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Managing Healthcare: Case Studies of Singapore and Britain

Chapter 3

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Essential Questions:

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

• How effective are the various healthcare models in meeting the people’s needs?

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Challenges in managing healthcare

• Need to provide basic healthcare regardless of whether ppl can afford to pay

• Rising expectations and demands for quality healthcare

• Rising cost of healthcare

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Who Pays For It?Individual

Self:

People pay for healthcare services directly

Personal insurance:

Buy insurance and make claims from the insurance company to pay for treatment

Employer

Employer-paid insurance:

Employers pay a certain sum of money to insure workers. Claims are then made to the insurance companies

Government taxes:

Govt collects taxes from ppl and uses a portion for medical services

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Healthcare in Singapore, 1960s-70s

• 1960s: Healthcare was part of Singapore’s overall plans for improvement and development after independence

• Healthcare measures as part of housing programme

• Need to curb spread of infectious diseases

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Healthcare in Singapore, 1960s-70s

• Hospitals, clinics and outpatient dispensaries

• Vaccination• Medical officers and nurses sent to

schools to provide healthcare for students

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Healthcare in Singapore, 1960s-70s

• 1970s: Singapore economy improved, higher standard of living

• People wanted better healthcare services

• Polyclinic replaced dispensaries• Facilities in gov hospitals and

quality of healthcare improved

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Healthcare expenditure in 2004

Others, 94.1%

Healthcare, 5.9%

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Healthcare Since 1980s

• Concern: rising cost of healthcare• National Health Plan, 1983• Wanted to encourage public

debate on how to manage long-term healthcare needs

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Aims of National Health Plan

• Build a healthy and physically fit population

• Encourage Singaporeans to stay well and reward those who do

• Build up individual resources so that those who fall sick will be able to pay

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National Health Plan

Individual Government Community

•Encourages self-reliance

•Maintains good health

•Keeps healthcare affordable

•Promotes healthy lifestyle

•Provides some healthcare services

•Provides support services

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Medisave Scheme Medishield Scheme

- compulsory

- retirement plan

- 6 – 8% salary

- voluntary

- medical plan

- small sum through Medisave

Encouraging Self-Reliance

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Encouraging Self-reliance

• Medisave Scheme, 1984• Certain amount from workers’ CPF

channelled into Medisave accounts• Can be used to pay hospital bills

and certain medical treatment• Shared responsibility between

government and individual• No need to raise taxes to pay for

rising healthcare costs

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Encouraging Self-reliance

• Medishield, 1990• National healthcare insurance

scheme• Covers large medical bills for

illnesses not covered under Medisave

• For people who require long-term treatment of more serious illnesses

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Keeping Healthcare Affordable

• Government subsidies• Medifund• Restructuring of hospitals• Means-testing

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Government Subsidies

Ward Class Subsidy Rate Individual

A No subsidy 100%

B1 20% 80%

B2 65% 35%

C 80% 20%

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Medifund

• Started in 1993• Provide help to those who cannot

afford healthcare• Started with $200million• Interest earned is provided to

hospitals to help needy patients• Patients can apply for the fund at

hospital

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• To reduce medical costs• Health education and campaignsWorking with Organisations:• Some voluntary welfare

organisations (VWOs) organisations given grants to provide medical care

• Community hospitals

Promoting a Healthy Lifestyle

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

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Origins of the National Health Service (NHS)

Managing the NHS

Effectiveness of the British healthcare system

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Origins of the Welfare StateOrigins of the Welfare StateSir William Beveridge’s report in 1942- recommended that the govt put an end poverty, disease and unemployment - rebuild people’s lives after WWII

Britain after World War II- high unemployment and poverty- ‘cradle to grave’ policy: minimum standard for a decent life (pg. 83)- NHS is part of the welfare state: free healthcare for ppl

Sir William Beveridge’s report in 1942- recommended that the govt put an end poverty, disease and unemployment - rebuild people’s lives after WWII

Britain after World War II- high unemployment and poverty- ‘cradle to grave’ policy: minimum standard for a decent life (pg. 83)- NHS is part of the welfare state: free healthcare for ppl

Early Beginnings of the NHS

• Very popular with the ppl• All medical services free of charge• Br. Gov expected demand for

healthcare to increase and then stabilise

• Hwr, demand was overwhelming• By 1951, the NHS was unable to

meet these demands• A small fee was charged

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Managing the NHS

• Managing government spending• Increasing efficiency• Providing quality

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Managing government spending

• 1980s Margaret Thatcher• Cut back on govt spending on

welfare benefits• Wanted to create a system that

would make the individual more responsible

• Reason: govt was spending too much on welfare benefits

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Managing Government Spending

• Fear that reduction in welfare would result in inferior healthcare services

• 2000: PM Tony Blair promised increased spending on healthcare

• Accompanied by increases in National Insurance contributions

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Increasing Efficiency

• Problem of insufficient doctors, nurses and facilities to cope with increased demands

• Tatcher policy of privatisation• Reduce govt subsidies• Save costs• Make the NHS more efficient• Services no longer free except for

a few groups of ppl

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Providing Quality Service

• By 1980s people felt the NHS had poor standards

• Provide more information to help patients decide on own treatment

• Problem of long waiting time• NHS Plan (2000)• NHS Improvement Plan (2004)• NHS Direct

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Have British Healthcare policies met the needs of the people?

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Conclusion

• Similar problems, different approaches

• Singapore: shared responsibility• Britain: provide welfare