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Background: Rare diseases pose immense challenges for healthcare systems due to their low prevalence, associated disabilities, and attendant treatment costs. Advancements in gene therapy, such as treatments for Spinal Muscular Atrophy (SMA), have introduced novel therapeutic options, but the high costs, exemplified by Zolgensma® at US$2.1 million, present significant financial barriers. This scoping review aimed to compare the funding approaches for rare disease treatments across high-performing health systems in Australia, Singapore, South Korea, the United Kingdom (UK), and the United States (US), aiming to identify best practices and areas for future research. Methods: In accordance with the PRISMA-ScR guidelines and the methodological framework by Arksey and O'Malley and ensuing recommendations, a comprehensive search of electronic databases (Medline, EMBASE, and Cochrane) and grey literature from health department websites and leading national organizations dedicated to rare diseases in these countries was conducted. Countries selected for comparison were high-income countries with advanced economies and high-performing health systems: Australia, Singapore, South Korea, the UK, and the US. The inclusion criteria focused on studies detailing drug approval processes, reimbursement decisions and funding mechanisms, and published from 2010 to 2024. Results: Based on a thorough review of 18 published papers and grey literature, various strategies are employed by countries to balance budgetary constraints and access to rare disease treatments. Australia utilizes the Life Saving Drugs Program and risk-sharing agreements. Singapore depends on the Rare Disease Fund, which matches public donations. South Korea's National Health Insurance Service covers specific orphan drugs through risk-sharing agreements. The UK relies on the National Institute for Health and Care Excellence (NICE) to evaluate treatments for cost-effectiveness, supported by the Innovative Medicines Fund. In the US, a combination of federal and state programs, private insurance and non-profit support is used. Conclusion: Outcome-based risk-sharing agreements present a practical solution for managing the financial strain of costly treatments. These agreements tie payment to actual treatment efficacy, thereby distributing financial risk and promoting ongoing data collection. Countries should consider adopting and expanding these agreements to balance immediate expenses with long-term benefits, ultimately ensuring equitable access to crucial treatments for patients afflicted by rare diseases. [ABSTRACT FROM AUTHOR]

This review paper describes the development of the pre-hospital system in Singapore from the pre-war days. Every country's prehospital community needs a deep understanding of how they developed over the years, factors that played a part, and the aspirations their community and government have set for this. This can guide future evolution of the services to ensure that care provided is relevant, applicable and in keeping with the community's needs. Countries with similar contextual circumstances, but at a different stage of development of their PECs, may learn from these. [ABSTRACT FROM AUTHOR]

Background: As with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized. Methods: This is a single-center cross-sectional observational study of patients aged 55 to 75 years old who visited the ED with urgent conditions, Patient Acuity Category Scale (PACS) P2 or P3, who were subsequently discharged. The patients visited a public hospital in Singapore on four randomly selected weekdays in April 2023. The utilisation of hospital resources and manpower was studied. A formulated criteria was used to determine the appropriate site of care, such as an Urgent Care Centre (UCC), Primary Care Providers (PCP) clinic or the ED. Results: There were 235 eligible patients during the study period, with a mean age of 65.1 years of which a majority, 183 (77.9%) were allocated to patient acuity category scale P2. Most of the patients were walk-in patients with no referrals (169 (71.9%)). Based on the criteria, the majority of 187 (79.6%) of these patient may be safely managed at an outpatient setting; 71 (30.2%) patients by PCP, 116 (49.4%) patients may be managed by an UCC, with the remaining 48 (20.4%) requiring ED care. Conclusion: Our findings indicate that a significant portion of discharged older ED adults with urgent but non-emergent conditions may be adequately managed at outpatient medical services that are appropriately resourced. More research is needed on healthcare initiatives aimed at developing the capabilities of outpatient medical services to manage mild to moderate acute conditions to optimise ED resource allocation. [ABSTRACT FROM AUTHOR]

Previous research suggests that descriptive norms positively influence proenvironmental behavior, including littering prevention. However, in some behavioral contexts, a weak descriptive norm may increase individuals' feelings of responsibility by signaling a need for action. We examined this effect in the context of litter prevention by conducting structural equation modeling of survey data from 1400 Singapore residents. The results showed that descriptive norms negatively predicted ascription of responsibility and were negatively related to littering prevention behavior via ascription of responsibility and personal norms. It also showed that strong injunctive norms can reduce the inhibitory effect of descriptive norms on ascription of responsibility. These findings were consistent with several hypotheses constituting the model of norm-regulated responsibility, a novel explanatory framework offering new insights and a more nuanced and comprehensive understanding of social norms' influence on proenvironmental behavior. [ABSTRACT FROM AUTHOR]

Political scientists have crafted intricate taxonomies to classify nations beyond liberal democracy, positioning these societies along an authoritarian continuum. Despite the pivotal role of journalists in accelerating political dynamics, there exists a lack of comparative research on media governance in these regimes. Consequently, this study scrutinizes the media governance ecosystems in Vietnam and Singapore. Vietnam is a one-party authoritarian state, whereas Singapore represents a hybrid political system. However, both countries exhibit a stable and uninterrupted rule by the respective ruling party. Our research uncovers the nuances of Singapore's media regulation, which embeds trusted stakeholders with financial interests in key press roles to reinforce the implicit political norms. Conversely, Vietnam employs a more direct, coercive, and state-centric approach. Media actors in both nations occasionally test the boundaries of acceptable discourses, with each government's responses being shaped by specific contexts and broader history. Reforms in Vietnam, embracing privatization and commercialization, mirror Singapore's integration of capitalism, public ownership, and commercial interests when governing media. These findings highlight diverse yet effective authoritarian media governance strategies, unique features, and commonalities in both systems. Overall, media structures in these Southeast Asian countries have undergone profound evolutions towards more sophisticated regulatory tools to manage societal and political transformations. [ABSTRACT FROM AUTHOR]