Social Studies – Chapter 3

Managing Healthcare

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Done by: Elijah Chai © 2012

What is healthcare?

• Psychological, Medical and Dental needs

• Infrastructure

• Personnel

• Monetary provisions

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Points to Ponder

• To what extent is healthcare the responsibility

of the government?

• What makes a healthcare system effective?

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What challenges do governments face in

managing healthcare?

• Costs

• Peoples’ Expectations

• Quality of Service

• Quality of Care

• Infrastructural

• What else?

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How is healthcare paid for?

• Individual

– Self: People can pay for healthcare services when

they receive treatment (e.g. patients pay the

doctor directly after each visit).

– Personal Insurance: People can buy medical

insurance. They can make claims from the

insurance company to pay for certain medical

treatment such as surgery.

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How is healthcare paid for?

• Employer

– Employer-paid Insurance: Employers pay a certain

sum of money for insurance for their workers.

Employers can claim medical fees from the

insurance company when medical services are

used by their workers.

– Government Taxes: Government collects taxes

from the people and uses a percentage of the

taxes to pay for medical services used.

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Healthcare in Singapore

• 1960s

– Part of overall plan for post-independence improvement and development

– Squatters and overcrowded areas were cleared

– People moved to HDB flats

– Hospitals, clinics and outpatient dispensaries were built to provide healthcare to the growing population

– Vaccination en masse

– Medical officers and nurses sent to schools

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Healthcare challenges in 1960s Singapore

• Infectious diseases such as tuberculosis were

common and spread easily

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Healthcare in Singapore

• 1970s

– Singapore’s economy had improved

– Singaporeans now wanted better healthcare services

– Polyclinics replaced the old outpatient dispensaries

– Polyclinics provided a wider range of healthcare, i.e.

medical check-ups for babies.

– Conveniently located, i.e. town centres.

– Facilities in government hospitals improved

– Quality of healthcare improved

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Where did the money come from?

• Government Budget

• In 2004, healthcare accounted for 5.9% of the

national budget.

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Healthcare in Singapore

• 1980s

– Key concern: Rising Cost of healthcare

– Then - Health Minister, Mr. Goh Chok Tong, raised

this concern several times.

– “Resources are finite (absolute, fixed, inflexible) 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 that

you want.” – GCK

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Healthcare in Singapore

• 1980s

– In 1983, MOH published the NATIONAL HEALTH

PLAN.

– Public debate was encouraged on how to manage

the long-term healthcare needs of the people.

– 20-year plan to improve Singapore’s healthcare

system

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NATIONAL HEALTH PLAN

• Aims:

– Build a healthy and physically fit population

– Encourage Singaporeans to stay well and reward

those who do so

– Build up individual financial resources so that

those who fall sick will be able to pay

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Key Points of the NHP

• Healthcare policies should not put a strain on

government spending

• They should encourage:

– Self-responsibility

– Community support

• Government would maintain policies to keep

healthcare affordable

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NHP

Individual

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Government Community

• Encourages

self-

reliance

• Maintains

good health

• Keeps

healthcare

affordable

• Promotes

healthy

lifestyle

• Provides

some

healthcare

services

• Provides

support

services

Encouraging Self-Reliance

• Medisave

– Introduced in 1984

– Encourages Singaporeans to be responsible for

their own health

– 6 – 8% of workers’ monthly CPF contributions

channelled into their Medisave accounts

– Can be used to pay hospital bills and certain

medical treatment

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Other benefits of Medisave

• Singaporeans share the costs of healthcare

with the government.

– Shared responsibility

– Government need not raise taxes to pay for

healthcare costs

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But…

• Not all Singaporeans make CPF contributions,

therefore do not have Medisave.

• People who required long-term treatment of

more serious illnesses were not able to pay for

their hospitalisation

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Medishield

• National healthcare insurance scheme

• Singaporeans pay using their Medisave

• Can make claims for large medical bills that

Medisave does not cover

– e.g. dialysis

• Constantly evolving

– e.g. Eldershield

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Medishield Timeline

• 1990: Introduction of Medishield

• 1994: Medishield Plus to cover hospitalisation

in A and B1 wards

• 2002: Eldershield to cover disabilities for

people above 40 years old

• 2005: Reformed Medishield to cover larger

hospitalisation bills for patients in B2 and C

wards

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Government Subsidies• Direct subsidies are given to government

hospitals, polyclinics, and nursing homes

– To ensure that basic healthcare services are

available for all Singaporeans

• In 2000, subsidies make up ¼ of government

spending on healthcare

• Hospital Subsidies

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Ward Class Subsidy Rate Individual

A No Subsidy 100%

B1 20% 80%

B2 65% 35%

C 80% 20%

Medifund

• Set up in 1993

• Provides help for those who are not able to

pay for healthcare

• Government started with a fund of $200m

• The interest earned from this fund is given to

public hospitals to provide help for needy

patients

• Patients apply directly to their hospitals

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Other measures

• Restructuring of hospitals

• Means-testing

• Promoting a healthy lifestyle

• Working with organisations

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Effectiveness?

• Have Singapore’s healthcare policies met the

needs of the people?

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HEALTHCARE IN BRITAIN

• Healthcare is a public good that is provided by

the National Health Service (NHS)

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Beginnings of the NHS

• Before the 20th C, the British government did

not provide much medical care for its citizens.

• In the 1940s, the government felt that it was

their responsibility to look after its citizens.

• 1942, William Beveridge delivered the

Beveridge Report

– Recommended that the government put an end to

poverty, disease, and unemployment.

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Beginnings of the NHS

• This was to help rebuild people’s lives after

WWII

• To reward the people for the sacrifices they

made during the war

• People contribute to a national fund to help

the more needy people in their country

• Set up as part of the welfare system to provide

free healthcare for its people at the point of

need29

What does this mean?

• People do not have to pay for the medical

treatments that they receive when they are

attended to by doctors at clinics or hospitals

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Result?

• Very popular

• Free for all citizens

• The British government expected demand for

healthcare to increase and then stabilise after

a while

• Problem:

– Too many people wanted to use the free medical

care

– Doctors used or recommended medical treatment

freely without much consideration for cost31

1951

• No longer free

• Charged a small fee

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How has the British government

managed the NHS over the years?

• Managing government spending

• Increasing efficiency

• Providing quality service

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Managing Government Spending

• 1980s, under PM Margaret Thatcher, tried to

cut back on healthcare.

• 2000, PM Tony Blair promised that the

government would increase public spending

on healthcare and improve the NHS.

• However, there was a corresponding increase

in the National Insurance contributions in

2003.

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Increasing Efficiency

• 1980s, increasing demand for healthcare due

to the rise in the numbers of elderly.

• Population growth slowed, and number of tax-

payers would reduce.

• People expect more and better treatments

• NHS has ballooned, but still not enough

resources to cope with the demand.

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How?

• Margaret Thatcher introduced the policy of

privatisation within the NHS

• Citizens also encouraged to take responsibility

for their own welfare and health

• Only a few groups of people had the privilege

of receiving free medicine, treatment, and

services.

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Privatisation

• Aims: Reduce government subsidies, save

costs, and make the NHS more efficient.

• Private companies had to be efficient to make

profits

• Patients have more choices

• Hospitals would improve their services

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Providing Quality Service

• NHS Plan 2000

– Made changes based on feedback

– Provided for increase in amount of government

spending till 2004

– Planned to work towards offering patients faster

and more convenient services

• NHS Improvement Plan 2004

– Patients can choose from 4 providers

– NHS pay for treatment

– Patients can access their own records online38

More

• Under the NHS IP (2004), NHS Direct was

introduced so patients could communicate

with doctors over the phone.

• Save resources

• Save patients an unnecessary trip

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Questions

• Have British healthcare policies met the needs

of the people?

• How has the NHS performed over the years?

• How different is this system and policy from

Singapore’s?

40

Similar problems, different approaches

Singapore’s Approach: Shared Responsibility in

Healthcare

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Encourage

self-reliance

by having

Medisave and

Medishield

for all

Singaporeans

Promote a

healthy

lifestyle

among

Singaporeans

by raising

awareness

about the

importance

of good

health

Keep

healthcare

affordable by

maintaining

government

subsidies,

providing

Medifund,

restructuring

hospitals and

introducing

means-testing.

Work with

organisations

by supporting

community

groups that

provide

healthcare

support

services

Similar problems, different approaches

Britain’s Approach: Free Healthcare at the Point

of Need

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Increase efficiency

by privatising some

areas in NHS

Manage

government

spending by

balancing

spending and

increasing taxes

Provide quality

service by

reducing waiting

time and giving

choices to patients

THE END

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