Chapter 3 Managing Healthcare In S Ingapore


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Chapter 3 Managing Healthcare In S Ingapore

  1. 1. CHAPTER 3 MANAGING HEALTHCARE: Case Studies of Singapore & Britain
  2. 2. Chapter at a Glance: <ul><li>To what extent is healthcare the responsibility of the government? </li></ul><ul><li>What makes a healthcare system effective? </li></ul>
  3. 3. Trigger Activity: <ul><li>Your Classmate John has been missing from school for a week. </li></ul><ul><li>Then you heard the news that John has been hospitalised: </li></ul>
  4. 4. Trigger Activity: <ul><li>You have heard that medical treatment is very expensive. </li></ul><ul><li>You are worried if John could afford the bill. </li></ul>
  5. 5. Trigger Activity: <ul><li>How will you help John ? </li></ul><ul><li>How affordable do you think healthcare is? </li></ul><ul><li>Do you think healthcare is a basic need? </li></ul>
  6. 6. Managing Healthcare <ul><li>The need to provide basic health care for the sick who can’t afford. </li></ul><ul><li>How to provide healthcare given the limited resources and competing needs of the country </li></ul>What challenges do governments face in managing health care?
  7. 7. Less developed country More Developed Country Comparison of Healthcare between two countries:
  8. 8. Comparison between two countries: Less developed country More Developed Country Mauritania in West Africa <ul><li>Only one large hospital in the capital city. </li></ul><ul><li>Infectious diseases are common in the rural areas. </li></ul><ul><li>There are insufficient doctors, nurses, clinics and medicine. </li></ul>Sweden in Europe <ul><li>Main concern -To continue to provide good quality healthcare for the citizens. </li></ul><ul><li>Healthcare services are provided by the government. </li></ul><ul><li>The money for healthcare comes from taxes. </li></ul>
  9. 9. How is healthcare paid for? Healthcare provider, .e.g. hospital and clinic Individual <ul><li>Self </li></ul><ul><li>Patients pay the doctor directly after each visit </li></ul>Individual <ul><li>Personal Insurance </li></ul><ul><li>Make claims from the insurance company </li></ul>Employer <ul><li>Employer-paid insurance </li></ul><ul><li>Employers pay a certain amount for insurance for their workers </li></ul>Employer <ul><li>Govt. collect Taxes and uses a % to pay for medical services used. </li></ul>
  10. 10. Healthcare in Singapore <ul><li>How was healthcare managed in the 1960s & 1970s? </li></ul><ul><li>Part of overall plans for improvement & development after independence. </li></ul><ul><li>Healthcare measures were part of public housing programme . </li></ul>
  11. 11. The situation in the 1970s… <ul><li>The economy had improved </li></ul><ul><li>People enjoyed a better standard of living. </li></ul><ul><li>Thus, they wanted better healthcare. </li></ul>
  12. 12. The solution: <ul><li>Old outpatient dispensaries were replaced with polyclinics. </li></ul><ul><li>They provided a wide range of healthcare & conveniently located in town centres. </li></ul><ul><li>Facilities in government hospitals and the quality of healthcare were improved. </li></ul><ul><li>Money came from government budget. </li></ul>
  13. 13. Healthcare services in the 1970s
  14. 14. How has the approach to manage healthcare changed since the 1980s? <ul><li>Concerns- rising cost of providing healthcare. </li></ul><ul><li>National Health Plan- aim to encourage public debate on the suggestions made on how to manage the long-term healthcare needs of the people. </li></ul>
  15. 15. What are the messages behind the following three slides ?
  16. 16. An Extract of Speech made by then Health Minister Mr.Goh Chok Tong in 1981 <ul><li>Resources are finite in terms of funds, doctors and nurses. Providing welfare in healthcare will affect people’s incentive to work. It is necessary to pay for the services you want. </li></ul>
  17. 18. <ul><li>Initiated in 1983 and implemented since 1984 </li></ul><ul><li>To build a healthy and physically fit population. </li></ul><ul><li>To encourage Singaporeans to stay well and reward those who do. </li></ul><ul><li>To build up individual financial resources so that those who fall sick will be able to pay. </li></ul>Singapore's National Health Plan
  18. 19. Approach to healthcare in Singapore <ul><li>Health care policies not to strain government spending </li></ul><ul><li>Encourage self responsibility and community support </li></ul><ul><li>Govt. to maintain affordable healthcare policies </li></ul>
  19. 20. Approach to healthcare in Singapore <ul><li>Individual </li></ul><ul><li>Encourage self reliance </li></ul><ul><li>Maintains good health </li></ul>Government <ul><li>Keeps healthcare affordable </li></ul><ul><li>Promotes healthy lifestyle </li></ul>Community <ul><li>Provides some healthcare services. </li></ul>
  20. 21. Medisave Medishield Medifund PRIMARY CARE ACUTE CARE CATASTROPHIC (LONG TERM CARE) Financing Method Private Payment Compulsory Savings Social/Private Insurance PUBLIC SUBSIDIES Taxes PUBLIC HEALTH SERVICES (Eldershield) (Elderfund)
  21. 22. Encouraging Self-Reliance <ul><li>1. Medisave </li></ul>2. Medishield
  22. 23. Encouraging Self-Reliance <ul><li>1. Medisave </li></ul><ul><li>Introduced in 1984. </li></ul><ul><li>Comes from the Worker’s CPF (6-8%) </li></ul><ul><li>To pay for hospital bills and certain medical treatment. </li></ul><ul><li>Impact: </li></ul><ul><li>Singaporeans are better able to afford health care. </li></ul><ul><li>They share the cost with the government. </li></ul><ul><li>A shared responsibility- lighten the government’s burden. </li></ul>
  23. 24. What you have learnt in Chapter 2 : <ul><li>A “Bill” will be debated in parliament before a law is passed </li></ul><ul><li>People were encouraged to give feedback </li></ul>
  24. 25. The importance of feedback: <ul><li>With more feedback from people, Medisave has been extended to pay for more types of medical treatment </li></ul>Source: The Straits Times, 30 th January 2008.
  25. 26. Encouraging Self-Reliance 2. Medishield <ul><li>To help people who cannot afford long-term treatment. </li></ul><ul><li>National Healthcare insurance. </li></ul><ul><li>Pay with medisave. </li></ul><ul><li>Make claims to pay for treatment not covered by Medisave. </li></ul><ul><li>Impact: </li></ul><ul><li>People can meet their specific needs. </li></ul><ul><li>Can pay for long-term treatment of serious illnesses. </li></ul>
  26. 28. Keeping Healthcare Affordable The government’s concerns: Sharing responsibility, Limited resources, Providing safety nets. Government Subsidies <ul><li>Given to Nursing homes, government hospitals and polyclinics. </li></ul><ul><li>¼ of government spending on healthcare. </li></ul><ul><li>Different rates of subsidies to the different class wards . </li></ul>Medifund <ul><li>Given to needy Singaporeans. </li></ul><ul><li>Low-income workers & self-employed people. </li></ul><ul><li>Apply at the hospital </li></ul>Restructuring of hospitals <ul><li>More freedom for hospitals to re-organise to meet the needs of Singaporeans </li></ul><ul><li>To cut down subsidies </li></ul>
  27. 29. Public Hospital Subsidies
  28. 30. Promoting a Healthy Lifestyle <ul><li>A way of coping with the rising cost of health care. </li></ul><ul><li>A good health no need medical treatment savings on medical expenses. </li></ul>
  29. 31. Promoting a Healthy Lifestyle <ul><li>Anti-smoking campaigns </li></ul><ul><li>Community health screening </li></ul><ul><li>Schools- Towards a healthy school tuckshop </li></ul><ul><li>Activities organised by the Health Promotion Board </li></ul><ul><li>Encourage healthy eating ( low in fat and calories) </li></ul>
  30. 32. Working with organisations Community hospitals
  31. 33. Did You Know ? <ul><li>Who founded The Nursing Home Foundation? </li></ul><ul><li>What services does it provide? </li></ul>
  32. 34. <ul><li>Read the two articles on Figures 3.26 and 3.27. </li></ul><ul><li>What is your opinion if you were Mr. Tay Chew Guan in Figure 3.27? </li></ul>Have Singapore’s healthcare policies met the needs of the people?
  33. 35. Have Singapore’s healthcare policies met the needs of the people? <ul><li>Medisave helps to pay for hospital bills. </li></ul><ul><li>Medishield helps those who do not have enough in their medisave. </li></ul><ul><li>The elderly and the unemployed who do not have the opportunity to save for healthcare can depend on the government or community </li></ul>
  34. 36. Have Singapore’s healthcare policies met the needs of the people? For those who say Singapore is ‘stingy’ in spending on healthcare, I say, you must look at the better outcome; whether its sickness rate, life expectancy, or infant mortality rate, you will discover that Singapore has done quite well.
  35. 37. <ul><li>The health of Singaporeans has improved over the years </li></ul><ul><li>High quality health care </li></ul><ul><li>High life expectancy </li></ul><ul><li>Low Infant mortality </li></ul><ul><li>Healthcare spending is less than 3% of GDP </li></ul>Healthcare would always be borne by Singaporeans (medishield, taxes…)
  36. 38. A view from Russia with Love: <ul><li>LOCAL HEALTHCARE PROVIDERS WOO MORE MEDICAL TOURISTS </li></ul><ul><li>From Russia with love of S'pore's medical facilities Cancer man picks S'pore over the US, China, Korea By Ng Wan Ching January 30, 2008 </li></ul>“ In my country, patients lose hope….There is lack of proper equipment…..(Here) the doctors are always smiling, the equipment is up-to-date. I feel better about my chances here.- Mr.Laptev