Bmc social studies_chapter3_healthcare(spore&uk systems)
Healthcare Provision(Singapore and UK) Should the State provide…?
Lesson Agenda After the lesson, students would be able to: Appreciate the various stages of healthcare provision in Singapore. Understand the various schemes to support healthcare in Singapore. Practice an approach to Comparison questions (SBQ).
Healthcare Provision in Singapore 1960’s Healthcare measures linked to public housing because Singapore was overcrowded. Healthcare programmes focussed on public hygiene Eg. govt. cleared squatters and slums – citizens relocated to HDB flats. Clinics and hospitals were built to meet growing pop. Effects of overcrowding reduced - public health improved and spread of major diseases minimized.
Healthcare Provision in Singapore 1970’s Economy improved & standard of living went up – citizens now wanted better quality healthcare. (F) Polyclinics built conveniently within HDB estates to replace “out-patient dispensaries” (E1 + E2) Better facilities in government hospitals – sophisticated equipment and treatment. Healthcare costs rising. (L)
Healthcare Provision in Singapore 1980s to the present Government observed - population is ageing. healthcare costs will rise. Government resources would be taken away to pay for healthcare. 1980s, Govt. developed a new approach to healthcare:
National Health Plan Healthcare = Shared responsibility. The Individual + the Government + the Community = Healthcare provision in Singapore
Healthcare Provision in Singapore The Individual Self-reliance: 1984 Introduced MediSave Account. 8% of monthly contribution to CPF channelled to MediSave. Singaporeans to take charge of their own healthcare. MediSave further enhanced - includes 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: This is a national healthcare insurance scheme. Just like insurance – Singaporeans pay for MediShield from monthly contributions from MediSave. Allows greater financial cover for rising healthcare costs.
Healthcare Provision in Singapore The Individual (Self-reliance) - Eldershield This is another insurance scheme. Targeted for those above 40. It uses CPF MediSave accounts to pay premiums. Caters for those who have not built up enough savings in their MediSave accounts. Provides assistance for those who cannot pay for high Medishield premiums.
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 to better meet needs to Singaporeans Government has flexibility to reduce the amount of subsidies when necessary Keeping healthcare affordable (Means testing) Govt must ensure fairness in subsidies. Lowest income receive most. Higher income receive less. Important because - Subsidies must benefit patients who are in most need of them.
Healthcare Provision in Singapore The Government (Promoting Healthy Lifestyle) A healthy person does not need a lot of medical care Government encourages citizens to keep healthy. This means a well-balanced diet & habit of physical exercise. This will reduce the reliance on healthcare provision in the later years. This keeps healthcare affordable.
Provision of Healthcare in Singapore The Community- healthcare support Some patients require help to fully recover after discharge. Voluntary & private organizations given grants to operate these facilities. Grants given to provide specialised healthcare services: NKF and SATA (Singapore Anti Tuberculosis Assoc.) Eases the burden of healthcare costs to the Govt as many agencies are providing these services.
Making Comparisons What is a comparison? It is a way of evaluating two (or three) items or subjects using a category or classification. For example: You can compare two bags according to their colour (one classification) or according to their prices (second classification). You are not describing the differences or similarities! You are stating what makes them different or similar
Making Comparisons Note: The two bags are different in colour. (Inference). Bag A has a bright red colour while Bag B has a dull blue colour. (Support)
Let’s practice! Alfred always kept to himself and never spoke to anyone. Melissa spoke only when spoken to Inference? Alfred & Melissa are similar in the way they deal with others Support: I know this because, Source A tells me that “Alfred kept to himself…” Similarly, Source B tells me that Melissa “…only spoke when spoken to…”
Let’s Practice Can you come up with your own examples? Come up with two sources and figure out how you are going to compare them Present to the class…
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? Advantages Disadvantages
Initial years of NHS Govt. expected demand to increase & then stabilize. However increases went beyond expectations. Too many people wanted healthcare services Treatments prescribed 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 Ageing pop & rising health 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 Challenge 1: Loss of people’s support : Reduction in healthcare spending = NHS could not continue to provide free health services. Citizens used to receiving free healthcare – now very unhappy. Government concerned about losing the support from citizens. Healthcare policy needed to be carefully balanced to meet citizens’ expectations & managing costs
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. Despite cuts to healthcare spending - 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. Lead to declining standards in the NHS. Govt responded by providing patients with info on their treatment - they can monitor rising costs themselves. But long queues 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.
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
The Comparison Question 3 Steps to answering the question: Step 1: Identify the type of comparison required Step 2: locate similarities and/or differences Step 3: Write out the answer – do not describe differences or similarities.
Comparison Questions Type 1 (Similarities or Differences ONLY): Provide, support & explain similarities only; or Provide, support & explain differences only Possible question words: What are the similarities between these 2 sources? In what ways are Sources A and B similar? How do the 2 sources differ? What are the differences between the 2 sources?
Comparison Question Type 2 (Similarity & Differences): Provide, Support & Explain 2 Similarities + 1 Diff. Provide, Support & Explain 2 Differences + 1 Sim Possible question words: How similar are these 2 sources? How different are Sources A and B? To what extent are the 2 sources similar? How far are these 2 sources different? How far does Source A support/differ from Source B?
Comparison Question Step 2: “locate” similarities and/or differences. Read the sources – search for: What the sources have in common What makes the sources different look for POV (point-of-view), tone (Negative tone, positive tone etc.) Don’t describe the differences! Common mistake: A is red in colour and B is blue in colour, therefore they are different. Try: The difference bet. A and B is colour.
Comparison Question – Type 1 Template and guiding wordsCommon factor Support ExplainBoth sources differ or are This is shown in Source A, Source A (Make explanationsimilar in (state criteria for “…” However as seen in linking inference of Source Acomparison) Source B, “…” to the issue of the question) …However, Source BInfer highlights/comments that (Make explanation linkingSource A shows that (state inference of Source B to theinference) …whereas issue of question)Source B comments (stateinference) Repeat Infer, Support and Explain (ISE) for every similarity/difference inference that has been identified.
Comparison Questions Conclusion for comparison questions: Link similarities/differences back to the question issue and; Highlight the connection difference or similarity) with the issue.
Lesson recap Are there any differences between the Singapore healthcare system and that of the UK? What are the features of Singapore’s National Healthcare Plan? What were some of the challenges that British governments faced in managing the NHS?