Healthcare: How robust is the Singapore system?

Here is an excerpt from the headlines in the United Kingdom of late:

“LONDON (Reuters) – The deaths of hundreds of hospital patients, left without food or water in filthy conditions, exposed an urgent need to change the culture of Britain’s National Health Service (NHS). Between 400 and 1,200 patients are estimated to have died needlessly at Stafford Hospital in central England between January 2005 and March 2009. “There were patients so desperate for water that they were drinking from dirty flower vases,” Prime Minister David Cameron told parliament in a statement on the report. Describing events at Stafford Hospital as “a despicable catalogue of clinical and managerial failures”

Across the world, healthcare is always a hot button issue that can polarise people and divide nations. While it’s important that people have access to affordable public healthcare as countries need healthy citizens to drive the economy, it’s also a question of how much of taxpayers’ dollars should be spent to keep the system running. Healthcare can be costly to the individual and potentially blow his or her life savings, and it’s unfair for anyone to be denied medical attention because he or she couldn’t afford it. Major procedures like heart surgery can cost several hundred thousand dollars in Singapore for example, and that’s not something that the average Singaporean can afford to pay. Insurance is a smart option, but insurance providers have conditions that often exclude those who have a previous medical record or senior citizens as these individuals would be more likely to fall ill and file insurance claims.

What then, is the solution to this problem, especially in countries like Singapore where we have a greying population? Should healthcare be free or heavily subsidised? How will taxpayers then be affected? Let’s have a look at two contrasting models: the UK’s healthcare system which is fully paid for by taxpayers versus Singapore’s system which is based on a hybrid model where medical costs are co-funded by residents and the government.

 

The UK’s National Health Service

The UK system is an example of tax-financed healthcare where services are provided free of charge and funded by the state. In 2010-2011, the UK government spent a whopping 137.4 billion pounds on the National Health Service, which is equivalent to 8.9 percent of national income. The key advantage of such a system is that no citizen is left behind and this solves the problem of the less well-off being denied healthcare because they couldn’t afford it.

However, with every upside there is a downside. Demand for healthcare in the UK often exceeds supply and many have to wait in line just so that they can receive attention or treatment. It’s not uncommon for patients to wait weeks or months before they get to see a doctor. Now, if more resources are used to meet the high demand, then healthcare spending will go up inevitably. Not to mention the strain on healthcare workers to support the population, which would then lead to lower service standards. It’s apparent that this system, while it helps lower-income citizens meet their healthcare needs, is fraught with problems.

 

Singapore’s healthcare system

Singapore’s healthcare system is based on a hybrid model where citizens receive subsidies for healthcare as opposed to being fully funded by the state. In 2012, the Singapore government spent only about 1.6% of GDP on healthcare – a figure that is much lower than other developed countries but resulting in health outcomes that are comparable if not better than other developed nations. In the year 2000, Singapore was placed 6th in the world in the World Health Organization’s ranking of the World’s Health Systems. Singapore was only one of two Asian countries in the list, with the other being Japan at 10th position. So what makes the Singapore system so successful?

Singapore’s public healthcare is split into two broad areas, namely primary care and hospital care. Primary care, which covers small ailments and is often less convoluted as they can be treated with common medicines, is predominantly managed by the private healthcare industry and paid for by citizens themselves or by their employers under company-based insurance schemes. 80 percent of the primary care sector is left in the hands of private medical practitioners.

Hospital care, on the other hand, is largely managed and subsidised by the government. There are regulations and policies in place to ensure that there are enough public hospitals, doctors, nurses and healthcare workers to meet the demands of a growing population. There are also community hospitals where patients are placed if they do not require specialised treatment and services that are only available at the major hospitals. Singapore residents are also given ward class options where they receive the highest subsidy (80 percent of hospital charges) for the lowest ward class. The purpose is to enable lower-income individuals to enjoy the benefits of a top-notch healthcare system without the frills (eg. in C-class wards, fans are used instead of air-conditioning to save costs) while the well-heeled can opt for the higher-class wards with less or no subsidy from the government. Regardless of the ward class, patients receive the same quality of treatment and medication.

To defray healthcare costs, which are already subsidised by the government, Singapore has a 3Ms financing framework consisting of three schemes: Medifund, Medisave, and MediShield. These enable Singaporeans and PRs to fund part of their individual medical costs. Most Singapore residents are covered under Medisave and MediShield, while those who are still unable to foot their hospital bills can rely on Medifund, which is an endowment fund set up by the government to help the poor.

 

Looking ahead

It’s without a doubt that the Singapore healthcare system has been working for the nation for decades, and by comparison with the UK system is more efficient in many areas. But with a growing yet ageing population, we cannot afford to be complacent.

With an anticipated one million more people to add to the current population of 5.3 million within the next 15 or 20 years, much more needs to be done to expand and refresh the infrastructure so that the quality of healthcare isn’t compromised and that Singaporeans, regardless of income level, can get the medical attention they need in a timely and efficient fashion.

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The Editor

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1 Comment

  • Before we get too smug, SG’s system is overly skewed to burden the patient. My wife works in healthcare and you should hear some of the financial horror stories. Think Medisave will help you? It’s limited in terms of how much you can withdraw and over what period. Spent 2 days in the ICU and have a bil for $4000? Check how much Medisave allows you to pay for the sat “per day”. The limits and overly complicate rules means, many SGeans are inconvenienced and impacted by this beggar your neighbour approach. It’s time the pendulum swung from one extreme to a bit more in the other direction. how much? I leave it up to the experts – if the government is listening. Spending a tiny percentage of GDP on healthcare could be something to be proud of – or to be ashamed. Go figure

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