Scaling up hospital in the home – what can we learn from Singapore?

Recovering from surgery, receiving intravenous treatment, and monitoring vital signs are all now possible from home, under Singapore’s Mobile Inpatient Care at Home (MIC@Home) program.

Known globally as Hospital in the Home (HITH), the model is a hit with professionals and patients, and often sees better health outcomes, with patients walking more, sleeping better, and less susceptible to infection.

The MIC@Home model has already redefined healthcare delivery in Singapore, becoming mainstream in just two years since its inception.

But despite its popularity, HITH is not always easy to scale up at a national level, according to Dr. Yi Feng Lai, Acting Deputy Director of the Integrated General Hospital Programmes at the MOH Office for Healthcare Transformation, Singapore.

He says issues with policy and the surrounding ecosystem can act as barriers, leaving hospitals unclear on how to move forward.

“As researchers, we already answered the question of how good HITH is. So, the next frontier from a researcher perspective is how we can do its implementation better, and scale it up more meaningfully to drive efficiencies. Because at the moment, these questions are really puzzling hospitals and implementation teams on the ground,” he said.

What is working for Singapore?

While Singapore is just eight months into its post-mainstream journey, it already has a range of MIC@Home use cases on offer, across all of its public hospitals. These include:

? Acute Medical Inpatient Substitution – This service allows patients to receive hospital care in their homes, including access to a care team 24/7, remote vital signs monitoring, intravenous infusions, home visits, and support from community-based services.

? Post-surgery Early Supported Discharge – This service offers post-surgery care and monitoring at home.

? Hospitalisation for Nursing Home Residents – An in-situ hospitalisation service that offers hospital-level care to nursing home residents.

? Palliative Care – This service allows palliative patients with acute, reversible, organic medical needs to be cared for without transferring them back to hospitals for management.

? Bone Marrow Transplant – Post-transplant patients can be cared for and closely monitored at home after receiving their initial chemotherapy where the risk of infections can be mitigated.

The model underwent a proof-of-concept phase from 2019 to 2021, followed by a scaled-up proof-of-value phase in 2022 to 2023. According to Dr. Lai, this process provided valuable insights into the key factors that facilitate or hinder scalability.

The importance of government backing

“We have really learned the importance of full government support. Singapore may be small, but it acted quickly and decisively to grow this model – and we owe much of its success to that,” Dr Lai said.

“We know that in some other countries, there is strong momentum to advance HITH programs, but that policy directions are evolving.

“For example, the USA is making significant progress, with a CMS waiver extension currently being considered in Congress to extend support for hospital-at-home implementation. They have a clear commitment to healthcare transformation, but are navigating a more complex policy landscape.

“In Singapore, we started our HITH journey around the same time, and our mainstream service has benefited greatly from early and cohesive government support.”

How collaboration drive success

While strong government support is critical, it is only part of the equation. Dr Lai says collaboration across healthcare sectors has been another driving force behind Singapore’s success.

“The MIC@Home initiatives owes much of its success to collaboration among policymakers, implementation teams, clinicians, and enabling units such as technology and innovation agencies.

“We have a close-knit community that allows us to advance the implementation agenda efficiently,” he said.

Onlookers have also noticed Singapore’s collaborative spirit, with a recent high-profile speaker highlighting its diverse delegation at a recent conference.

“He highlighted Singapore’s approach, praising our ability to send a diverse delegation to the conference.

“Our team included policymakers, clinicians, IT professionals, and representatives from various agencies and government bodies—a level of integrated participation that is rare in other countries.”

The importance of perspective

While MIC@Home was originally developed for acute inpatient care, Singapore has drawn inspiration from Australia, and is exploring the model’s upstream potential.

“Like Australia, we are looking at virtual emergency departments and virtual triaging. This aligns with the broader virtual and community-anchored care vision of encompassing care from community touchpoints and emergency medical services to acute care settings,” Dr. Lai said.

It is also looking to extend its model into post-acute care.

“In post-acute care, there are clear opportunities to support patients through continued monitoring, especially those with multi-morbidity or chronic disease management needs. We are exploring how to deliver ambulatory and post-acute care as a seamless continuation of the acute crisis episode from which patients are recovering,” he said.

The importance of publicity

Despite strong government and stakeholder support, Dr. Lai acknowledges that public awareness of Singapore’s MIC@Home model remains largely untapped, due to its rapid progression from inception to mainstream.

“In Singapore, our journey has been swift. We launched our proof-of-concept in 2020, and by April 2024, it had become a mainstream service of our healthcare system. This quick trajectory has left us with limited time to promote the model effectively. Many patients may still be unaware that MIC@Home is a viable care option for them, so there’s significant opportunity to enhance public awareness and outreach,” he said.

Dr. Lai also underscored the importance of internal publicity and buy-in from clinicians, who play a pivotal role in referring patients to the service.

“MIC@Home relies heavily on referrals from other departments, such as traditional inpatient wards, where many patients could benefit from early supported discharge. However, getting clinicians to embrace this model can be challenging, especially when some hold traditional views that hospitals—equipped with centralised resources—are the safest place for acute or crisis care,” he explained.

“We need to communicate how advances in technology have made care at home as safe as hospital care, and share compelling evidence from the literature. Studies show that patients at home sleep better, walk more, and face reduced risks of delirium, infections, and deconditioning. Beyond clinical outcomes, care at home offers a level of patient-centred experience that hospitals simply cannot replicate,” he said.

Why ecosystem readiness matters

Building support and raising awareness among key stakeholders, such as IT and logistics teams, is also a critical focus of Singapore’s ecosystem readiness agenda, Dr. Lai explained.

“We are working to establish the necessary infrastructure and support systems to ensure the long-term sustainability of the MIC@Home model,” he said.

“A robust ecosystem is essential, as the absence of such foundational supports can drive up costs associated with the model. These elevated costs, in turn, act as barriers to scaling, affecting both uptake and broader acceptance of the model.”

Creating an ecosystem equipped to support MIC@Home is not just about efficiency but also laying the groundwork for widespread implementation, he emphasised.

“By addressing these challenges proactively, we aim to lower barriers to entry and enable the MIC@Home model to flourish as a mainstream component of healthcare delivery.”

Further insight

While MIC@Home offers a blueprint for other nations seeking to scale HITH programmes, it has not been without challenges.

Reflecting on these and sharing more on Singapore’s approach to multi-sector collaboration and ecosystem readiness, Dr. Lai will present at the upcoming Hospital in the Home Conference, as part of Connect Virtual Care.

One ticket to Connect Virtual Care gives you access to three conferences: Medication Safety & Efficiency, National Telehealth and Virtual Care, and Hospital in the Home.

This year’s event will be held 2-3 April 2025 at the Hilton Sydney.

Learn more and register your tickets here.