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    Sec3 chapter3 managing_healthcare(intro&singapore's system)_slideshare Sec3 chapter3 managing_healthcare(intro&singapore's system)_slideshare Presentation Transcript

    • Healthcare Provision(Singapore and UK) Should the State provide…?
    • Lesson Recap What are the key features of MediShield scheme? Which group of people does MediFund serve?
    • Today’s Lesson By the end of the lesson students should be able to:  Identify the challenges government’s face in managing healthcare  State the features of healthcare in Singapore from the 1960s to the present.  Explain Singapore’s approach to healthcare.
    • Healthcare as a Public Good Healthcare provision can be grouped under 3 systems.  Governments that provide and subsidize healthcare. Healthcare is a public good.  Government provides healthcare and subsidizes part of its cost. The rest of the costs are funded by citizens.  Healthcare is provided by private companies and completely paid for by citizens.
    • Which system works best… Depends on:  Expectations of the citizens  Economic development of the nation  Characteristics of the nation (i.e. ageing, major illness etc.)
    • Healthcare Provision in Singapore 1960’s  Healthcare measures linked to public housing – emphasis on public hygiene  Cleared squatters and slums – relocated to HDB flats  Clinics and hospitals were built to meet growing pop.  Infectious diseases common – citizens encouraged to go for vaccination.
    • Healthcare Provision in Singapore 1970’s  Standard of living improved – now wanted better quality healthcare.  Polyclinics built conveniently within HDB estates to replace “out-patient dispensaries”  Better facilities in government hospitals – sophisticated equipment for more precise medical tests and examinations.
    • Healthcare Provision in Singapore 1980s to the present  Government realised Singapore population is ageing…so healthcare costs will increase.  Government resources would be taken away to pay for healthcare…solution?  1980s – Govt. introduced new approach to healthcare:  Healthcare = Shared responsibility between: The Indivdual, the Government and the Community
    • Healthcare Provision in Singapore The Individual  Self-reliance:  1984 Introduced MediSave Account. 8% of monthly contribution to CPF channelled to MediSave.  Singaporeans encouraged to take charge of their own healthcare provisions.  Later MediSave further enhanced to include Medishield (for those who do not have CPF Accounts) and Eldershield (for those above 40 who have disabilities)
    • Healthcare Provision in Singapore The Individual (Self-Reliance):  MediShield scheme is a national healthcare insurance scheme. Just like insurance – Singaporeans pay for MediShield from monthly contributions from MediSave.  Eldershield another insurance scheme for those above 40. Use CPF MediSave accounts to pay premiums for Eldershield.
    • Healthcare Provision in Singapore The Government  Keeping healthcare affordable (Government Subsidies)  Provide government subsidies to hospitals, polyclinics and nursing homes.  Government saved $200mill and from the interest it gets it provides Medifund to subsidize hospital wards.  Hospital authorities decide how to use funds for individual cases.
    • Healthcare Provision in Singapore The Government  Keeping healthcare affordable (Restructured Hosp.)  Restructuring means – Hospitals now have freedom to reorganise and better meet needs to Singaporeans  Government can reduce the amount of subsidies  Keeping healthcare affordable (Means testing)  Subsidies provided must benefit patients who need them most. Very low income receive most. Higher income means get less subsidies.  Very difficult issue…how to know who deserves more??
    • Healthcare Provision in Singapore The Government (Promoting Healthy Lifestyle)  A healthy person does not need a lot of medical care  Government encourages the need for citizens to keep healthy  Encourage a well-balanced diet and habit of physical exercise.
    • Provision of Healthcare in Singapore The Community  Community provides healthcare support  After discharge some patients still need support to fully recover: Voluntary organizations and private organizations given grants to operate these facilities.  Government gives grants to organizations that provide specialised healthcare services: NKF and SATA (Singapore Anti Tuberculosis Assoc.)
    • Lesson Re-cap What is the challenge of governments in providing healthcare? What was Singapore’s healthcare system like in the 1960s and 70s? What are the principles healthcare provision here…since the 1980’s?
    • Welfare State & Healthcare Provision in UK Before the 20th Century, the British government did not provide much medical care for its citizens. The poor, aged or homeless had to depend on private charities, friends or family to help them pay for healthcare. After the war – Government felt it was necessary to look after these groups of people. The state would look after its citizens – for free
    • Welfare State & Healthcare in the UK In a Welfare state, the government looks after its citizens from ‘cradle-to-grave’. This means that the government would ensure that every citizen would have a minimum standard of welfare to live a ‘decent’ life:  Each citizen would have a job  Each citizen would have a home  Each citizen would have access to healthcare.
    • NHS in the initial years Initial success: It was popular with the people. The government provided free basic medical service for all citizens. Free medical treatments: This means that all medical services, dental and even optical treatments were FREE.
    • Buzz Break What are the advantages and disadvantages of living under a welfare system?
    • Initial years of NHS Government expected demand for healthcare to increase and then stabilize. However increases went beyond expectations.  Too many people wanted healthcare services  Doctors recommended medical treatment without consideration for costs. By 1951 NHS could not meet expectations.  “Free at the point of service” was not working  Now had to charge for some treatments
    • Britain and the NHS now Britain has to manage healthcare resources. Rising healthcare costs affects Britain too. The British approach is to ensure that healthcare spending is put to good use:  No wastage or unnecessary expenditures.  Resources cater for specific patient needs.
    • Managing healthcare in UK (1980s) Managing government spending:  The government is expected to provide healthcare to everyone.  Healthcare costs rise. This means government has to collect more taxes.  In the 1980s – new government in Britain wanted to reduce expenditure in healthcare.
    • Managing healthcare-Thatcher’s policies Prime Minister Thatcher’s approach:  Cut back on government spending on welfare benefits including healthcare.  Return some services to be provided by private companies (privatization).  Healthcare should also be the responsibility of the individual.
    • Challenges faced by UK Thatcher’s cut-back of the NHS and Welfare system created challenges for the UK government of that period: Challenge 1: Loss of people’s support:  Reduction in healthcare spending would mean that NHS could not continue to provide free health services.  Government could lose support from voters.
    • Challenges faced by UK Challenge 2: Cost increase & increasing tax contribution:  Healthcare costs are rising.  Britains National Insurance contributions (which partly paid for NHS services) also had to increase.  This was not always popular. Increases meant there would be less money for people to spend on other things.
    • Challenges faced by UK Challenge 3: Increasing efficiency  Demand for healthcare grew with an ageing population.  Numbers of people paying taxes to support the NHS was declining.  There was still not enough resources to support the demand.
    • Challenges faced by UK Challenge 4: Privatization.  The aim was to reduce government subsidies.  To save costs and make NHS more efficient.  Private companies would now provide some services to the public.  E.g. All non-medical services would be supplied by private companies under a contract  Cleaning services and catering.
    • Challenges Challenge 5: Providing Quality Services  By the late 1980s demand for services was high.  NHS system could not cope with this demand  There were poor standards in the NHS.  Providing patients with quality information on their treatment.  But long queues for services still common.
    • Response of Challenges NHS Plan (2000)  Based on feedback from patients, staff and doctors  Increase government spending up to 2004  To offer patients more convenient services  Could make use of facilities in private hospitals without the patients paying for it.
    • UK Response to Challenges NHS Plan (2004)  Patients had a choice of 4 different healthcare providers. Treatment paid for by NHS.  Every patient have access to their own records on the Internet (HealthSpace).  Patient’s with minor illness can get advice from doctors over the phone (NHS Direct).
    • Let’s Compare No one system is better than the other. The UK system works in there because:  people’s expectations are different  Standard of living is high etc. Singapore system of healthcare works here because of our different cultural and social characteristics
    • Comparison 1: How citizens participate in the system UK S’pore Citizens make use of benefits –  Promote self-reliance among Govt. manages costs by citizens – Govt. plans for citizens carefully controlling to share the costs of their own government spending. healthcare Citizens pay two types of taxes:  MediSave and Medishield from Income tax & National citizen’s CPF contributions. Insurance tax
    • Comparison 2: Keeping Healthcare affordableUK S’pore Privatization to reduce:  Government subsidies  given to nursing homes, polyclinics  Operating costs  Govt. subsidies  Medifund  Given to hospitals to use to off-set  Increase efficiency patient’s bill (needy cases) Every individual encouraged to  Restructured hospital be responsible for welfare and  Govt. is able to give less subsidies. health (except for expectant mothers, mothers with young  Means Testing  ensure that Govt. subsidies given to children and students below 19) patients who need.
    • Comparison 3: Lifestyle choices and role of community UK S’pore Citizens encouraged…but no  Government provides support by government programme or championing healthy lifestyle policy to promote healthy choices through Health Promotion lifestyles. Board (a govt. agency) Community provides nursing  Government gives grants (sums of support, social services etc…but money for specific purposes) to these are self-funded. VWOs to operate: day rehabilitation centres, nursing homes and community hospitals Government (through NHS) for discharged patients still seen as the main provider of healthcare services and aftercare
    • Lesson recap What were the 2 reasons that Beveridge report cited as the reason for the Welfare State? List 2 features of the healthcare provision in the welfare state. What were some of the challenges that British governments faced in managing the NHS?