1. Chapter 3: Managing Healthcare: Case Studies of Singapore and Britain

2. Learning Outcome
A comparative study of public health care polices in Singapore and Britain
how policies work in different countries
impact of policies on society and nation
evaluate the effectiveness of the policies in meeting health care needs of the people and nation

4. Challenges Governments Face in Managing Healthcare
Healthcare = Public good which governments have to provide for the people, given the limited resources and competing needs of the country
Providing Quality Healthcare
Improvements in science and healthcare have enabled people to live longer
Today, people expect more and better healthcare services

5. Challenges Governments Face in Managing Healthcare
Increasing Expenditure on Healthcare
Funds have been invested in research for better treatments, more effective medicines and training for better-qualified medical staff
Individuals and governments want to have the best possible healthcare they can afford for themselves and their citizens respectively

6. How is Healthcare Paid For?
The government is responsible to make the best use of limited resources to meet the healthcare needs of its people

8. Healthcare in Singapore

9. Healthcare in Singapore
Managing Healthcare in the 1960s and 1970s
1960s: Healthcare was part of Singapore’s overall plans for improvement and development
E.g. Squatters and overcrowded areas were cleared and people moved to Housing and Development Board (HDB) flats

10. Healthcare in Singapore
Built hospitals, clinics and outpatient dispensaries to provide healthcare for a growing population
People had to go for vaccination against diseases
Medical officers and nurses were sent to schools to provide healthcare for students

11. Healthcare in Singapore
1970s: Improvement in Singapore’s economy + Better standard of living
People wanted better healthcare services
Polyclinics provided wider range of healthcare such as medical check-ups for babies
Conveniently located in town centres
Improvement in facilities in government hospitals and the quality of healthcare

12. Healthcare in Singapore
Government budget is used in to pay for the building of polyclinics, government hospitals and providing of healthcare services
5.9% of government expenditure on healthcare

13. Healthcare in Singapore
Approach to Managing Healthcare since the 1980s
Government’s concern = rising cost of providing healthcare

14. Healthcare in Singapore
1983: National Health Plan
Suggested that healthcare policies should not put a strain on government spending
Should encourage self responsibility and community support
Government should maintain policies to keep healthcare affordable

17. Healthcare in Singapore
Encouraging Self-Reliance
Medisave
Introduced in 1984
A certain amount (6-8%) from the workers’ Central Provident Fund (CPF) is channelled into their Medisave accounts
Can be used to pay hospital bills and certain medical treatment when needed

18. Your Boss will pay
You will pay

19. Healthcare in Singapore
Impacts: (1) Encourages Singapore to be responsible for their own health (2) Better able to pay for healthcare (3) Lighten government’s burden of paying for healthcare services – need not depend on raising taxes to pay for rising healthcare costs

20. Healthcare in Singapore
Medishield
National healthcare insurance scheme
Pay with their Medisave
Claim from Medishield to pay for large medical bills not covered by Medisave
Help people pay for their long-term treatment of more serious illnesses
Expanded its uses
paying premiums for Eldershield – pay for healthcare in case of disability of those above 40 years old

22. Healthcare in Singapore
Keeping Healthcare Affordable
Shared responsibility = individuals are self-reliant + the government ensures healthcare remains affordable
Government subsidies
Direct subsidies given to government hospitals, polyclinics and some nursing home for the elderly
Impact: Ensure basic healthcare services are available for all Singaporeans

23. Healthcare in Singapore
Different subsidies given to different classes of wards in hospitals
Class C wards receive the most subsidies
Impact: Ensure healthcare remain affordable to the middle-income group

24. Healthcare in Singapore
Medifund
Set up in 1993
Provide help to those who are not able to pay for healthcare
Government started with $200 m fund and the interest earned from the fund is used to help needy patients
Needy patients apply for the fund at the hospital where they are being treated

25. Healthcare in Singapore
Restructuring of hospitals
Started in 1990s
Hospitals have more freedom to reorganise to meet the needs of Singaporeans
Government is able to reduce the amount of subsidies to hospitals
Impact: Many people felt that restructuring = higher hospital bills
Singapore General Hospital

26. Healthcare in Singapore
Means-testing
Defn: The way to check whether the patients are able to pay for healthcare
Needy patients should get most of the subsidy while the richer ones should get the least.
Not implemented in government hospitals yet
Impact: Affordability of a patient is dictated by the government

27. Healthcare in Singapore
Promoting a Healthy Lifestyle
Helps to cope rising cost of healthcare for both the government and individuals
Schools and workplaces have programmes to emphasise the need to maintain good health
E.g. Regular physical exercises
Impact: Will not need medical treatment and save on medical expenses

28. Healthcare in Singapore
Working with Organisations
The community also provides some healthcare support services to meet peoples’ needs
Not possible for government to run all healthcare services
Voluntary welfare organisations and some private organisations are given grants (money given by the government) to run community hospitals, nursing homes and day rehabilitation centres
Government gives support to cater to the needs of the poor or with particular illness

29. WORKING WITH ORGANISATIONS

30. WORKING WITH ORGANISATIONS

31. Have Singapore’s Healthcare Policies met the needs of the People?
To a large extent
Still some people who cannot pay for the healthcare services that they need
The elderly
Did not have the opportunity to save for healthcare when they were earning an income
Have to depend on the family, community or the government to look after their needs
Those unable to work
Have to depend on the government for their healthcare needs

32. Healthcare in Britain

33. Origin of National Health Service (NHS)
1940s: The British government felt that it was their responsibility to look after the citizens
1942: ‘The Beveridge Report’
Recommended that the government put an end to poverty, disease and unemployment
Aim: To help rebuild people’s lives after WWII
Government thus created a welfare system for the people of Britain

34. Origin of National Health Service (NHS)
Welfare State
The government looks after the citizens from ‘cradle to grave’
E.g. (1) Maternity grant and allowance, (2) Child benefits, (3) Supplementary benefits for the sick, injured and unemployed, (4) Retirement pension and (5) Death grant

36. Origin of National Health Service (NHS)
Ensure that every citizen has a minimum standard of welfare for a decent life
Job + Home + Healthcare
People of the country contribute to a national fund to help the needy people in their country

37. Origin of National Health Service (NHS)
Started in 1948 – very popular
Provide free healthcare for its people
People do not have to pay for the medical treatments that they receive when they are attended to by doctors at clinics and hospitals
E.g. All medical services, dental and optical treatments were free of charge

39. Origin of National Health Service (NHS)
Impacts: (1) Too many people wanted to use the free medical care (2) Doctors used or recommended medical treatment freely without much consideration for cost
1951: Medical treatment was no longer free
E.g. NHS charge a small fee for medicine given to patients
E.g. Charge for dental treatment

40. Managing NHS Managing Government Spending
The money to pay for healthcare came from the people
If healthcare costs increase, the government has to collect more taxes to pay for healthcare and other expenditure
Government’s challenge: To control spending on healthcare
1980s:

41. Managing NHS 1980s: Government under Margaret Thatcher
Cut back on government spending on welfare benefits such as healthcare
Wanted a system that would make the individual more responsible for his own healthcare and welfare
Because the government was spending too much on welfare benefits
Impossible to remove free healthcare for the British
The NHS was the most important public good provided by the government

42. Managing NHS
2000: Prime Minister Tony Blair promised the people that the government would increased public spending on healthcare and improve NHS
Resulted in increase in the National insurance contribution in 2003

43. Managing NHS Increasing Efficiency
1980s: Growing demand for healthcare for the elderly
Slower population growth caused reduction in taxes over time
People also expect more and better treatments
NHS had grown very large but insufficient resources to cope with demand
E.g. Insufficient doctors, nurses and facilities in hospitals for surgeries

44. Managing NHS Privatisation of NHS
Aims: (1) To reduce government subsidies (2) Save costs (3) Make NHS more efficient
E.g. Contract out non-medical services
Impact: Allow hospitals to concentrate on providing medical services

45. Managing NHS
Impacts: (1) Private companies had to more efficient to make profits (2) Patients would have more choices (3) Hospitals would improve their services to meet the people’s needs (4) Brtish citizens encouraged to take responsibility for their own health (5) Medicine, dental treatment and services provided by opticians no longer free except for students under 19 years old, expectant mothers and mothers with children under 1 year old

46. Managing NHS Providing Quality Service
Late 1980s: People felt that NHS were of poor standard
1998: NHS focus on providing quality service for patients
Impacts: (1) Patients were given information to help them decide on their own treatment and care (2) Wait a long time to receive medical treatment

47. Managing NHS NHS Plan (2000)
2 plans were introduced to deliver quality service by putting the needs of the patients as top priority
NHS Plan (2000)
Made changes based on feedback from staff, patients and all those involved in healthcare
Provided for increase in the amount of government spending till 2004
To work towards offering patients faster and more convenient services
Allow NHS to use facilities in private hospitals without having the patient pay for it

48. Managing NHS NHS Improvement Plan (2004)
Patients have the right to choose from 4 different healthcare providers
NHS pay for the treatment
Every patient have access to their own personal HealthSpace on the Internet where they can view their care records

49. Managing NHS E.g. NHS Direct
A service to provide medical advice over the phone to patients with minor illnesses
Impacts: (1) Save a visit to the doctor (2) Not strain the resources of the NHS with doctors having to attend to too many patients

50. Have British Healthcare Policies met the Needs of the People?
To a large extent
The intention of providing healthcare based on need has remained unchanged since 1948
Challenge: NHS has to ensure that resources are best used to meet the needs of the people
Involves the provision of funds and the management of the NHS
Many Britons are thankful for the NHS and feel safe knowing that they can have medical services when they need them

51. Have British Healthcare Policies met the Needs of the People?
Doctors also feel that NHS has improved over the years
Others felt that there has been no real improvement
For the last 50 years, NHS has reformed to meet the changing needs of the people in healthcare