How much responsibility should the government/ individual take for the

healthcare of an individual citizen?Britain

(90% govt, 10% ind)

v.s.Singapore

(50% ind, 40% govt, 10% community)

Managing Healthcare in Britain

British WelfareWelfare System• Recommended by

Beveridge Report (by Sir William Beveridge) to end poverty, diseases and unemployment after WWII

• Welfare system Welfare system to look after citizen from ‘cradle to grave’ started in 1948

Healthcare: National Health Service (NHS)

• Basic healthcare services are free for all citizens

• Healthcare system based on meeting the needs of the people, rather than focusing on the ability to pay

Healthcare: National Health Service (NHS)

Benefits:•Ensures that the people had a minimumminimum standard of welfare for a decent life•People were happy with the system and continued supporting the government

Main problem: Inability to handle

demand

• Methods to solve problems must

(In your explanation)(1)Reduce demand(2)Increase resources(3)Change the way the resources are used

so that patients who really need the services can access it

Main problem: Inability to handle

demand

Problems and Solutions

Over-expenditure on Healthcare

Low efficiency Low quality of service

ProblemsProblems

SolutionsSolutions

Encouraging self-responsibilityEncouraging self-responsibility

Increase efficiencyIncrease efficiency

Provide quality serviceProvide quality service

• Some services were no longer free

• Some services were no longer free

• Privitisation within NHS

• Privitisation within NHS • NHS Plan (2000)

• NHS Improvement Plan (2004) – Providing choices

• NHS Plan (2000)• NHS Improvement

Plan (2004) – Providing choices

1) Encouraging self-responsibility

• Managing spending by encouraging self-responsibility– Cutting back on

government spending on healthcare

– Create a system where the individual is more responsible for one own’s healthcare and welfare

Margaret Thatcher (1980s)

Problem: Over-expenditure on Healthcare

1) Encouraging self-responsibility

• Encourage responsibility for own health–Medicine, dental

treatment and optical services were no longer free except for some groups: e.g.• Expectant mothers• Students under 19

Helps to reduce demand and wastages!

1) Encouraging self-responsibility

• Managing spending by encouraging self-responsibility– Cutting back on

government spending on healthcare

– Create a system where the individual is more responsible for one own’s healthcare and welfare

Margaret Thatcher

British were

British were

unwilling to

unwilling to

accept this!!

accept this!!

1) Encouraging self-responsibility

Tony Blair (2000)

“..NHS remains the

symbol of social justice.. So that

every patient can access treatment

whenever they want and need

…”

1) Encouraging self-responsibility

Tony Blair (2000)

“..We decided to make a

historic commitment to

a sustained increase in NHS

spending. We would spend the

money if, but only if, we also

changed the inefficiency of

the NHS…”

1) Encouraging self-responsibility

Tony Blair (2000)

• Increasing taxes– Increases in

National Insurance contributions in 2003

– Spent £69 billion for NHS (15.8% of budget)

2) Privatization

• Policy of Privatization • Contract out non-medical

services – laundry, cleaning, catering– Private companies are

concerned with profit-making, thus they would try to remain competitive and efficient

• Hospitals can concentrate on medical services improve their own efficiency

Problem: Low efficiency

3) Increase quality of service

Focus:Focus:•Patients were given more information to make informed choices of treatment and care•Putting the needs of patients as top priority

Problem: Low quality service

3) Increase quality of service

NHS Improvement Plan (2004)

MoreMore choices: Patients could choose from four different healthcare providers and NHS would pay for the treatment

NHS Direct: provide medical advice over the phone to patients with minor illnesses saves time and money

Has the British Healthcare Policies met the needs of the

people?Many different opinions from the people….

• People of Britain identify themselves with and feel strongly about it

• British citizens are grateful for the system

• Many great improvements to the system

Has the British Healthcare Policies met the needs of the

people?Many different opinions from the people….

• No real improvements to the system – still low efficiency and quality of service

• Excessive government spending

• More reforms needed to meet the changing needs of the population

Problems and Solutions

Over-expenditure on Healthcare

Low efficiency Low quality of service

ProblemsProblems

SolutionsSolutions

Encouraging self-responsibilityEncouraging self-responsibility

Increase efficiencyIncrease efficiency

Provide quality serviceProvide quality service

• Some services were no longer free

• Some services were no longer free

• Privitisation within NHS

• Privitisation within NHS • NHS Improvement

Plan (2004) – Providing choices

• NHS Improvement Plan (2004) – Providing choices

Healthcare in Singapore

Healthcare in Singapore

• Challenges of managing healthcare

• Who pays for the healthcare services in Singapore?

• Singapore healthcare system – Individual, Government, Community

• Have Singapore’s healthcare policies met the needs of the people?

Healthcare in Singapore

• What are some complaints that you have about healthcare in Singapore?– Visiting a doctor?– Getting MCs?– Paying for the bills?

Healthcare in Singapore

• Providing basicbasic healthcare

• Providing quality quality healthcare

• Providing affordableaffordable healthcare

What are the challenges of managing healthcare in Singapore?

To ensure that all Singaporeans who need the healthcare service can afford it..

(In your explanation)

(1)Reduce demand(2)Increase resources(3)Change the way the resources are used(4)Make healthcare affordable

so that patients who really need the services can access it

Government’s approach to Healthcare in Singapore today.

What is the approach to healthcare in Singapore today?

Medisave• A certain amount of money

from people’s Central Provident Fund (CPF) is put into their Medisave account

• This money can be used to pay hospital bills and certain medical treatment when needed.

How is the Individual responsible for his own healthcare?

• Why Medisave?–Medisave encourages

Singaporeans to be responsible for their own health

– Government does not have to increase taxes, or take on the burden of healthcare in Singapore.

– Healthcare as a shared responsibility. How is the Individual responsible for his own healthcare?

• Brainstorm:

Is Medisave all good and sufficient?

How is the Individual responsible for his own healthcare?

• So.. Is Medisave enough?

Source A: A view by a heart specialist, Dr Charles Toh, on the medisave

scheme in 1983.

With Medisave, people would have to take care of themselves. Sometimes, the financial burden would be transferred to their children when a person cannot pay his hospital bill. Worse of all, what about the people who cannot pay their hospital bills?

Is Medisave all good?

Source B: A comment by the retired and former Health Minister, Dr Toh Chin Chye, on the Medisave Scheme in 1983.

Healthcare is the responsibility of the government. It is the duty of the government to find ways of using taxpayers’ money to meet different objectives. Moreover, smaller companies would find it hard to bear additional costs arising from Medisave.

Bad point: • Not all Singaporeans

make CPF contributions and therefore, do not have Medisave. –E.g. Tuition teachers,

self-employed Singaporeans.

How is the Individual responsible for his own healthcare?

MediShield • National healthcare insurance scheme• Medisave is used to pay for this scheme• Patients can make claims from

MediShield to pay for large hospital bills that Medisave does not cover.

How is the Individual responsible for his own healthcare?

MediSave STILL not enough..

Lucky got MediShield…

MediSave STILL not enough..

Lucky got MediShield…

Why MediShield? • To help people who

require long-term treatment of more serious illnesses but are unable to pay for their hospitalization

How is the Individual responsible for his own healthcare?

Is MediShield good?• Healthcare is made

more affordable• Needs of specific

groups of Singaporeans are catered to – Dependent on the

premiums you can pay

How is the Individual responsible for his own healthcare?

Maintaining Good Health

• Stay strong and healthy by doing more exercises and eating right

• Save possible expenses on healthcare

How is the Individual responsible for his own healthcare?

Summary• Medi-S2

–Medisave–MediShield

• Maintain good health

How is the Individual responsible for his own healthcare?

MS2

Government’s approach to Healthcare in Singapore today.

What is the approach to healthcare in Singapore today?

• Government provides monetary aid to organizations that provide healthcare support services

How is the Community responsible for healthcare?

• Why?– The community

can provide some healthcare support services for Singaporeans.

– It is not possible for the government to run all healthcare services

How is the Community responsible for healthcare?

• Examples: – Voluntary welfare

organisations and private organisations are given money to run community hospitals, nursing homes and day rehabilitation centres for patients

How is the Community responsible for healthcare?

Government’s approach to Healthcare in Singapore today.

What is the approach to healthcare in Singapore today?

Government subsidies • Direct subsidies are given to government

hospitals, polyclinics and some nursing homes for the elderly

• Subsidies to lower classes of wards in hospitals (Class C) to help the needy

Why such subsidies?

• To ensure that basic healthcare services are available for all Singaporeans

How is the Government responsible for healthcare?

Medifund• $200 million and the interest earned

from this fund, is given to public hospitals to provide help for needy patients

• Patients who need help can apply for this fund at the hospital

How is the Government responsible for healthcare?

Why Medifund?• For Singaporeans who are unable

to afford healthcare despite Medisave, Medishield and government subsidies. –E.g. low-income workers, or self-

employed people.

How is the Government responsible for healthcare?

So… Is Medifund good?• Ensures that basic healthcare is

affordable for Singaporeans

How is the Government responsible for healthcare?

HURRAY FOR Medifund!!! HURRAY FOR Medifund!!!

Through Medishield and Medisave

Note: Government’s role here is to encourage.

How is the Government responsible for healthcare?

Why?• A healthy person will

not require medical treatment and therefore, he can save on medical expenses.

How is the Government responsible for healthcare?

• How?–Schools and workplaces

have programmes to emphasise on the need to maintain good health• E.g. physical education

classes in schools• E.g. posters to encourage

healthy eating in canteens

How is the Government responsible for healthcare?

How is the Government responsible for healthcare?

Government’s approach to Healthcare in Singapore today.

What is the approach to healthcare in Singapore today?

Is healthcare in Singapore affordable?

•Medisave helped patients who have little savings afford healthcare•Medishield and Medisave helped patients pay for part of hospital’s bill

YES!

Is healthcare in Singapore affordable?

• Elderly who used to work but had no schemes to help them make compulsory savings – dependent on family members, community and government• People who are unable to work – dependent on government for their healthcare needs

NO!

Is healthcare in Singapore successful?

• High quality of healthcare services• Increased life expectancy• Low infant mortality• Used only less than 3% of National Income • People are more aware of the need to be responsible for

their own healthcare – Medishield/ Medisave• Medifund for the needy• Community help/ services for the needy

YES!

Is healthcare in Singapore successful?

•Old people without medisave/ insurance not able to afford healthcare services•Healthcare costs is continuing to rise• Still very much dependent on government subsidies

NO!

Government’s approach to Healthcare in Singapore today.

What is the approach to healthcare in Singapore today?