chapter 3 - managing healthcare in singapore
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Chapter 3Managing Healthcare
Singapore
Learning Points1. Identify the challenges governments face
in managing healthcare
2. Identify ways that healthcare is paid for in a country
Challenges that most Governments face
Public Good Quality Healthcare
Increasing Spending
A Public GoodExpectationAll citizens expect their government to provide basic healthcare.
ProblemAll countries have limited resources.
1
Quality HealthcareExpectationPeople in developed countries expect more and better healthcare services.
ProblemPeople live longer.
2
Rising SpendingExpectation1. Better
treatments,2. More effective
medicines3. Better-qualified
medical staff
ProblemPeople demand for the best healthcare.
3
How is healthcare paid for?
Self Personal Insurance
Employer-paid Insurance
Government Taxes
• Pay for your own healthcare services when you receive treatment
Self
• Pay for your own healthcare services when you receive treatment
Self
• Buy medical insurance
• Claim from insurance to pay for certain medical treatment
Personal Insurance
• Pay insurance for workers
• Claim from insurance when workers use medical services
Employer-paid Insurance
• Pay insurance for workers
• Claim from insurance when workers use medical services
Employer-paid Insurance
• Collect taxes from the people
• Use a percentage of taxes to pay for medical services
Government Taxes
Recap1. Identify the challenges governments face
in managing healthcare
2. Identify ways that healthcare is paid for in a country
Healthcare in Singapore
Learning Points1. Identify how the government managed
healthcare expenses before the 1980s
2. Identify how the government manages healthcare expenses after the 1980s
SINGAPOREBefore 1980s
Hock Lam Street during the 1960s
Bugis Street in the 1960s
Singapore during the 1960s and 1970s
What are the effects of poor housing conditions on people’s health?
Singapore Healthcare in the 1950s and 1960s
Health Centre
aka Polyclinic
Town Areas
Mobile Health Centres
Medical staff brought help to the people living away from town areas in mobile health centres (vans).
What did government do?Training
The government trained a huge number of nurses and doctors in hospitals to improve healthcare.
Education
The government also educated people on how to prevent illnessesthrough health programmes.
PhysicalEducation
The government introduced physical education to the students to keep people healthy.
Singapore Healthcare after 1960s
Improved healthcare services such as having more clinics and medical staff.
Health programmes like being healthy at work and going for medical checkups are implemented.
How does the government manage healthcare expenses?Healthcare expenses comes from the government budget.
Concept
The amount of money that the government plans on spending to meet the needs of the people.
Government Budget
Government Budgetis spent on needs of the people.
Healthcare Education Transportation Housing
Singapore’s Healthcare Expenditure (2014)
Healthcare4.4%
Others95.6%
Expenditure
SINGAPOREAfter 1980s
ProblemRisingCost of
Healthcare
LimitedResources
Strain on Government
Spending
Solution
Healthcare Cost
Individual
Community
Government
Solution• Relies on oneself • Be in good health
Individual
• Provides healthcare services
• Provides other support services
Community
• Keeps healthcare affordable
• Promotes healthy lifestyle
Government
Do you know the cost of healthcare in Singapore?
Hospital Wards ChargesClass of Ward / Charges per day (SGD)
A (1&1+) B (1&1+) B2 C
Restructured Hospitals AH / CGH / KK / NUH / SGH / TTSH
295470.80
188224.70
5675
2941
Private HospitalsESH / GH / MAH / MEH / TMC
500.76618.46
197.95260.01
133.75179.76
Appendicitis
Assume a person is hospitalised due to inflammation of the appendix and undergoes 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$8,950.
Breakdown of Hospital Bill Amount Payable (S$)
Room & Board (5 days) 750
Hospital Miscellaneous Expenses• Prescription drugs • Diagnostic Procedures • Operating Theatre Fees
2,950
Anaesthetic Fee 500Surgeon’s fee 1,700ICU (2 days) 2,250Post-Hospitalisation Treatment 800Total 8,950
Role of an IndividualSelf-reliance
Concept
Citizens to be responsible for themselves and take care of themselves.
Self-reliance
Medisave(what is it?)
Medishield(what is it?)
How?
Central Provident Fund (CPF)Employer
Contribution(15%)
Employee Contribution
(20%)
CPF
Ordinary Account
(23%)
Special Account(7.5%)
MedisaveAccount
(9%)
CPF
Medisave
Pay hospital bills &
medical treatment
MedisaveCPF
Saving Scheme
MediShieldNational healthcare insurance scheme
MedishieldMedisaveCPF
Why is Medishield required?
Isn’t Medisave sufficient?
For people
• who need long-term treatment and
• who cannot afford their treatment fees or hospitalisation fees and
• whose Medisave cannot cover the fees.
Self-reliant Singaporeans
The government
does not need to increase
taxes
This lightensthe
government’sload
Singaporeans pays for their
ownhealthcare
ProblemDoes every Singaporean have CPF?
How are they going to pay for their healthcare costs?
Role of the CommunityCommunity needs to provide healthcare and support services.
It is impossible for the government to run all of them.
Reason
The Communitycan be divided into 2 categories.
Voluntary Welfare Organisations
(VWOs)
Private Organisations
Voluntary Welfare OrganisationsExamples
Ren CiCommunity Hospital
St. Andrew’s Community Hospital
Private OrganisationsExample
National Kidney Foundation Singapore
It caters to the needsof specific groups of people such as the poor or those with a particular illness.
Role of the CommunityThey are given government grants to run
Community Hospitals Nursing Homes Day Rehabilitation
Centres.
Role of the Government
Use limited resource
Provide public services
Meet the needs of the people
Do you know?
has been allocated to MOH for FY2013 to
1. keep healthcare affordable and
2. promote good health.
$5.7 billion
How does the government keep
healthcare affordable?
1
Government Subsidies (to who?)
Medifund(what is it?)
Restructuringof Hospitals Means-testing
GOVERNMENT SUBSIDIES
The government gives direct subsidies to public general hospitals, polyclinics and some nursing homes for elderly.
Lower income group receive the most subsidies.
High IncomeMiddle Income
Low Income
The government gives different rates of subsidies to the different classes of wards in hospitals.
Class Creceives the most in subsidies.
MEDIFUND
was set aside by the government in 1993.
$200 million
TargetPeople who cannot pay for their medical feesdespite Medisave, Medishield and government 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
Concept
Hospitals have the freedom to reorganise to meet the needs of the people
Restructuring of Hospitals
Hospital becomes financially independent from the government where they have their own board of directors.
Therefore, the government is able to reducethe amount of subsidies to hospitals.
MEANS-TESTING
Concept
Lower-income group will receive a higheramount of subsidies than the higher-incomegroup.
Means-testing
Mean-testingDetermine if the patient is able to afford healthcare through a check on his financial background.
Monthly income Ownership of Private Property
BeliefSubsidies should benefit patients who need them the most.
The government gives heavy subsidies to polyclinics and government hospitalsespecially to class B2 and C wards.
How does the government promote a
healthy lifestyle?
2
Why?
By having health programmes in schools and workplaces
Prevention is better than
Cure.
The Great Singapore Workout
How successful is the healthcare policies in Singapore?
EffectiveProvide Singaporeans with the money to payfor healthcare
IneffectiveThere 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?
SUMMARY
SingaporeShared Responsibility in Healthcare
Individual
Self-reliance
Maintains good health
Community
VWOs
Private Organisations
Government
Keep healthcare affordable
Promotes a healthy lifestyle
Individual
Self-reliance
Medisave
Medishield
Maintains good health
Government
Keeps healthcare affordable
Government Subsidies Medifund
Restructuring of Hospitals Means-testing
Promotes a healthy lifestyle
Created by
Goh Bang Rui
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