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?