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Wednesday, September 30th, 2020

Singapore healthcare system not completely subsidised

by September 24, 2017 General

SEPTEMBER 24 — Singaporeans may not have gotten to vote for their president but we take comfort in the fact that we live in a developed country.

We certainly have developed world level infrastructure and then there’s our renowned healthcare system: the one that allows every Singaporean world-class care they can afford without placing a huge burden on government revenues.

Singapore has world-class healthcare that’s affordable for citizens and doesn’t burden the government?

Isn’t that amazing and a model every other country on earth should emulate?  Well, sort of. 

Singapore has a complex multi-tiered, multi-scheme, multi-payment type system of healthcare. It is a unique model; not like Britain’s effectively free (for patients) National Health Service, or France’s compulsory state backed insurance system or the USA’s expensive insurance driven hodgepodge.

To start with, nothing is free. Singaporeans pay for every bit of healthcare we receive.

The historical Bowyer Block which is part of the Singapore General Hospital... healthcare in Singapore is not fully subsidised but generally accessible to all citizens. — Picture from commons.wikimedia.orgThe historical Bowyer Block which is part of the Singapore General Hospital… healthcare in Singapore is not fully subsidised but generally accessible to all citizens. — Picture from commons.wikimedia.orgHowever, the amount we pay is subsidised and it depends on what we can afford.

Those whose incomes fall into lower brackets pay less than high income Singaporeans.

There are also different categories of wards eg. Class A, B and C wards with only the cheaper lower tiers — B and C — available to those receiving subsidies.

The system is essentially based on co-payments with the government paying for a portion of the treatment via a subsidy and the patient paying a portion depending on income.

Singaporeans can also make their share of the payment using Medisave, a compulsory saving scheme where about 8 per cent of an employee’s monthly income is transferred to a fund that can only be drawn out for health-related payments.

Then there’s Medishield which provides a certain degree of insurance coverage at a low rate and Medifund which covers patients in serious financial difficulty ie. those who have exhausted their Medisave funds etc.  

It is a comprehensive but very complex system but broadly it does allow Singaporeans, even those in low income brackets, to access a world-class health system.

Globally Singapore has been held up as a model for healthcare and our system fares well in World Health Organization (WHO) studies.

Recent reports though have shown Singapore’s healthcare model might not be all that it seems.

A New York Times article rated the system as weaker in terms of value for money and outcomes when compared to that of other world top-tier healthcare systems ie. those in Canada, Germany the UK and France etc.

What counted against Singapore was a lack of data on certain metrics compared to other leading health care systems, poorer outcomes in some categories like heart attacks and strokes and crucially cost.

Singapore’s healthcare system is cost-effective for the government. Our government, despite being among the richest in the world, spends just about US$1,000 (RM4,198) per citizen on healthcare — a fraction of what is spent by other developed nations.

The French government spends about US$4,000 per citizen on healthcare and even the private-sector loving US government spends upwards of US$4,000 per citizen on healthcare.

But, costs can add up for the user especially in instances of a chronic or terminal illness. Also, the system has drawn flak for being overly complex.

Government subsidies, Medisave, Medishield, Medifund; it is hard to keep them straight. Means tested payment scales come with its fair share of criticism too, time-consuming for one.

The number of income brackets is also mind bending; someone whose monthly income averages (it is not just a payslip, it is an average) S$3,350 (RM10,457) gets 79 per cent of their stay in a Class B ward subsidised but someone who averages S$3,351 gets only 78 per cent subsidised and it changes again for someone with an average of S$3,501!

Forget the ailment or treatment, working out how much you are going to pay is painful.

Another thing that could counts against the system overall is that just about every middle-income Singaporean also takes out private health insurance.

In the UK though, less than 10 per cent of the population sees the need for private health insurance as they feel the government system is sufficient.

Again, it is not necessarily a bad thing that people have private insurance and there is truth in the government’s old mantra that co-payment encourages responsibility and stops systems being over used.

At the end of the day, no one can say Singapore’s healthcare system is not healthy. By global standards it’s pretty good, but is it a model for the rest of the world to follow? That, I am not sure.

* This is the personal opinion of the columnist.