1. Healthcare Provision
(Singapore and UK)
Should the State provide…?

2. Lesson Recap
 What are the key features of MediShield
scheme?
 Which group of people does MediFund serve?

3. 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.

4. 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.

5. 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.)

6. 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.

7. 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.

8. 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

9. 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)

10. 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.

11. 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.

12. 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??

13. 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.

14. 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.)

15. 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?

16. 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

17. 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.

18. 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.

19. Buzz Break
 What are the advantages and disadvantages of
living under a welfare system?

20. 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

21. 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.

22. 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.

23. 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.

24. 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.

25. Challenges faced by UK
 Challenge 2: Cost increase & increasing tax
contribution:
 Healthcare costs are rising.
 Britain's 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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).

31. 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

32. 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

33. Comparison 2:
Keeping Healthcare affordable
UK 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.

34. 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

35. 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?