Singapore: The Future Now ©2013
Am Ang Zhang
The
Cockroach Catcher recently visited Singapore and is most impressed with how a
city state emerged from British Colonial rule to become a shining example to
the rest of the world both in terms of Employment, Education, Rule of Law and
most importantly Health Care.
Until
now, most health care in England has been “free” at the point of delivery. This
indeed may be where the trouble really is.
When
I was growing up in Hong Kong, education was not free nor was it compulsory.
Yet most of us valued it. Every single bit of book, pencil and paper were paid
for by hard working parents. There was no abuse of any of those items. Primary
education became compulsory (and free) from 1979, yes, late.
Well,
one thing I have to admit about British Colonialist is that they generally
leave a good government behind. How that is achieved is a mystery to many but
in general a stable government with a single policy for 150 years or so may
well be one of them. In recent years, the Civil Service in Hong Kong and
Singapore had been very efficient and whatever corruption there may have been
had been contained or controlled.
Old Singapore Today©2013 Am Ang Zhang
Citizens
of England might be surprised to hear that for most of us, health care is not
free.
No,
not for those of us who pay national insurance and taxes and if we include VAT,
that is just about everybody.
Singapore: NO! NOT FREE!
Singapore’s
health delivery is not free at any point. This has the singular advantage of
preventing the over-utilisation of any of its healthcare services. As England
struggled to stem the flow of new EU citizens from coming to use (or abuse) our
NHS, Singapore’s system simply see to it that it would not happen. Yet there is
a safeguard in public health for what is known as a catastrophic situation
which happened during the SARS outbreak.
Singaporeans
are considerably healthier than Americans, yet pay, per person, about one-fifth
of what Americans pay for their healthcare.
So how does Singapore achieve such
impressive results?
The
key to Singapore’s efficient health care system is the emphasis on the
individual to assume responsibility towards their own health and, importantly,
their own health expenditure.
The state recovers 20-100 percent of
its public healthcare outlay through user fees. A patient in a government
hospital who chooses the open ward is subsidized by the government at 80
percent. Better-off patients choose more comfortable wards with lower or no
government subsidy, in a self-administered means test.
I've heard a lot of
smart people warn that co-payments are penny-wise but pound-foolish, because
people cut back on high-benefit preventive care. Unless someone is willing to
dispute Singapore's budgetary and health data, it looks like we've got strong
counter-evidence to this view: Either Singaporeans don't skimp on preventive
care when you raise the price, or preventive care isn't all it's cracked up to
be.
More details on how Singapore's system works:
- There are
mandatory health savings accounts: "Individuals pre-save for medical
expenses through mandatory deductions from their paychecks and employer
contributions... Only approved categories of medical treatment can be paid
for by deducting one's Medisave account, for oneself, grandparents,
parents, spouse or children: consultations with private practitioners for
minor ailments must be paid from out-of-pocket cash..."
- "The private
healthcare system competes with the public healthcare, which helps contain
prices in both directions. Private medical insurance is also
available."
- Private healthcare
providers are required to publish price lists to
encourage comparison shopping.
- The government
pays for "basic healthcare services... subject to tight expenditure
control." Bottom line: The government pays 80% of "basic public
healthcare services."
- Government plays a
big role with contagious disease, and adds some paternalism on top:
"Preventing diseases such as HIV/AIDS, malaria, and tobacco-related
illnesses by ensuring good health conditions takes a high priority."
- The government
provides optional low-cost catastrophic
health insurance, plus a safety net "subject to stringent
means-testing."
So in Singapore private clinics
are responsible for 80% of primary care but public hospitals cover 80% of
hospital care!
Singapore
has some of the best public hospitals in the Far East if not the world so much
so that even those with private insurance often chose to have their operations
in a public hospital but staying in a more private room if their insurance
covers it. Public hospitals of this level of excellence become the natural
competitor for the private market and helps to keep overall cost down without
the need of draconian legislation. Such good public hospitals also provide some
of the best training grounds for future generations of top class doctors.
Singapore
together with Iceland has one of the lowest Infant Mortality rates in the world, a third the figure of the USA.
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