Managing Healthcare: Case Studies of Singapore and Britain

2 Requirements To what extent is healthcare the responsibility of the government? What makes a healthcare system effective?

3 2. Managing Healthcare 2.1 Challenges faced by Governments when managing healthcare: –Need to provide healthcare for the sick even if they are unable to pay –Provide healthcare, a public good, with limited resources and competing needs

4 2. Managing Healthcare 2.1 Challenges faced by Governments when managing healthcare: –Providing Quality Healthcare Expectations of better healthcare from people in developed countries Success of a government can sometimes depend on how well they meet peoples’ demands for healthcare

5 2. Managing Healthcare 2.1 Challenges faced by Governments when managing healthcare: –Increasing Expenditure on Healthcare Increase in the cost of healthcare due to research and development, training, etc

6 2. Managing Healthcare 2.2 How is healthcare paid for? –See next slide

7 Healthcare Provider Employer (Insurance) Governmen t Taxes Individual (Insurance) Individual (Self)

Providing Basic Health Care in the 1960s (concerns during early independence) More hospitals and clinics started to be built Island-wide Inoculation /vaccination Programme –Tuberculosis, smallpox common –Routine Examination of children in schools Clean-up of Singapore streets –Environmental pollution, indiscriminate littering & improper disposal of rubbish –Deterrents  Fines –Public Campaigns

Improving Health Care Services in the 1970s – with improvement in economy and better std of living Specialisation of Medical Services –Plastic & Reconstruction Department at the Singapore General Hospital (1972) Polyclinics replaced outpatient dispensaries –One-stop Health Centres Outpatient Medical Care, Maternal & Child Health Care –Conveniently located all over Singapore Improvement in hospital facilities & quality of healthcare

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20 3. Healthcare in Singapore 3.2 How has the approach to manage healthcare changed since the 1980s? –Rising cost –Finite resources Healthcare cost should not put a strain on government spending Healthcare should encourage individual responsibility and community support BUT government should also make healthcare affordable

21 3. Healthcare in Singapore

22 How is healthcare managed in Singapore? – Three Factors Individual (1) –Encouraging Self-Reliance Singaporeans use Medisave to pay for part of their hospital bills and medical treatment. Singaporeans can also opt to buy Medishield to pay for larger medical bills which Medisave does not cover. Encouraging self-reliance thus allows Singaporeans to share healthcare costs with the government, allowing the government to lighten its burden and allow it to devote more resources to more pressing issues.

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24 How is healthcare managed in Singapore? – Three Factors Individual (1) –Maintains Good Health / Healthy Lifestyle The individual maintains good health and adopts a healthy lifestyle, so that he or she will not have to spend money on medical treatment and save on medical expenses This releases the government from being burdened to provide additional resources for healthcare

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27 How is healthcare managed in Singapore? – Three Factors Government (2) –Keeps healthcare affordable The government gives direct subsidies to government hospitals, polyclinics and some nursing homes. In order to ensure that healthcare remains affordable for the lower-income group, more subsidies are given to the Class C wards in hospitals. To help needy Singaporeans who still cannot afford to pay their healthcare bills despite Medisave and Medishield, the government has Medifund which is given to public hospitals to provide help for needy patients. Patients who need help in paying for their healthcare can apply for the fund.

Singapore Hospitals Ward Classes Class of Ward Number to a Room SubsidyAir- Conditio -ning A 1 0% Yes B1 4 20% Yes B % Yes B2 6 up to 60%* No C 8 up to 80%* No 8/15/2015copyright (your organization)

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35 How is healthcare managed in Singapore? – Three Factors Government (2) –Keeps healthcare affordable The government has also considered means- testing which distributes medical resources and subsidies according to income levels. This ensures that those who would benefit more from subsidies get the most help. The government has also considered restructuring to allow hospitals to reorganise themselves to better meet their patients’ needs. This would allow the government to reduce the amount of subsidies to hospitals and reduce its burden to provide resources to meet rising healthcare costs.

36 How is healthcare managed in Singapore? – Three Factors Government (2) –Promotes a healthy lifestyle By promoting healthy lifestyle programmes in school and the workplace, and encouraging Singaporeans to do physical exercise and follow a healthy diet, the government can help Singaporeans to be healthy, avoid medical treatment and save on medical expenses thus reducing the government’s burden to provide resources to meet rising healthcare costs.

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38 How is healthcare managed in Singapore? – Three Factors Community (3) –Provides some healthcare services –Provides support services Private and non-government bodies provide healthcare services in addition to those provided by the government. These healthcare and support services range from long-term post-hospital care or care for specific illnesses. These services cater to the poor or those with specific illnesses who are unable to get any support. This helps to lighten the burden of the government in providing healthcare and allows it to divert resources to other needs.

39 How successful has Singapore been in meeting the healthcare needs of the people? Successful: –The government has put in place policies like Medisave, Medishield, and Eldershield so that people can be self-reliant and afford to pay for their healthcare needs –The government has put in place Medifund to help those who cannot pay for healthcare have access to it

40 How successful has Singapore been in meeting the healthcare needs of the people? Successful: –The government has put in place policies like Medisave, Medishield, and Eldershield so that people can be self-reliant and afford to pay for their healthcare needs –The government has put in place Medifund to help those who cannot pay for healthcare have access to it

41 How successful has Singapore been in meeting the healthcare needs of the people? Successful: –The government has put in place subsidies in hospitals so that healthcare will be more affordable for lower income Singaporeans –The government has also provided support to certain community organisations to provide specific healthcare support services to Singaporeans

42 How successful has Singapore been in meeting the healthcare needs of the people? Unsuccessful: –The elderly who did not have the opportunity to save for healthcare when they were working –They are dependent on their family, the community and the government for their healthcare needs –It is a problem because of an increasing aging population

43 How successful has Singapore been in meeting the healthcare needs of the people? Unsuccessful: –The unemployed also have problems paying for healthcare as they do not earn any money, thus they cannot contribute to their Medisave accounts

44 How successful has Singapore been in meeting the healthcare needs of the people? Conclusion: –Yes. Singapore has been successful to a large extent because the government has put in place several measures to make healthcare accessible and affordable to Singaporeans. –No. Singapore has been unsuccessful to a small extent as some of the elderly and unemployed Singaporeans have problems getting access to healthcare.

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William Beveridge Creator of the welfare state 46

NHS Live (Videos) 1940s 1950s 1960s 1970s 1980s 1990s Key Question: 47

Origins of the Welfare State High Unemployment in Britain after World War Two –Poverty, Shortage of food and fuel –Beveridge’s report Government’s duty to end poverty, disease, unemployment Decision to create a welfare state –Aimed at ending poverty and sickness –To look after the citizens from birth to death –Every citizen was guaranteed a minimum standard of living Job, home and medical care

Means of Achieving the Welfare State Nationalisation of Utilities and Industries –These industries to be operated for the benefit of the citizens and not making profits –To create employment and keep these services affordable Provision of Social Welfare –Welfare Benefits Provision of Health and Medical Care –National Health Service (1948) Free basic medical service for all citizens

Problems of Welfare State Low Efficiency –Reliance on government funds to survive –Long waiting queues at hospitals and clinics Increase in Government Spending –Costs of welfare benefits unchecked The ‘Why Work’ Attitude –Little motivation to work Loss of businesses –More money to be generated from taxes to pay for welfare services –Reduction in profits discouraged investments

Margaret Thatcher Wanted to improve the NHS 51

52 How has the British government managed the NHS over the years? Key Criteria: –Ensuring that healthcare spending is put to good use by: Managing Government Spending Increasing Efficiency Providing Quality Service

53 How has the British government managed the NHS over the years? Managing Government Spending –Balance government and the increasing of taxes –1980s – Dental and optical treatment was no longer free except to students under 19, expectant mothers and mothers with children under the age of 1

54 How has the British government managed the NHS over the years? Managing Government Spending –Increase in contributions to the National Insurance Tax in 2003 to finance healthcare –The government justified the increase in national insurance tax and at the same time manage to balance its spending to provide healthcare services to the public especially to the needy

55 How has the British government managed the NHS over the years? Increasing Efficiency –In order to continue to provide quality healthcare despite the rise of demand for NHS services and the insufficiency of medical personnel, Margaret Thatcher introduced privatisation for non- medical services (e.g. cleaning, laundry, meals preparation) so that hospital staff could concentrate on providing healthcare services

56 How has the British government managed the NHS over the years? Increasing Efficiency –By using private companies, whose aim is to make a profit, the non- medical services were more efficient and cost-effective. –Hospitals would improve their services to meet the need of the people and patients would have more choices in healthcare.

57 How has the British government managed the NHS over the years? Providing Quality Service –NHS Plan (2000) to improve poor service standards such as long queues and waiting times Allowing NHS patients to use private hospital care without them paying for it

58 How has the British government managed the NHS over the years? –NHS Improvement Plan (2004) Choose from 4 different healthcare providers Access medical records via the internet NHS Direct – Medical advice offered over the phone –This will help reduce the queues at the NHS and ease the strain on resources and medical staff so that they can attend to more urgent cases.

59 How has the British government managed the NHS over the years? –Which is the most effective factor: Improving efficiency is more effective because when efficiency is improved, it will lead to an improvement in quality services as people will not have to wait so long for treatment and medical staff can focus on urgent medical services. This will help the government manage its spending people would be more willing to pay for better service and not rely on the government to provide them