Concept Of Universal Health Care In Singapore: Overview Of Policies

Singapore’s Universal Coverage Model

Discuss about the Concept of Universal Health Care .

The essay deals with the concept of the universal health care also known as universal health or UHC. UHC is the outcome of WHO’s response in 1948 that declared “Health a fundamental human right”. UHC means the health services will be provided equally to all the individuals and the communities without any financial hardships. These services include essential health services from illness prevention to health promotion, treatment, palliative care and rehabilitation (Sen, 2015). Countries will make progress towards different health related targets if they progress towards UHC. Since UHC helps public to access services that can address the cause of ill health and death, it protects them from financial consequences. The public do not need to pay from own pockets therefore; they are free from the risk of falling into poverty (Tan et al., 2014). For example, the Single-payer health care is a system where the government pays for all the health care costs. The essay discusses the concept of UHC in Singapore and an overview of the healthcare policy over the last ten years. The Singapore government’s ministry of health implements universal health care system. The government implements a system of compulsory savings, price control and savings to ensure healthcare affordability within the public system (Haseltine, 2013). Further, the essay discusses how the government health policies are working towards providing an effective health system.

Singapore offers multiple layer of protection through its universal coverage. Singapore’s health care model involves compulsory health care savings, tax-based subsidies, risk pooling via insurance schemes and ultimate safety net for needy (Lin, 2015). It offers heavy government subsidies (80%) that are accessible by all the Singaporeans in acute hospital wards. Further, Singapore implements compulsory “individual medical savings account scheme” according to which the public is allowed to pay for their share of medical treatment.  It thus, minimises financial burden. Singapore has also implemented Medishield, which is a medical insurance scheme. This low cost scheme allows the public to risk pool the financial risks associated with major illnesses. Medishield includes features such as co-payment and deductibles that promotes individuals responsibility for one’s healthcare needs. Singaporeans can also subscribe for “Eldershield” which protects people from financial risk of struggling with severe disability. The other medical endowment fund named as “Medifund” is the government’s safety net for public who cannot afford their medical bills despite heavy subsidies such as Medishield and Medisave (Tan et al., 2014).

Preventive Healthcare Programmes in Singapore

Many people in Singapore also have private health insurances and are not covered by the government’s programmes. The country also allows the people to choose the providers within the government and private hospitals. The patients can also access 24-hour Accident & Emergency Departments in the government hospitals (Haseltine, 2013). In 2009, Singapore has established the “Agency for Integrated Care” to improve the community services and that in nursing homes. It integrates the long-term patient focused care (Chin et al., 2016). The country has established “Regional Health systems” to link the primary care and the rehabilitation centres with the hospitals. These initiatives of the government are supported by Temasek Cares. The country has launched “National Electronic Record Programme” in 2011 for supporting telemedicine and telehealth. Once fully developed the system of Electronic Health records it will enable patients to contribute to their personal health records (Fong & Tambyah, 2013).

In order to manage the rising health care cost, Singapore follows the ideology, “Prevention is better than cure”. Singapore has implemented preventive healthcare programmes such as subsidised or free “health screening programs”. These activities promote healthy lifestyle and reduce substantial incurring of medical expenditure (Wouters et al., 2016). This ideology deals with issue of increasing aging population in Singapore. This principle aims to decrease the increasing vulnerability of the people to the health issues which will eventually decrease the health care costs. To keep the costs in check it regulates the “supply and the prices” of the health care services (Kumar & Ning Zhang, 2008). Singapore government however, does not directly regulate the private medical care costs and are largely subjected to the market forces. These costs vary within the private sector depending on the services provided and the available medical speciality. The government spending on the health care increased from $5.8 billion in 2013-14 to $7.1 billion in 2014-2015 (Fong & Tambyah, 2013).

The effectiveness of the heath system is ensured by the government through benefits offered by the Medifund and Medisave. The first thing to be noted here is that Medisave only benefits the citizens of Singapore and its permanent residents who are prime contributors of the   Central Provident Fund or CPF. Medisave not only allows subsidising the healthcare expenditure but also to pay premiums of Medishield, that is covering 80% of the medical costs at B2/C level and other shield plans (Choon, 2010). Hence, the subscribers of Medishield can have the most of the outpatient and the inpatient care expenses (deductibles and co-insurance). It thus prevents intake of huge medical assistance and social stressor oh healthcare need.  However, it creates a burden on the individual to look after both personal and relative’s health care needs in addition to contributing towards CPF (Chen & Phua, 2013). It adds to additional burden if the contributor is sole income earner of the family. Hence, it is required for Singapore to develop alternate strategy or provide financial subsidies for individuals not contributing towards CPF. This approach will assist Singapore in effectively managing the rising health care costs (Hang et al., 2016).

Effectiveness of Singapore’s Health System

Medifund benefits the needy citizens of Singapore only after meeting a list of requirements such as inability of the patient and the family to pay for the medical expenses inspite of the heavy government subsidies, Medisave and Medishield (Lim, 2010). However, the government though appears to show great concern for the poor and the needy the initiative is still not wholesome. Therefore, the government needs to relook for such patients who are meeting most of the criteria but are refusing to pay the medical bill. Such patients should be eliminated from the benefits of Medifund. On the other hand there may be a family with single income earner who refuses to pay the medical expenses of the dependent households despite being able to. It will increase the health issues of the rest of the households. In 1978, the member countries of WHO have accepted the approach of primary health care with the goal to achieve “Health for all” which is also known as Alma-Ata Declartion (Choon, 2010). Thus, a decade ago Singapore was not meeting the definition of UHC, which has a prime objective of “Equity in access to health services” as well as Alma-Ata Declartion. As per this objective every person in need should be able to access the health care services irrespective of who can pay them. These are the areas which are to be revisited by the Singapore government although it has comprehensive and complete health care system (Ng & Li, 2011). 

In order to promote competition and transparency and prevent unwarranted rise in the health care costs, the Singapore ministry of health began to publish the hospital bills to highlight the variation of cost. It was aimed to push hospitals to do more with less, witches later led to some improvements such as the drop in the LASIK prices by more than $1,000 for each eye and is continuing till this day (Hang & Thampuran, 2016). It is of great benefits to the consumers. Further, the health outcomes are also published on the websites to encourage further improvement in hospitals which also assists people in making informed choice. There is available statistics that supports the success of the Singapore health system. According to the 2008 reports Singapore spent about $ 10.2 billion on healthcare and expended 2.7 billion on the health services. The drugs in Singapore are kept affordable through Group Purchasing Office that contains the costs of  Pharmaceutical related expenditure (Pwee, 2009).

Improving Transparency and Preventing Unwarranted Healthcare Costs

According to Lim (2016), the health care system in Singapore in 2015 was recognised to be the most successful in the world. It has achieved effective results in community health outcomes as well as in financing due to its well-organised health care delivery system. In order to ensure effective health system the government adjusts its policies regularly. Hang et al. (2016) described that the unique features of Singapore are difficult to be replicated in any other country. The medical facilities of Singapore are among the finest in the world. In 2012, the doctor to population ratio was 1:520, the nurses to population ratio were 1:150 and the ratio of dentist to population was 1:3230. Singapore has developed effective health care delivery system.

There are 1400 private clinics offering primary care and more than 18 public clinics that provide subsidised care including outpatient, health screening, immunization, pharmacy services and dental care (Lim, 2016). Singapore health care system is strengthening its ties to “private general practitioner networks”. In 2012, Singapore has introduced the “Community Health Assist Scheme” which provides subsidies to people from different socioeconomic groups to reduce disparities. The subscribers of this scheme have visits to the participating private clinics that are subsidised for acute conditions, specific dental procedures, chronic illnesses and health screening. There are 460 dental clinics and 720 medical clinics participating in this scheme (World Health Organization, 2013). In 2015, Singapore has revised CPF contribution rates to Medisave which encouraged the low- wage workers to save more for their retirement and medical needs (Chen & Phua, 2013).

Singapore has number of centres that are focusing on the outpatient specialist care such as cancer, skin diseases, cardiovascular diseases, oral care. The National Heart Centre offers full range of treatment to different cardiovascular complications. These centres also conduct research and training program. There are more than 30 clinics offering 24 hours emergency care. Further, public sector has begun renting private clinics to treat subsidised patient due to more number of beds available here.  The National Mental Health  Blueprint  of 2007 guides the agencies involved in mental health care. It laid a groundwork for integrated community living. The voluntary welfare organisations provides a long term care  and social support for the elderly population. It has consequently increased the effectiveness of care and has reduced the cost (Chia & Chan, 2008).

The key drivers promoting UHC in Singapore are organisation and planning, public consultation and regulations (Lin, 2015). The ministry of Health in Singapore undertakes responsibility of needs assessments, manpower planning, cost control, system governance and financing, services planning with the goal of ensuring quality care and responsiveness to citizens’ needs. The ministry of health has developed core regulatory functions, which are regular conducting of inspections and audits. It licenses health care institutions under the “private hospitals and Medical Clinics Act”. It safeguards public against false claims by marketing the licensed facilities. The “Health Sciences Authority” regulates the manufacture, supply, presentation and import of healthcare products and ensures that it meets the internationally benchmarked safety standards. The government of Singapore takes the public and stakeholder’s views through various sessions and survey. Based on the opinion, the government implemented various preventive and treatment services such as colonoscopies, mammograms and palliative care. The government also uses performance measurement and scorecard system to improve the performance of health care providers (Lim, 2016).

In conclusion, there is a significant improvement in Singapore’s health care system in the last ten years. It meets the principle of UHC and the Alma-Ata Declaration to a great extent. However, it still needs to address the socio-economic health issues. Singapore government should not manage the rising health care cost issue superficially by addressing its direct influence. Rather, it must prepare its citizens to accept the change and manage the rising health care costs. Hence, recommended approach for Singapore to manage the health care costs by implementing effective strategies is to implement differential healthcare financing schemes to assist people from various socioeconomic group. Further, the current strategies cannot tackle the health care cost due to inflation. Singapore, must review its salary compensation strategy and its employment assistance programs. It can initiate programs to help the unemployed group of people to seek employment in short span of time. Further, it can accord the salary compensation for particular profession or occupation based on the abilities, skills, experience, performance and inflation.

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