Impact of a national enrolment programme on preventive care uptake in Singapore: a cohort study of 268,315 patients

Background Preventive care uptake in Singapore remains suboptimal despite longstanding national programmes. Healthier SG, launched in July 2023, aims to strengthen primary care through empanelment, continuity, and proactive health planning, but evidence on its effectiveness is limited. Aim To evaluate the association between Healthier SG enrolment and uptake of preventive care services. Design & setting Retrospective cohort study using electronic medical records from National Healthcare Group Polyclinics. Method Adults aged≥40 years with at least two annual visits between January 2018 and September 2024 were included. Outcomes were cervical cancer screening, influenza and pneumococcal vaccination, and cardiovascular risk screening. Quarterly uptake rates were analysed across four periods: pre-COVID-19, COVID-19, post-COVID-19/pre-Healthier SG, and post-Healthier SG. Results Preventive care uptake in Healthier SG enrolees demonstrated more favourable uptake trajectories across all preventive care outcomes. For cervical cancer screening, uptake declined during COVID-19 and recovered thereafter. Following Healthier SG implementation, cervical screening showed a steeper upward trend among enrolees than non-enrolees (quarterly trend change+0.57% versus+0.05%). Although vaccination uptake declined after the post-pandemic peak, reductions were less pronounced among enrolees (influenza: -0.41% versus -2.18%; pneumococcal:+0.07% versus -1.13% per quarter). Cardiovascular risk screening demonstrated a ceiling effect, with a smaller decline among enrolees than non-enrolees (-0.03% vs -0.32%). Among eligible patients, lower enrolment in ethnic minority, single, lower SES housing suggest potential inequities. Conclusion HSG enrolment was associated with greater uptake of selected preventive services. As an observational study restricted to regular primary care users, findings may not be generalisable to less-engaged populations. Continued evaluation is needed to assess long-term impact and equity of preventive care uptake.