Chapt 3: Managing Healthcare

Case Study of Singapore

Learning Points

Identify the challenges governments face in managing healthcare

Identify some ways that healthcare is paid for in a country

Challenges that Governments Face…

1.Healthcare is considered as a public good - The citizens expect the government to

provide basic healthcare for them- Limited resources

2.The need to provide quality healthcare- Longer lifespan of people- People in more developed countries expect

more & better healthcare services

Challenges that Governments Face…

3. Increasing expenditure on healthcare

- People demand for the better treatments, more effective medicines and better-qualified medical staff

How is healthcare paid for?

Self

Employer-paid

insurance

Personal Insurance

Government taxes

Healthcare

Healthcare in Singapore

Learning Points

1. Identify how the government managed healthcare expenses before the 1980s

2. Identify how the government manages healthcare expenses after the 1980s

Life in Singapore1960s and 1970s

What are the effects of poor housing conditions on people’s health?

Singapore Healthcare In the 1950s and 1960s

Polyclinics were known as health centers. They are mostly located in rural areas. Medical staff brought help to the people

living away from town areas in mobile health centers (vans).

To improve healthcare, government trained a huge no. of nurses and doctors in hospitals.

The government also educate people on how to prevent illness through health programs.

To keep people healthy, students were introduced to physical education.

Video – Singapore Healthcare After the 1960s

Improved healthcare services like having more clinics and medical staff.

Health programs like being healthy at work and going for medical checkups are implemented.

How does the Government managed Healthcare Expenses?

Healthcare expenses comes from the government budget

Government budget isspent on needs of the people E.g. healthcare, education,transportation, housing …

What is govt budget?

The amount of money that the govt plans to spend on meeting the needs of the people

Others – 96%

Healthcare – 4%

Singapore’s Healthcare Expenditure

(2008)

Problems in the early 1980s:rising cost of healthcare → strain on govt spending

due to limited resources

Solution:1. Individuals must have self-reliance & to

maintain good health2. Government will keep healthcare affordable

and will promote healthy living3. Community will provide some healthcare

services and other support services

How does the Government managed Healthcare Expenses after the 1980s

Do you know the cost of healthcare in Singapore?

Charges of Hospital Wards

Class of Ward / Charges per day (SGD)

A (1&2) B (1&1+) B2 C

Restructured Hospitals

AH / CGH / KK / NUH / SGH / TTSH

196 – 295 113 - 177 50 - 57 25 – 29

Private HospitalsESH / GH / MAH /

MEH / TMC 200 – 460 135 – 200 110

Breakdown of Hospital Bill Amount Payable (S$)

Room & Board (5 days)

750

Hospital Miscellaneous Expenses• Prescription drugs • Diagnostic Procedures • Operating Theatre Fees

2,950

Anaesthetist Charge 500

Surgeon’s fee 1,700

ICU (2 days) 2,250

Post-Hospitalisation Treatment 800

Total 8,950

• Assume a person is hospitalized due to inflammation of the appendix and underwent an appendicitis operation.

• Staying a total of 7 days in a private hospital with 2 days in ICU, his total hospital bill came up to S$8,950.

• Assume a person is hospitalized due to Heart Disease and underwent a Coronary Artery Bypass Graft surgery.

• Staying a total of 9 days in a private hospital, his total hospital bill came up to S$18,900.

Breakdown of Hospital Bill Amount Payable (S$)

Room & Board (7 days) 5,870

ICU Charges (2 days) 1,630

Surgical Procedure 9,000

Surgical Implants / Approved Medical Consumables

2,400

Total 18,900

Role of an Individual

To have self-reliance

How?1. Medisave (what is it?)2. Medishield (what is it?)

What is self-reliance?

Citizens to be responsible for themselves and take care of themselves

Central Provident Fund (CPF)

Medisave

Comes from the individual’s CPF Can be used to pay for hospital bills

and medical treatment

MediShield

National healthcare insurance scheme Individuals pay for this through Medisave

Why is it required? Isn’t Medisave sufficient?

- For people who needs long-term treatment who cannot afford their treatment fees or hospitalization fees and Medisave cannot cover the fees.

Advantages of Singaporeans being self-reliant

Singaporeans share the cost of healthcare with the government by paying for their own healthcare

Help lighten the government’s load-> Government does not need to increase taxes

Problem: Does every Singaporean have CPF?

So how are they going to pay for their healthcare costs?

Role of the Government

1. To keep healthcare affordable

How?1. Government subsidies (to who?)2. Medifund (what is it?)3. Restructuring of hospitals4. Means-testing

A total budget of $3,705 million has been allocated to MOH for FY2009 to promote good health and keep healthcare affordable

Government Subsidies Direct subsidies given to govt hospitals,

polyclinics and some nursing homes for elderly.

Lower income group receive the most subsidies.

Govt gives different rates of subsidies to the different classes of wards in hospitals. Class C receive the most in subsidies.

Medifund

A sum of money set aside by the govt Started in 1993 with a fund of $200 million

For people who cannot pay for their medical fees despite Medisave, Medishield and govt subsidies

E.g. low-income workers, self-employed people who do not make any CPF contributions

People who need help apply for the fund at the hospital where they are being treated

Restructuring of Hospitals

Hospital have the freedom to reorganise to meet the needs of the people

Hospital becomes financially independent from the govt where they have their own board of directors therefore govt able to reduce the amount of subsidies to hospitals

Govt belief: Subsidies should benefit patients who need them the most

Govt gives heavy subsidies to polyclinics and government hospitals especially to class B2 and C wards.

Means-testing implemented in Jan 2009 where lower-income group will receive a higher amount of subsidies than the higher-income group

Means testing takes into consideration the patient's monthly income and ownership of private property.

Means-testing

Checking the financial background of a person to see if they are able to afford healthcare

Role of the Government

2. Promote a healthy lifestyle

How?- By having health programmes in schools and workplaces

Good healthWill not need

medical treatment

Save medical expenses

Role of the Community Community needs to provide healthcare

support services as it is not possible for the govt to run all of them

1. Voluntary welfare organizations2. Private organizations

They are given grants to run community hospitals, nursing homes, day rehabilitation centres

Role of the Community

Voluntary welfare organizations

E.g. Ren Ci, St. Andrew’s Community Hospital

Private organizations

E.g. NKF (cater to the needs of specific groups of

people such as the poor or those with a particular illness)

How successful is the healthcare policies in Singapore?

Effective Ineffective

Provided Singaporeans with the money to pay for healthcare

There are still groups of people who are still not able to pay for their own medical expenses:1. Elderly2. People who are unable to

work

How are they going to pay for their own healthcare then?

1. Self-reliance• Medisave• MediShield

2. Maintains good health

1. Keeps healthcare affordable• Govt subsidies• Medifund• Restructuring of hospitals• Means-testing

2. Promoting a healthy lifestyle

Voluntary welfare and private organisations providehealthcareand support services

Singapore:Shared Responsibility in Healthcare

Individual Government Community

http://worldfocus.org/blog/2009/01/27/the-fundamentals-of-singapores-health-care-system/3795/

http://www.geraldtan.com/medaffairs/meanstest.html