic Population Model(System Dynamics Review, 2017-04-01) Ansah, JP; Koh, V; Chiu, CT; Chei, CL; Zeng, Y; Yin, ZX; Shi, XM; Matchar, DBChina is aging rapidly, and the number of Chinese elderly with dementia is expected to rise. This paper projects, up to year 2060, the number of Chinese elderly within four distinct cognitive states. A multi-state population model was developed using system dynamics and parametrized with age–gender-specific transition rates (between intact, mild, moderate and severe cognitive impairment and death) estimated from two waves (2012 and 2014) of a community-based cohort of elderly in China aged ≥65 years (N = 1824). Probabilistic sensitivity analysis and the bootstrap method was used to obtain the 95% confidence interval of the transition rates. The number of elderly with any degree of cognitive impairment increases; with severe cognitive impairment increasing the most, at 698%. Among elderly with cognitive impairment, the proportion of very old elderly (age ≥ 80) is expected to rise from 53% to 78% by 2060. This will affect the demand for social and health services China. Copyright © 2017 System Dynamics Society.Item Open Access The impact of population dynamics and foreign labour policy on dependency: the case of Singapore(Journal of Population Research, 2015-06-15) Ansah, JP; Riley, CM; Thompson, JP; Matchar, DBUnderstanding population dynamics is crucial to understanding current and future health care needs and designing systems to meet those needs. In this paper, we provide a methodological approach to investigate population dynamics in a system dynamics model configurable to initialise in dynamic equilibrium or disequilibrium. We then use the model to investigate how the current measured population compares to a population of the same size in equilibrium, and how a dependency ratio will change over time under different scenarios. We apply our approach to Singapore, which, like many other countries, has a rapidly increasing proportion of elderly in the population.Item Open Access Viewing the Role of Alternate Care Service Pathways in the Emergency Care System through a Causal Loop Diagram Lens(Systems) Kumar, A; Liu, Z; Ansah, JP; Ng, YY; Leong, BSH; Matchar, DB; Ong, MEH; Siddiqui, FJGlobally, Emergency Care Systems (ECS) are a critical resource that needs to be used judiciously as demand can easily exceed supply capacity. Sub-optimal ECS use contributes to Emergency Department (ED) crowding; this adversely affects ECS as well as system-wide service performance. Alternate Care Service Pathways (ACSPs) are innovations intended to mitigate ED crowding by re-routing less-urgent cases to sites of care other than the ED. As in other countries, policymakers in Singapore need to respond to increasing ED utilization and are evaluating the introduction of ACSPs. However, developing ACSPs is costly, entails tinkering with established critical services, and runs the risk of unintended adverse consequences. Through a Causal Loop Diagram (CLD) developed in four stages, we present a view of the current Singapore ECS and the intended role of ACSPs in relieving its stress. This exercise suggests that to be successful ACSPs must change the prevailing mental model of the ED as a “one-stop shop” but should focus on integrating with primary care. The discussions stimulated by the development, critiquing, and revision of the CLD highlighted the importance of accounting for the reservations of stakeholders for changes. The CLD has enhanced shared understanding and will be used to guide quantitative simulation modeling to promote informed policy.