Not long ago, a patient told me her asthma was “fine”.
It was a familiar response — said quickly, politely, almost reflexively. But when we reviewed her asthma questionnaire together, a different story emerged. She was waking up coughing several nights a week and avoiding daily activities she once enjoyed. What she had normalised as “fine” was, in fact, a daily burden.
That short conversation changed the consultation. It shifted my focus from prescribing “just in case” treatments to understanding what truly mattered to her, and how appropriate care could meaningfully improve her life.
Moments like these remind me why appropriate and value-based care (AVBC) should not just be a theory, but a practical and ethical necessity for doctors today.
As a doctor who has spent decades caring for patients and studying healthcare systems, I have seen both the strengths and the growing strains of Singapore’s healthcare landscape.
We are rightly proud to have one of the world’s most effective systems. Yet we face pressures familiar to healthcare systems everywhere: a rapidly ageing population, rising rates of chronic diseases, escalating healthcare costs and patient expectations, as well as a workforce stretched by demand.
It is because of these challenges that AVBC has become not just timely, but essential.
Simply put, AVBC is about ensuring all patients receive care that genuinely helps them, at a cost that both the patients and the system can afford.
This means three things.
First, care must be appropriate for the individual.
Being appropriate is not about withholding care, but doing what is medically prudent and meaningful. It means avoiding unnecessary tests, procedures and medications that do not improve outcomes. Sometimes this means doing more; often, it means recognising that less is more.
Second, care must be value-based.
This means achieving the best possible outcomes for patients while using our finite resources wisely.
And the quality of care cannot be sacrificed to reduce cost, and cost cannot balloon without improving results. Value is not cheaper care or more care, but smarter care.
Third, every decision must be what matters to the patient.
This requires understanding patients’ goals, fears, what they need to live well, and what a “good outcome” looks like to them, and not simply assuming we already know.
