1. Chapt 3: Managing Healthcare Case Study of Singapore

2. Learning Points Identify the challenges governments face in managing healthcare Identify some ways that healthcare is paid for in a country

3. Challenges that Governments Face… 1.Healthcare is considered as a public good - The citizens expect the government to provide basic healthcare for them - Limited resources 2.The need to provide quality healthcare - Longer lifespan of people - People in more developed countries expect more & better healthcare services

4. Challenges that Governments Face… 3.Increasing expenditure on healthcare - People demand for the better treatments, more effective medicines and better-qualified medical staff

5. How is healthcare paid for? Healthcare Government taxes Personal Insurance Employer- paid insurance Self

6. Healthcare in Singapore

7. Learning Points 1. Identify how the government managed healthcare expenses before the 1980s 2. Identify how the government manages healthcare expenses after the 1980s

8. Life in Singapore 1960s and 1970s

11. What are the effects of poor housing conditions on people’s health?

12. Singapore Healthcare In the 1950s and 1960s Polyclinics were known as health centers. They are mostly located in rural areas. Medical staff brought help to the people living away from town areas in mobile health centers (vans). To improve healthcare, government trained a huge no. of nurses and doctors in hospitals. The government also educate people on how to prevent illness through health programs. To keep people healthy, students were introduced to physical education.

13. Video – Singapore Healthcare After the 1960s Improved healthcare services like having more clinics and medical staff. Health programs like being healthy at work and going for medical checkups are implemented.

14. How does the Government managed Healthcare Expenses? Healthcare expenses comes from the government budget Government budget is spent on needs of the people E.g. healthcare, education, transportation, housing … What is govt budget? The amount of money that the govt plans to spend on meeting the needs of the people

15. Others – 96% Healthcare – 4% Singapore’s Healthcare Expenditure (2008)

16. Problems in the early 1980s: rising cost of healthcare → strain on govt spending due to limited resources Solution: 1. Individuals must have self-reliance & to maintain good health 2. Government will keep healthcare affordable and will promote healthy living 3. Community will provide some healthcare services and other support services How does the Government managed Healthcare Expenses after the 1980s

17. Do you know the cost of healthcare in Singapore?

18. Charges of Hospital Wards Class of Ward / Charges per day (SGD) A (1&2)B (1&1+)B2C Restructured Hospitals AH / CGH / KK / NUH / SGH / TTSH 196 – 295113 - 17750 - 5725 – 29 Private Hospitals ESH / GH / MAH / MEH / TMC 200 – 460135 – 200110

19. Breakdown of Hospital BillAmount Payable (S$) Room & Board (5 days) 750 Hospital Miscellaneous Expenses Prescription drugs Diagnostic Procedures Operating Theatre Fees 2,950 Anaesthetist Charge 500 Surgeon’s fee1,700 ICU (2 days)2,250 Post-Hospitalisation Treatment800 Total8,950 Assume a person is hospitalized due to inflammation of the appendix and underwent an appendicitis operation. Staying a total of 7 days in a private hospital with 2 days in ICU, his total hospital bill came up to S$8,950.

22. Assume a person is hospitalized due to Heart Disease and underwent a Coronary Artery Bypass Graft surgery. Staying a total of 9 days in a private hospital, his total hospital bill came up to S$18,900. Breakdown of Hospital BillAmount Payable (S$) Room & Board (7 days)5,870 ICU Charges (2 days) 1,630 Surgical Procedure 9,000 Surgical Implants / Approved Medical Consumables 2,400 Total18,900

23. Role of an Individual To have self-reliance How? 1. Medisave (what is it?) 2. Medishield (what is it?) What is self- reliance? Citizens to be responsible for themselves and take care of themselves

24. Central Provident Fund (CPF)

25. Medisave Comes from the individual’s CPF Can be used to pay for hospital bills and medical treatment

26. MediShield National healthcare insurance scheme Individuals pay for this through Medisave Why is it required? Isn’t Medisave sufficient? -For people who needs long-term treatment who cannot afford their treatment fees or hospitalization fees and Medisave cannot cover the fees.

27. Advantages of Singaporeans being self-reliant Singaporeans share the cost of healthcare with the government by paying for their own healthcare Help lighten the government’s load -> Government does not need to increase taxes Problem: Does every Singaporean have CPF? So how are they going to pay for their healthcare costs?

28. Role of the Government 1. To keep healthcare affordable How? 1. Government subsidies (to who?) 2. Medifund (what is it?) 3. Restructuring of hospitals 4. Means-testing A total budget of $3,705 million has been allocated to MOH for FY2009 to promote good health and keep healthcare affordable

29. Government Subsidies Direct subsidies given to govt hospitals, polyclinics and some nursing homes for elderly. Lower income group receive the most subsidies. Govt gives different rates of subsidies to the different classes of wards in hospitals. Class C receive the most in subsidies.

31. Medifund A sum of money set aside by the govt Started in 1993 with a fund of $200 million For people who cannot pay for their medical fees despite Medisave, Medishield and govt subsidies E.g. low-income workers, self-employed people who do not make any CPF contributions People who need help apply for the fund at the hospital where they are being treated

32. Restructuring of Hospitals Hospital have the freedom to reorganise to meet the needs of the people Hospital becomes financially independent from the govt where they have their own board of directors therefore govt able to reduce the amount of subsidies to hospitals

33. Govt belief: Subsidies should benefit patients who need them the most Govt gives heavy subsidies to polyclinics and government hospitals especially to class B2 and C wards. Means-testing implemented in Jan 2009 where lower-income group will receive a higher amount of subsidies than the higher-income group Means testing takes into consideration the patient's monthly income and ownership of private property. Means-testing Checking the financial background of a person to see if they are able to afford healthcare

34. Role of the Government 2. Promote a healthy lifestyle How? - By having health programmes in schools and workplaces Good health Will not need medical treatment Save medical expenses

37. Role of the Community Community needs to provide healthcare support services as it is not possible for the govt to run all of them 1. Voluntary welfare organizations 2. Private organizations They are given grants to run community hospitals, nursing homes, day rehabilitation centres

38. Role of the Community Voluntary welfare organizations E.g. Ren Ci, St. Andrew’s Community Hospital Private organizations E.g. NKF (cater to the needs of specific groups of people such as the poor or those with a particular illness)

39. How successful is the healthcare policies in Singapore? EffectiveIneffective  Provided Singaporeans with the money to pay for healthcare  There are still groups of people who are still not able to pay for their own medical expenses: 1. Elderly 2. People who are unable to work How are they going to pay for their own healthcare then?

40. 1. Self-reliance Medisave MediShield 2. Maintains good health 1.Keeps healthcare affordable Govt subsidies Medifund Restructuring of hospitals Means-testing 2. Promoting a healthy lifestyle Voluntary welfare and private organisations provide healthcare and support services Singapore: Shared Responsibility in Healthcare IndividualGovernmentCommunity

41. http://worldfocus.org/blog/2009/01/27/ the-fundamentals-of-singapores-health- care-system/3795/ http://worldfocus.org/blog/2009/01/27/ the-fundamentals-of-singapores-health- care-system/3795/ http://www.geraldtan.com/medaffairs/ meanstest.html http://www.geraldtan.com/medaffairs/ meanstest.html