CHAPTER 3CHAPTER 3MANAGING MANAGING

HEALTHCARE:HEALTHCARE:

Case Studies Case Studies of Singapore of Singapore

& Britain& Britain

Chapter at a Glance: Chapter at a Glance:

To what extent is healthcare the To what extent is healthcare the responsibility of the government?responsibility of the government?

What makes a healthcare system What makes a healthcare system effective?effective?

Trigger Activity:Trigger Activity:

Your Classmate John has been Your Classmate John has been missing from school for a week.missing from school for a week.

Then you heard the news that John Then you heard the news that John has been hospitalised: has been hospitalised:

Trigger Activity:Trigger Activity:

You have heard that medical You have heard that medical treatment is very expensive.treatment is very expensive.

You are worried if John could afford You are worried if John could afford the bill. the bill.

Trigger Activity:Trigger Activity:

How will you help John ?How will you help John ?

How affordable do you think How affordable do you think healthcare is?healthcare is?

Do you think healthcare is a Do you think healthcare is a basic need?basic need?

Managing HealthcareManaging Healthcare

The need to provide basic health care for the sick who can’t afford.

How to provide healthcare given the limited resources and competing needs of the country

What challenges do governments face in managing health care?

Less developed country

More Developed

Country

Comparison of Healthcare between two countries:Comparison of Healthcare between two countries:

Comparison between two Comparison between two countries:countries:

Less developed country

More Developed Country

Mauritania in West Africa

• Only one large hospital in the capital city.

• Infectious diseases are common in the rural areas.

• There are insufficient doctors, nurses, clinics and medicine.

Sweden in Europe

•Main concern -To continue to provide good quality healthcare for the citizens.

•Healthcare services are provided by the government.

•The money for healthcare comes from taxes.

How is healthcare paid for?How is healthcare paid for?

Healthcare provider, .e.g. hospital and

clinic

Individual

Self

Patients pay the doctor directly after each visit

Individual

Personal Insurance

Make claims from the insurance company

Employer

Employer-paid insurance

Employers pay a certain amount for insurance for their workers

Employer

Govt. collect Taxes and uses a % to pay for medical services used.

Healthcare in SingaporeHealthcare in Singapore

How was healthcare managed in the 1960s & 1970s?

Part of overall plans for improvement Part of overall plans for improvement & development after independence.& development after independence.

Healthcare measures were part of Healthcare measures were part of public housing programmepublic housing programme..

The situation in the 1970s…The situation in the 1970s…

The economy had improved The economy had improved People enjoyed a better standard of People enjoyed a better standard of

living.living. Thus, they wanted better healthcare.Thus, they wanted better healthcare.

The solution:

Old outpatient dispensaries were replaced with polyclinics.

They provided a wide range of healthcare & conveniently located in town centres.

Facilities in government hospitals and the quality of healthcare were improved.

Money came from government budget.

Healthcare services in the Healthcare services in the 1970s1970s

How has the approach to How has the approach to manage healthcare changed manage healthcare changed

since the 1980s?since the 1980s? Concerns- rising cost of providing Concerns- rising cost of providing

healthcare.healthcare.

National Health Plan- aim to National Health Plan- aim to encourage public debate on the encourage public debate on the suggestions made on how to manage suggestions made on how to manage the long-term healthcare needs of the long-term healthcare needs of the people.the people.

What are the messages behind What are the messages behind the following three slides ? the following three slides ?

An Extract of Speech made by An Extract of Speech made by then Health Ministerthen Health Minister

Mr.Goh Chok Tong in 1981 Mr.Goh Chok Tong in 1981 Resources are finite in Resources are finite in

terms of funds, terms of funds, doctors and nurses. doctors and nurses. Providing welfare in Providing welfare in healthcare will affect healthcare will affect people’s incentive to people’s incentive to work. It is necessary work. It is necessary to pay for the services to pay for the services you want.you want.

Initiated in 1983 and implemented since Initiated in 1983 and implemented since 19841984

To build a healthy and physically fit To build a healthy and physically fit population.population.

To encourage Singaporeans to stay well To encourage Singaporeans to stay well and reward those who do.and reward those who do.

To build up individual financial resources To build up individual financial resources so that those who fall sick will be able to so that those who fall sick will be able to pay.pay.

Approach to healthcare in Approach to healthcare in SingaporeSingapore

Health care policies not Health care policies not to strain government to strain government spendingspending

Encourage self Encourage self responsibility and responsibility and community support community support

Govt. to maintain Govt. to maintain affordable healthcare affordable healthcare policies policies

Approach to healthcare in Approach to healthcare in SingaporeSingapore

IndividualIndividual

•Encourage self reliance

•Maintains good health

Government

•Keeps healthcare affordable

•Promotes healthy lifestyle

Community

•Provides some healthcare services.

Medisave

Medishield

Medifund

PRIMARYCARE

ACUTECARE

CATASTROPHIC(LONG TERM CARE)

FinancingMethod

PrivatePayment

CompulsorySavings

Social/Private Insurance

PUBLIC SUBSIDIES

Taxes PUBLIC HEALTH SERVICES

(Eldershield)

(Elderfund)

Encouraging Self-RelianceEncouraging Self-Reliance

1. Medisave1. Medisave 2. Medishield

Encouraging Self-RelianceEncouraging Self-Reliance

1. Medisave1. Medisave •Introduced in 1984.

•Comes from the Worker’s CPF (6-8%)

•To pay for hospital bills and certain medical treatment.

Impact:•Singaporeans are better able to afford health care.

•They share the cost with the government.

•A shared responsibility- lighten the government’s burden.

What you have learnt in What you have learnt in Chapter 2 :Chapter 2 :

A “Bill” will be debated in parliament A “Bill” will be debated in parliament before a law is passedbefore a law is passed

People were encouraged to give People were encouraged to give feedbackfeedback

The importance of The importance of feedback:feedback:

With more feedback With more feedback from people, Medisave from people, Medisave has been extended to has been extended to pay for more types of pay for more types of medical treatmentmedical treatment

Source: The Straits Times, 30th January 2008.

Encouraging Self-RelianceEncouraging Self-Reliance

2. Medishield

•To help people who cannot afford long-term treatment.

•National Healthcare insurance.

•Pay with medisave.

•Make claims to pay for treatment not covered by Medisave.

Impact:•People can meet their specific needs.

•Can pay for long-term treatment of serious illnesses.

Keeping Healthcare Keeping Healthcare AffordableAffordable

The government’s concerns:

Sharing responsibility, Limited resources, Providing safety nets.

Government Subsidies

• Given to Nursing homes, government hospitals and polyclinics.

• ¼ of government spending on healthcare.

• Different rates of subsidies to the different class wards.

Medifund

•Given to needy Singaporeans.

•Low-income workers & self-employed people.

•Apply at the hospital

Restructuring

of hospitals

•More freedom for hospitals to re-organise to meet the needs of Singaporeans

•To cut down subsidies

Types of Beds

% Subsidy

% Individual

Class A (1 bedded)

0 100

Class B1 (3-5 bedded)

20 80

Class B2 (6-10 bedded)

65 35

Class C (open ward)

80 20

Promoting a Healthy Promoting a Healthy LifestyleLifestyle

A way of coping with the rising cost of health care.

A good health no need medical treatment savings on medical expenses.

Promoting a Healthy Promoting a Healthy LifestyleLifestyle

Anti-smoking campaigns Community health

screening Schools- Towards a

healthy school tuckshop Activities organised by

the Health Promotion Board

Encourage healthy eating ( low in fat and calories)

Working with organisations Working with organisations

Community hospitals

Did You Know ?Did You Know ?

Who founded Who founded The Nursing The Nursing Home Home Foundation?Foundation?

What services What services does it provide?does it provide?

Read the two articles on Figures Read the two articles on Figures 3.26 and 3.27.3.26 and 3.27.

What is your opinion if you were What is your opinion if you were Mr. Tay Chew Guan in Figure 3.27? Mr. Tay Chew Guan in Figure 3.27?

Have Singapore’s Have Singapore’s healthcare policies met the healthcare policies met the

needs of the people?needs of the people?

Have Singapore’s healthcare Have Singapore’s healthcare policies met the needs of the policies met the needs of the

people?people? Medisave helps to pay for hospital Medisave helps to pay for hospital

bills.bills. Medishield helps those who do not Medishield helps those who do not

have enough in their medisave.have enough in their medisave. The elderly and the unemployed The elderly and the unemployed

who do not have the opportunity to who do not have the opportunity to save for healthcare can depend on save for healthcare can depend on the government or communitythe government or community

Have Singapore’s Have Singapore’s healthcare policies met the healthcare policies met the

needs of the people?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.

The health of Singaporeans has improved over the years

High quality health care High life expectancy Low Infant mortality Healthcare spending is less than 3%

of GDP

Healthcare would always be borne by Singaporeans (medishield, taxes…)

A view from Russia with A view from Russia with Love:Love:

LOCAL HEALTHCARE LOCAL HEALTHCARE PROVIDERS WOO PROVIDERS WOO MORE MEDICAL MORE MEDICAL TOURISTS TOURISTS

From Russia with From Russia with love of S'pore's love of S'pore's medical facilities medical facilities Cancer man picks Cancer man picks S'pore over the S'pore over the US, China, Korea US, China, Korea By Ng Wan Ching By Ng Wan Ching January 30, 2008January 30, 2008

“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