Cost And Quality Of Health Care System In Singapore

The Iron Triangle of Health Care in Singapore

Discuss about the Cost and Quality of Health Care System.

Health care system in a nation depends upon several factors; not only the health care professionals or care givers are contributing to the system, rather there are several parameters and aspects, which are the basis of the system in a nation. This essay focuses on Singapore health care and addresses specifically the three specific pillars of Singapore health care system such as access, cost and quality of health care system in Singapore. These are three pivotal parts in health care systems; each of the elements significantly contributes in successful health care delivery to care users and determine the health status of entire society (Meng-Kin, 1998) The Ministry of Health in Singapore looks after all aspects of health service in the country. According to WHO’s health system report, Singapore had achieved 6^th rank in the year 2000. A non-modified universal health care system is present in Singapore, where government tries to maintain affordability in health service through price control strategies.

Singapore is regarded as the healthiest country in the world. Access, cost and quality of health care system are three aspects, sharing common features and these are interdependent aspects, thus, while discussing one aspect, the other two are being discussed simultaneously. It is because, health care cost determines access of health care by different socioeconomic group in the community, whereas, the overall health care quality is dependent on the cost expenditure by government or private organization (Lim, 2005). Therefore, together these three aspects determine the quality of health care services delivered to the healthcare service users in Singapore community. According to the concept of The Iron Triangle of Health Care, access, quality and cost are three competing health care issues, present identical priorities, and change in one result in change to other one or both issues (Pocock & Phua, 2011). For instance, if a health care policy enhances access to health care, it would lower the quality of health care and increase cost. There are four key factors that have helped the nation to reach its health care goals. These are; “ability of recognizing and establishing national priorities, thereby providing its economy time for growing before putting high investment in health care”, “political unity, a cooperative culture within government an constancy of purpose”, “a great desire of shared social harmony and well being” and “attention to education, rights and health care priorities in women” (Moh.gov.sg, 2016).

Cost of Health Care in Singapore

While discussing about the cost of health care, the main elements of Singapore health care system is that there is absence of free medical service. Except subsidy in service, no free services are provided even in public health care system. The key intention of the system is to reduce over-utilization of health care system. The country provides maximum health coverage to its citizen by incorporating the philosophy of affordable care and individual care. The country has got the sixth rank in world’s health outcomes, spending less in the health care domain compared to any other high income country, which has been measured on the basis of GDP fraction spent on health and as expenditure per person (Phua, 1991). There are multiple layers in Singapore health care financing system.

The Singapore health service combines compulsory savings from payroll deductions, which make the system able to give subsidies through a nationalized health insurance plan, “Medisave”. In this system, each person gathers their funds, which can be united within the entire extended family. This scheme has been adopted by the majority of Singapore population. During a health care episode, one of the three levels of subsidy is selected by the patient. Therefore, the country’s system has implemented such a scheme or policy that has made its citizen self-sufficient. Medisheild is a low cost insurance policy that helps people whose funding is not sufficient to meet their medical expenses. Moreover, Medifund provides safety net to the needy Singaporeans. There is a rise in Government’s spending on the heath care sector, from SG$5.8 billion to SG$7.1 billion within 2013-14 to 2014-15, which will enhance health care cost about 22 % (Sturmberg,  O’Halloran & Martin, 2012). Overall, government is spending only 1.6 % of annual GDP in public health care, which is approximately $1,104 per person (Chongsuvivatwong et al., 2011). Moreover, government spends very less in private health care system. Instead of government expenditure, the expense in private health care sector is high compared to other high income countries, which also contribute to highly accessible care services, along with the government’s philosophy that citizen should be accountable for their self care (Moh.gov.sg, 2016).

Innovative integration of citizen medical saving scheme promoted the access of every level of individual to Singapore health care system. Access to the health care system is an important component of health care system, which includes five dimensions. Availability is referred to the presence of adequate number physicians and other health care providers for generalized as well as specialized services.             Singapore has shown finest medical facilities in both public and private sectors (Crisp & Chen, 2014). Till 2012, there are 10,225 doctors in health care delivery system, providing a doctor to population ration of 1: 520; there are total 34,507 nurses, providing a nurse to population ratio is 1: 150. In 2012, it has been estimated that in Singapore, there were total 10,756 hospital beds in 25 hospitals and specialty centers (Feldstein, 2012). In addition, 8 public hospitals include 6 general hospitals, a psychiatry hospital and a women’s and children hospital.

Access to Health Care in Singapore

Acceptability refers to the trust and acceptance of health care service users towards health care providers. The secured medical insurance scheme has established a trustworthy relationship within care users and health care system in Singapore. On the other hand, patients are able to select either government or private health providers. There are private and government health care delivery system or polyclinic, where individual can consult for the best possible health care option. There are emergency services, which is 24 hours available (Blais, 2015). Accommodation is referred to the relationship within health care user’s needs and the manner through which health care providers organizes services and facilities to meet health care users’ needs. Accommodation is very important in Singapore health care system. The entire system has its uniqueness for their addressing patient’s needs through their financing and staffing philosophy. In addition to the public-centered insurance schemes, patient protection and affordable care act helps in supporting innovative or promising care practice model in the health service.

Affordability refers to the relationship between health care service price and the ability of health care users to pay. Singapore government has integrated such a scheme that helps its citizens to help themselves to afford their health care cost, while government also pays a fraction of their health care cost. The system is unique, by introducing a mixed financing system, ensuring that no Singaporean citizen is denied access to basic health care service due to affordability issues. For low SES groups, there are additional schemes. Accessibility is referred to relationship between location of health care services supply and the location from where client will access health care service or facilities. The national health care system include 24 hours and emergency departments in government hospitals and there are several government and private clinics from where  people  can get a primary health care assistance before accessing a private or government hospital (Rosen, Waitzberg & Merkur, 2015). The agency for integrated care was developed in 2009 for improving health care services in the community. In addition, for make the health more accessible to public; regional health systems are developed for linking hospital with primary care and rehabilitation centers. Moreover, telehealth and telemedicine is playing a major role in enhancing accessibility of healthcare in Singapore.

In terms of quality and efficiency, Singapore has got the 1^st rank throughout the world in 2014. Singapore health care system is a lesson to any high income country for integrating a principle, representing that it is possible t develop high quality and affordable health care system with limited resources through long term planning and innovative policymaking. Moreover, economic and geographic location of the nation helps it to evolve and transform its healthcare system from an acute care system to a comprehensive system for acute a chronic care. In this context, Donabedian model can be used for assessing the health care services and evaluating the quality of health care of Singapore health care system (Swayne, Duncan & Ginter, 2012). This model depicts that quality of care can be determined from three interrelated categories that include “structure”, “process” and “outcomes”. Structure includes the factors affecting the context of health care delivery. Process is referred to the collection of actions making up the healthcare system as a whole. Finally, outcome is referred to the effect of healthcare activities upon health care population, which can be estimated by the positive outcomes and patient satisfaction.

Affordability of Health Care in Singapore

In current era, Singapore has introduced a mixed service delivery model. 80 % of the public health care domain is predominating by acute care centre. On the other hand, hospitals and nursing homes are provide by welfare organizations, funded by Ministry of health care, Singapore government. The financial scheme developed by the government is the key factor promoting the high quality services in the system. The system ensures that people are aware of taking care of their own (Milovic & Milovic, 2012). When people are aware of that they would have to pay for their health, it enhances the quality of health care overall. On the other hand, promotion of competition and transparency has led the quality of national health care system to the top most level. The hospitals has been pushed on this effort to “do more with less’. It has been revealed that success has become greater since the competition and transparency is integrated in the system.

The Ministry of Health is integrating new technologies in the health care system, instead of investing more in the system, which is also enhancing its quality. The Ministry is progressively influencing the publication of health outcomes in government website, for encouraging service providers as well as service users along with further improvement and helping patients to make more informed choice. Overall, all these functions are promoting a better quality of health care service delivered to patients.

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