TROUBLED by the sniffles or a cough? Your first stop should be your general practitioner or a polyclinic.

If you need hospitalisation, a regional hospital - Changi General Hospital (CGH), Tan Tock Seng Hospital, the upcoming Khoo Teck Puat Hospital in Yishun or the one proposed for Jurong - is probably where you should head.

Only if you are among the few with a complex medical problem will you be referred to either of the tertiary hospitals - National University Hospital (NUH) or the Singapore General Hospital (SGH).

The shape of the ideal public health system here, envisioned by Health Minister Khaw Boon Wan, would, therefore, be that of a pyramid.

He is changing the way public hospitals and polyclinics here are managed to create this pyramid which, he says, will improve services for patients and keep health-care costs down.

Since 2000, all public hospitals here have been run by one of two public health clusters - Singapore Health Services (SingHealth) and National Healthcare Group (NHG). Before that, they were run directly by the Ministry of Health (MOH).

The two clusters will not be dismantled, said Mr Khaw, who added that the model he is proposing would be 'a logical evolution'.

Under the model, the regional hospitals will be given more autonomy in day-to-day operations and will manage a few polyclinics in their corners of the island.

They will focus on improving links with other health providers in the community - the polyclinics, private general practitioners, community hospitals and nursing homes - so that patients can move seamlessly from one provider to another when necessary.

At tertiary hospitals NUH and SGH, treatment by specialists would cost more than in the regional hospitals, MrKhaw said.

'So patients with common conditions should get their treatment in the regional hospitals which are competent enough to provide such services at a lower cost,' he added.

With the regional hospitals taking in the bulk of patients with run-of-the-mill conditions, NUH and SGH would be free to focus on patients with complicated conditions and on research, he said.

MOH would take charge of items needed by all hospitals so it can reap economies of scale from, for example, bulk purchases of drugs and IT management.

Mr Khaw stressed that the changes would be made gradually, and that details have yet to be worked out.

His ministry has started the ball rolling with the Khoo Teck Puat Hospital, which will open in 2010, by getting it to set up its own board of directors last October.

Later that month, a governance board was set up to run both NUH and the National University of Singapore's medical school.

Mr Khaw expects CGH to be next to form its own board.

Professor Tan Ser Kiat, SingHealth's chief executive officer, said the proposed model would use resources more effectively and allow the tertiary hospitals to focus on research.

NHG chief Lim Suet Wun said the proposed changes should result in better coordination between hospitals and other health providers.

It will also allow for more patients to be treated at the most appropriate site, 'which would ultimately benefit patients'.

Madam Halimah Yacob, who chairs the Government Parliamentary Committee for Health, said it makes sense to channel patients where they would be served most effectively.

'For patients, what is most important is that they get good and affordable service which is convenient,' she said.

huichieh@sph.com.sg