In light of the recent announcement by the health ministry that it will be looking into improving the affordability of healthcare in Singapore, I feel compelled to share my own experience in a country which boasts one of the most efficient and affordable healthcare systems in the world: South Korea. Last December, I was spending my family vacation in Seoul where to my misfortune, two planned full days of shopping, eating and sightseeing were laid to ruin by a terrible stomach problem that made me unable to leave my bed. Worried that it may be something more serious than a stomach bug, I took a taxi to Sinchon Yonsei Hospital, a private hospital not too far away from my hotel. (It’s quite a nice hospital, take a look: http://www.scys.co.kr/main.asp). Prior to falling ill, I had already been given a rough introduction to the healthcare system in South Korea by our tour guide. She was not at all bashful in praising the system. We were told that in South Korea, healthcare is viewed almost like a human right and is entirely state sponsored. Virtually everybody can afford basic private healthcare. In fact, almost all hospitals are private and only a handful of community hospitals exist. Every South Korean receives affordable, state-sponsored medical insurance. If the patient is employed, the employer pays half of the premium while the employee covers the other half. The premium levels are means tested; the most destitute members of society are exempted from paying altogether. We were also told of the short waiting times and extremely affordable health bills, with the exception of serious illnesses. When I first heard her description, I found it quite difficult to be true. However, my experience at the hospital certainly proved otherwise. As I walked through the hospital doors, I began to recall the horror stories about inefficiencies of state sponsored healthcare systems, and their long waiting times. The fact that it was a Sunday morning in the midst of a very cold winter only added to my fears. However, to my surprise, the waiting time between registration and consultation was a mere five minutes. I was impressed. After three minutes of whimsical miming and tortured attempts at communicating in English (much to the nurses’ amusement), the doctor finally concluded that there was a possibility of appendicitis and suggested that I take a blood test, urine test and an x-ray. Insecure about my state of health, I agreed. I did not have to wait at all for the tests. They took my blood and urine on the spot. After that I was directed to the basement where I had my x-rays. By the time I was finished, the lab results for the tests were back. I was clear. I waited another ten minutes and the doctor called me in to tell me I was fine and that after a jab, I could be discharged. Despite the communication barrier, everything was done efficiently. I walked through the front door at 11am and walked out at 12 20pm. At this point, I was already very much impressed. I wouldn’t have considered myself awestruck though. Well, that was until I saw the bill. The entire cost of my visit including consultation, x-ray, urine test, blood test and injection fees was a mere SGD$52. The same treatment might have cost at least two to three times more in Singapore. Here, I didn’t even have to use my credit card. After this experience, I could not help but compare the healthcare system in South Korea versus that of Singapore. There are actually some similarities. For example, the shared payment of insurance premiums mirror the split of CPF contributions back home between employees and employers, a part of which enters the Medisave account. In terms of hospital density, both countries are excellent. Yet in so many areas including affordability and efficiency, the South Korean model trumps the Singapore one. Also, you may be surprised to know that despite the existence of a heavily subsidized healthcare system, the Korean government’s expenditure on healthcare is lower than that of many developed countries, consisting 6.3% of its GDP. (as compared to the European/Canadian average of around 10% and USA’s appalling 15%). One method, I was told, that the Koreans use in keeping cost low is the use of the single-payer system where everything is paid for in advance using the pool of resources generated by the national insurance scheme, thereby reducing administrative costs. Should Singapore begin to adopt certain features of the South Korean model? It does look like a very attractive system. By favoring breadth over depth, its system ensures that nobody is left behind. Importantly, low-income families benefit the most from the low costs of basic and emergency healthcare. This is because without subsidies, low-income individuals are equally likely to fall sick as high-income individuals, but end up spending a larger portion of income on healthcare. As a result, the redistributive effect of healthcare in South Korea is therefore very high, and helps close the widening income gap. However, no system is without its drawbacks. To begin with, the low price of healthcare in South Korea has caused Korean doctors to earn a fraction of what their counterparts in the US and Europe do. This has led to a decline in the interest in the medical profession. This phenomenon can pose several long-term problems. In fact, one emerging problem I read about was the problem of doctors carrying out extremely quick consultations in the hope of covering more patients. This is because with the shortage of medical graduates, doctors are paid based on the number of patients they see. The lack of sufficient attention as such invariably increases the propensity for error, thereby putting patients at risk. (Still, one may argue that quick and cheap consultations are better than no consultations at all) Next, the medical coverage is strong, but limited. While South Koreans pay very little for standardized treatment, they face serious financial difficulties when dealing with advanced diseases like cancer. This is because a lot of the treatments required are considered ‘electives’ and therefore not covered under the state’s medical insurance scheme. Without Singapore’s method of mandatory savings, South Koreans without private insurance are in an extremely vulnerable position. Singapore diverts very little government expenditure to healthcare. In 2012, the allocation was 1.5% of GDP. Compared to South Korea’s 6.3%, I would safely conclude that our healthcare system is extremely value for money. This is probably one of our proudest achievements. However, can we do more? I believe we should try. There are many Singaporeans who can benefit from cheap consultation fees and heavily subsidized medicine in Singapore. I therefore applaud the commitment of our Health Ministry to reducing the costs of healthcare and making healthcare more affordable. My own experiences back home have shown that we have a long way to go. I hope that one day the affordability and efficiency of healthcare in Singapore would reach South Korean standards. Yet, I hope that many of the shortcomings observed in the South Korean system will not emerge here. There is a saying that goes “A good man learns from his mistakes. A great man learns from other people’s mistakes.” As we try to improve our system, learning from the triumphs, as well as the setbacks of countries like South Korea would be an important step to take.
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