In Part 3 (you can read Part 2 here) of my series of the issues that are most likely to be discussed in this general election, I’ll discuss the current issues that engulf healthcare in Singapore. Healthcare is another touchy subject with many people often asking either “why the government isn’t doing more” or “why do I have to pay for other people getting sick”. In this segment I’ll glide quickly through what the Singapore system is like and it’s flaws before addressing the alternative policy as suggested by the SDP.
Singapore Healthcare System
Currently the healthcare financing system is centred around paying for the costs incurred in the hospital or when a person is hospitalised. For that there are three existing schemes, (1) Medisave, (2) Medishield and (3) Medifund. Medisave operates as a healthcare savings account, where a small percentage of a person’s wages are garnished and placed in this account. Additionally, a interest rate of 5% per annum which is quite high and is practically unheard off in the private sector. However there are limits to how one can use the Medisave account, daily withdrawal limits for hospital stays and outpatient care. Medishield is a catastrophic insurance protection plan which provides insurance in the instance of major medical and healthcare bills. Medifund comes in when a person can’t afford to pay the deductible or other medical bills and is from the lower income bracket. Medifund was established by a $3 billion endowment by the government, with the income and interest used to cover requests on a year to year basis.
Additionally there was also an Eldershield scheme for older citizens. This scheme has since been integrated into a new and improved Medishield Life. Medishield Life is an expansion of the original Medishield programme and covers people essentially from cradle to grave, with higher coverage and no lifetime limits. Medishield Life starts coverage at the end of 2015. However the success of any insurance based system is whether or not the people that are insured are able to afford the deductibles. For the most party a person is able to use his medishield (up to a certain point) to pay the deductible amount, in a way this acts as a pressure to not over-consume medical resources since they are paid for through the public kitty.
In short the government has been able to improve and redesign the plan to make sure that it covers as many people as possible and it provides as wide a coverage as possible.
The SDP Plan
The SDP plan is designed around making healthcare basically cost free to the general public as well as increasing the “personal” touch by reducing or eliminating the large wards and moving to a 4 bed ward system by and large. To be honest, these are all great suggestions but the problem is that they are all based on a the current hospital and healthcare system which is largely outdated or outmoded for our growing (albeit slowly) and ageing population. The demand for longer bed stays and increased medical needs will stress the current medical model to the point of breaking unless we rapidly increase the number of medical staff, medical institutions and medical support programs in the coming 10 years, and even then it is unlikely to be enough to handle the volume. A quick glance to other developing countries with larger populations is a good way to identify the shortfalls of such a strategy that would only lead to long-term financial depletion and eventually burden future generations with the choices of the past.
The Future of Singapore Healthcare (or what it should be)
The problem with all the current proposals that are being presented are that they ultimately are about improving/optimising the existing system which is ultimately an unsustainable approach when you’re facing a potentially astronomic rise in the need for the healthcare going forward. To properly consider the healthcare problem we need to look at everything from (1) system design, (2) healthcare financing and even (3) manpower management and training.
- System Design
- Integrated Practice Units (Multi-disciplinary approach to chronic and acute diseases. Looking at a disease or hospital episode as something more than just a “one-time” episodic approach).
- Bundled Payments (Instead of charging patients on a per-use basis, care should be bundled into “sets of care”).
- More care should be centred in the community but not simply by having hospitals (which current perform that task) move care to the polyclinics and the private GPs.
- Healthcare Financing
- The Singapore finance model is outdated in the sense that it seeks to focus on the anticipation of costs rather than in the prevention or avoidance of it. The system would happily subsidise hospital visits, operations and stays but is not designed to incentivise good behaviour.
- The system should move towards a more active approach such as providing higher subsidies to patients with chronic conditions that manage their conditions well (with or without) the help of medication. Rebates (Medishield) should be given to members that maintain a healthy body fat percentage or to people that go for yearly check-ups and show that they are indeed healthy individuals.
- A small amount of a person’s Medisave/Government Assistance should be set aside for individuals to see their local Therapists, GPs, TCMs, or chiropractors. Non-hospital based care is important and cost barriers need to come down.
- Manpower Management and Training
- Undoubtedly our healthcare system could use more doctors. Currently people that study at the medical schools in Singapore are required to serve a 6 year bond with the government providing healthcare services. However, there are many that go overseas (when places aren’t available here) and many more that upon rejection choose to go into other fields of study. MOH, using some common sense should seek to provide a scholarship system to send aspiring medical professionals overseas for an education (maybe with a longer bond) to increase the number of Singaporeans that can enter the medical profession.
- It is also needs to be said that we need more nurses, allied health professionals and ancillary staff. Although doctors get all the medical glory and recognition, without the rest of these hard workers, hospitals would barely function. MOH needs to start investing now in improving the education system so that getting into these professions becomes a more well thought out decision rather than “I couldn’t get in anywhere else” outcome. Additionally as these staff take more work and responsibility away from doctors, they should rightly be better remunerated. While pay has certainly gone up in recent years, the pay gap between junior doctors and senior nurses hasn’t quite closed.
I won’t claim to be a healthcare expert nor an expert on the Singapore healthcare system, but these are some common sense (in my opinion) things that we can do to improve how we approach and understand the issue that healthcare would be for us going forward, if we don’t take a proactive stance.