1. Why Ireland Needs to Study the Singapore Health System A Case Study in Health Care Expenditure:

8. 2. General Comparison Ireland Singapore Gained independence 1922 1965 Population 4,422,100 4,657,000 Size 70280 km 2 710 km 2 Population density 60/km 2 6,814/km 2 GDP $191.9 Billion $241.1 Billion GDP per capita $46,200 $51,600 Human development index 0.962 0.918

9. Economic Indicators Ireland (2008) Singapore (2008) GDP growth -2.3% +1.2% Unemployment 8.1% +2.3% Inflation +4.1% +4.3% Trade Current account/GDP -4.5% +11.2% Exports $128 Billion $235.8 Billion Imports $91.3 Billion $219.5 Billion Public Finances Debt/GDP 31.5% 10.5% Revenue $62.0 Billion $28.6 Billion Expenditure $73.1 Billion $27.5 Billion

10. Labour Force and Population Ireland Singapore Labour force 2,200,000 2,960,000 Agriculture 6% 0% Industry 27% 23% Services 67% 77% Median age 35 39 0-14 years 20.9% 14.4% 15-64 years 67.1% 76.7% 65+ years 12.0% 8.9% Fertility rate 1.85 1.09 Birth rate (per 1,000) 14.3 9.0 Death rate (per 1,000) 7.8 4.5

11. Health Personnel Ireland (2006) Singapore (2003) Nursing and midwifery personnel 81,901 19,090 Nursing and midwifery personnel per 1,000 19.50 4.50 Number of physicians 12,394 6,380 Physicians density per 1,000 2.90 1.50 Number of dentistry personnel 2,414 1,190 Dentistry personnel density per 1,000 0.6 0.3 Number of pharmacy personnel 3,565 1,280 Pharmacy personnel density per 1,000 0.9 0.3

12. Health Indicators Ireland Singapore Life expectancy 78.2 82.0 Male 75.6 79.4 Female 81.1 84.9 Infant mortality/1000 live births 5.14 2.31 Mortality between 15 and 65 per 1,000 m/f 88/56 83/50 Health care expenditure per capita $3,125 $1,140 HCE as % of GDP 8.2 % 3.5% HCE as % of government expenditure 27.0% 7.0%

13. Comparative Health Expenditure in Singapore and Other Systems U.S. Germany Canada Australia U.K. Singapore Year

14. Health Systems Performance WHO Rankings, 2000 Ranking Country HCE/GDP (2005) HCE/Capita (2005) Public:Private 1 France 11.2% 10 th $4,056 8 th 80:20 2 Italy 8.9% 27 th $2,845 20 th 77:23 3 San Marino 7.3% 62 nd $3,591 15 th 84:16 4 Andorra 6.3% 84 th $2,815 21 st 70:30 5 Malta 8.4% 36 th $1,295 32 nd 78:22 6 Singapore 3.5% 173 rd $944 35 th 34:66 7 Spain 8.2% 40 th $2,263 26 th 72:82 8 Oman 2.5%% 184 th $325 73 rd 84:16 9 Austria 10.2% 15 th $3,864 12 th 77:23 10 Japan 8.2% 39 th $2,690 24 th 82:18

15. Ranking Country HCE/GDP (2005) HCE/Capita (2005) Public:Private 11 Norway 9.1% 26 th $6,267 4 th 84:16 12 Portugal 10.2% 16 th $1,830 27 th 72:28 13 Monaco 4.6% 141 st $6,343 3 rd 74:26 14 Greece 10.1% 17 th $2,733 23 rd 42:58 15 Iceland 9.4% 23 rd $4,962 6 th 83:17 16 Luxembourg 7.7% 54 th $6,610 2 nd 91:9 17 Netherlands 9.2% 24 th $3,784 13 th 62:38 18 United Kingdom 8.2% 41 st $3,065 17 th 88:12 19 Ireland 8.2% 38 th $3,888 10 th 78:22 20 Switzerland 11.4% 9 th $5,878 5 th 60:40 37 United States 15.2% 2 nd $6,714 1 st 46:54

16. Public/Government Sector Not-for-Profit/Voluntary Sector Private/Commercial Sector 3. The Singapore Health System Primary Care Health Centres/ Polyclinics Secondary Care General Hospitals/ Outpatient Clinics Tertiary Care Specialist Hospitals/ National Centres Public Health Services Legislation, Regulation and Enforcement/ Health Promotion/ Preventative Services Private Hospitals/Groups Private Practitioners Ministry of Health Department of Health

18. Instill personal and family responsibility (Cost-sharing) + Ensure future sustainability with ageing and avoid inter-generational problems (Savings) + Achieve risk-pooling and social protection (Insurance) + Target subsidies and equitable distribution (Taxation) Healthcare Financing Strategies

21. Individuals Health Care Providers Health Care Services Government Medisave Insurer Medifund Medishield Tax Direct payment and co-payment Contribution through CPF Premium Injection Payment Public expenditure Payment Payment Claims Payment Premium

22. Sources of Healthcare Financing in Singapore Medisave 8% Medishield 2% Private Insurance 5% Out of pocket 25% Government subsidies 25% Employer Benefits 35%

23. 4. The Central Provident Fund Employers Employees Medisave Accounts Central Provident Fund Ordinary Accounts Special Accounts Medical Expenses, Health Insurance Premiums Retirement Savings Housing, Insurance, Third-Level Education, Approved Investments

28. Medisave Balances

29. Medisave Balances

35. Medifund Payouts

37. Public Hospital Subsidies

38. Wards

42. Strongly Agree Agree Neutral Disagree Strongly Disagree I should be personally responsible for my own health. 15.7 78.4 3.7 2.2 - It is my personal responsibility to build my own savings to help pay for my healthcare expenses. 4.2 68.6 15.1 11.1 1.0 It is my personal responsibility to buy medical insurance to help me pay for high medical bills. 3.6 54.3 26.2 15.2 0.7 The government should fix the price of medicines in Singapore. 14.4 52.1 21.2 11.4 0.9 Medisave should be used mainly for the person whose account it is 1.4 24.6 9.4 51.1 13.5 Medisave should be used at the discretion of the account holder 15.8 66.0 8.7 9.2 0.3 I am familiar with the way the healthcare system in Singapore works. 1.6 43.6 31.8 22.1 0.9 Healthcare in Singapore is generally affordable. 1.3 43.8 25.6 26.6 2.7 Singapore has a good healthcare system. 4.8 72.1 15.4 7.5 0.2