Managing Healthcare In Singapore


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Managing Healthcare In Singapore

  1. 1. MANAGING HEALTHCARE Case-Study of Singapore
  2. 2. Understanding Goals Students will be able to understand and appreciate: The changes in healthcare policies over the 2) years The role and responsibilities of the government 3) in responding to the changing needs in healthcare The effectiveness of the healthcare system in 4) Singapore
  3. 3. Different healthcare challenges faced globally Developing countries versus the Developed Countries Less resources and more resources Better health care and not so good healthcare Sweden and Africa.(Two extreme examples)
  4. 4. Managing healthcare : What challenges do governments face? Equality to all  Countries must provide healthcare even if citizens unable to pay Healthcare a public good-to be accessible to all citizens  Balancing other needs Limited resources-balance with other needs of the country.
  5. 5. Managing healthcare : What challenges do governments face? Providing Quality Healthcare People live longer due to improved lifestyle Expectation of better healthcare services Success of the govt hinges on healthcare successes Increasing expenditure on healthcare Better treatment due to latest inventions More healthcare personnel More expensive
  6. 6. How is healthcare paid for? Individuals Pay the doctor when they visit Personal insurance-For surgery and more expensive treatments Employer Pay a certain sum Government taxes - to subsidise expensive treatments
  7. 7. Providing Basic Health Care in the 1960s Improving Health Care Services in the 1970s Issues in Health Care Services in the 1980s
  8. 8. Challenges faced: • self-government in 1959 • rapid urbanisation led to pollution • indiscriminate littering • improper disposal of rubbish • health care important for nation building How were challenges handled? • government responsibility of providing health care • more hospitals and clinics built • island-wide innoculation programme • routine check-up at schools • public education on effects of littering through campaigns like ‘Keep Singapore Clean’
  9. 9. Challenges faced: • wealthier and better-educated people • demand for better-quality medical services • need for specialisation of medical services How were challenges handled? • polyclinics introduced - one-stop health centres with variety of services - located in town centers • government services improved - better facilities provided - better services provided
  10. 10. • 1980s –Rising healthcare costs • Resources were finite • National Health Plan introduced in 1983 -Manage the healthcare needs in the long-term • SHARED RESPONSIBILITY: Three major components 5) Individual 2) Government 3) Community
  11. 11. Challenges faced: • could not provide very generous subsidies • need for Singaporeans to be responsible and not over-rely on state welfare How were challenges handled? • Encourage individuals in maintaining good health • Encourage individuals in self-reliance through medical savings plans
  12. 12. 1) Encouraging the individual in Maintaining Good Health Good health ensures less spending on medical  treatments Health Promotion Board organises activities to  promote healthy lifestyle through physical exercises and healthy diets Schools and workplaces have programmes to  emphasise the need to maintain good health
  13. 13. 2) Encouraging self-reliance Encourage individuals in self-reliance  through medical savings plans individuals pay part of medical expenses  through personal savings such as Medisave from one’s CPF account government keeps basic health care  affordable by subsidies e.g. different subsidies for different ward classes in government hospitals
  14. 14. Individual Self-Reliance : the CPF The Central Provident Fund (CPF) is a comprehensive  social security savings plan that has provided many working Singaporeans with a sense of security and confidence in their old age. The overall scope and benefits of the CPF encompass the  following: Retirement Healthcare Home Ownership Family Protection Asset Enhancement
  15. 15. CPF Contributions Working Singaporeans and their employers make monthly contributions to the CPF and these contributions go into three accounts: 1. Ordinary Account (18-22%) - the savings can be used to buy a home, pay for CPF insurance, investment and education. 2. Special Account (5-7%) - for old age, contingency purposes and investment in retirement-related financial products. 3. Medisave Account (6-8%) - the savings can be used for hospitalisation expenses and approved medical insurance.
  16. 16. Medical Care for the Masses Medisave Scheme Medishield Scheme - compulsory - voluntary - retirement plan - medical plan - 6 – 8% salary - small sum through Medisave
  17. 17. Medisave • Medisave introduced in 1984 • Medisave Account help to build up savings for one’s healthcare needs • Medisave can be used to pay for individuals’ or their dependant(s)' hospitalisation expenses. • It can also be used for certain outpatient treatments like chemotherapy and radiotherapy treatments. • Principle of Co-sharing by the people and the government • Shared responsibility means there is no need to raise taxes for healthcare
  18. 18. Is Medisave Enough? when faced with...catastrophic bills, depending “ However, solely on Medisave to meet future hospitalisation needs is not enough. To ensure that Singaporeans can afford catastrophic bills, members are strongly encouraged to 'risk- pool' by taking up MediShield.” “For Singaporeans who would like to stay in higher class wards upon hospitalisation, they should purchase private medical insurance plans to complement Medisave. This would help finance high hospitalisation bills and stretch the use of Medisave monies.” - CPF Board
  19. 19. MediShield Medisave savings can be used to pay the  premiums for MediShield or private medical insurance plans under the Private Medical Insurance Scheme (PMIS). These are catastrophic medical insurance  schemes for the individuals and their dependants. They help to defray the high medical costs of prolonged or serious illnesses.
  20. 20. ElderShield For older CPF members, there is  ElderShield, an affordable severe disability insurance scheme that provides insurance coverage to those who require long-term care. All Singaporeans and Permanent Residents  (PRs) who are CPF members are automatically covered under ElderShield when they turn 40 years old, unless they opt out of the scheme.
  21. 21. “Looks like everything’s been taken care of!” What are the assumptions made in this comic cartoon?
  22. 22. What happens if… You are unemployed and has insufficient  CPF savings? You are an ad-hoc part-time worker with  no stable income and CPF? How can one rely on himself/herself if this happens?
  23. 23. Role of the government Keep Healthcare Affordable  Ensuring access to healthcare for ALL  Promote healthy lifestyle  Prevention of chronic and contagious  diseases
  24. 24. Keeping healthcare affordable 1) Shared responsibility-Individuals and government 2) Government subsidies-Hospitals, polyclinic and nursing homes e.g. C Class wards-higher subsidy 3) Medifund-$1.6 billion fund (2008) for needy patients 4) Restructuring of hospitals – hospitals given the autonomy to reorganise operations in meeting the needs of Singaporeans which reduces the amount of subsidies to hospitals 5) Means-testing- Fair distribution of resources – Lower income group receive higher subsidies
  25. 25. Medifund Medifund is an endowment fund set up by the  Government to help needy Singaporeans who are unable to pay for their medical expenses. Medifund acts as a safety net for those who  cannot afford the subsidised bill charges, despite Medisave and MediShield coverage. Set up in April 1993 with an initial capital of S$200  million, the Government will inject capital into the fund when budget surpluses are available. The Government utilises the interest income from  the capital sum, which stands at S$1.66 billion (FY 2008), to help needy patients who have exhausted all other means to pay their medical bills.
  26. 26. Medical Care for Senior Citizens Challenges faced: Senior citizens need more health care services than others. How can they cope amidst increasing health costs? •Health education-Active healthy lifestyle •Sensible diet • Campaigns e.g. National Healthy Lifestyle Campaign- importance of being healthy •Regular medical check ups •Ensure enough savings for medical expenses •Eldershield
  27. 27. Role of the Community Challenges faced: How can the community play a role in providing healthcare services to the people? •Voluntary welfare organisations and private organisations-Collaborate with the government •Run community hospitals, nursing homes through government grants • e.g.Ang Mo Kio Community Hospital, Ren Ci Hospital, NKF etc •Volunteers can offer their services
  28. 28. Indicators of Singapore’s Healthcare success… “ The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970... Yet, indicators such as infant mortality rates or years of average healthy life expectancy are slightly more favorable in Singapore than in the United States... …international experts rank Singapore's healthcare system among the most successful in the world in terms of cost- effectiveness and community health results.” – Singapore’s Success, Henri Ghesquire.
  29. 29. Factors leading to success in managing Healthcare in Singapore 3Ms  1) Medisave: Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contribution 2) MediShield: The government provides optional low-cost catastrophic health insurance 3) Medifund: a safety net quot;subject to stringent means-testing.quot; Competition between private and public healthcare  - The private healthcare system competes with the public healthcare, which helps contain prices in both directions. - Private medicalinsurance is also available. - Private healthcare providers are required to publish price lists to encourage comparison shopping.
  30. 30. Heavy subsidies from the government  The government pays for basic healthcare services subject to tight expenditure control. Bottom line: The government pays 80% of basic public healthcare services. Prevention policies  Government plays a big role with contagious disease, and adds some paternalism on top: Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority. Active role of voluntary organizations and non-government  organizations in the provision of healthcare services and support
  31. 31. IN A NUTSHELL… The public system guarantees health care to all.  A combination of quot;community support and individual  responsibility.quot; Individuals and their employers contribute almost two-  thirds of funding, much higher than in other developed countries. Health Savings Accounts (Medisave) are mandatory.  Emphasis on general well-being and prevention.  Chronic disease management programs are in place and  follow evidence-based medicine guidelines.
  32. 32. Have Singapore’s Healthcare policies met the needs of the people? YES  Ensures that most Singaporeans are taken care of in the event of any illness  Medisave, Medishield etc ensure that monetary concerns are minimal  As payment is shared by the individual and government there is not much wastage  Lower income groups are heavily subsidized particularly if they take the C ward  Healthcare in Singapore is more efficient and of better quality than most countries  Life expectancy and infant mortality rates are quite commendable.
  33. 33. Have Singapore’s Healthcare policies met the needs of the people? NO  Despite the various schemes, people who do not have enough savings are not able to pay  Need to depend on community and government  People who are unable to work may not be able to pay for their health expenses.  However these people are very few and there are adequate safeguards to ensure that every Singaporean is taken care of.