Singaporean Healthcare, the last decade
Background
Singapore is currently ranked 3rd best healthcare infrastructure in the world.
From a small fishing village to one of the world’s top competitive cities, Singapore has come a long way in a short span of 50 years.
As she celebrates her semicentennial, I wanted to take a closer look at the healthcare system in Singapore.
- From policy to implementation
- Impact on Singaporean citizens
- Grassroot sentiments of policy
Thus forming a full feedback cycle.
I wanted to start by presenting data from the World bank:
I observed an interesting trend in the pre-Lee Hsien Loong era. The election years tend to have a smaller percentage of money spent:
However, of course in absolute dollars, due to Singapore’s rising GDP, the dollar amount spent has been increasing:
Comparing with inflation, it still seems very stable and we are still spending at a rate slower than inflation (note the gradients of the two graphs)
Compared to the USA Singapore’s expense is rather minimal:
Now begs the question, what are the things the money has bought?
Over the time of this data 3 new hospitals have been setup:
- Changi GeneralHospital
- Khoo Teck Phuat Hospital
- Ng Teng Fong General Hospital
Judging from the location of the hospitals, this was set up to help to cover the periphery locations of the east, west and north.
Policy
Healthcare policy in Singapore is dictated by the Ministry of Health (MOH). In terms of legislation, over 20 acts fall under the scope of MOH ranging from enforcement of drugs to promotion of elderly wellbeing.
As of now, there are multiple schemes to help with medical payments:
- Medisave
- Medishield
- Medifund
- Eldershield
Medisave is part of the superannuation CPF funds. All employees are required to set aside 20% of their monthly pay and employers are required to contribute an additional 17% (to 7.5% dependent on age). The amount is further split into 3 accounts, ordinary, special and Medisave. The amount that goes towards Medisave increases with age:
Medishield acts as universal insurance that covers all Singaporeans. Wealthier Singaporeans can opt for better coverage, however, Medishield will be enough to cover 80% of class B2 or class C hospitalization.
Medifund will further reduce the burden of payment for the poor.
Elderfund helps to offset expenses that arise from disability from old age.
In order for the healthcare system to be sustainable, it must weed out selfish individuals who may wish to take advantage of cheap/ free healthcare. I believe from the financial policies that were set, all individuals are forced to feel a pinch (adjusted for financial background) whenever they visit the healthcare facilities. The subsidies given are adequate to cover bills but still ensure individuals work to support themselves. With an aging population and a larger age dependence ratio, sustainability of the healthcare system will be a top priority.
Present population profile:
Singapore is definitely facing an increasingly aging population:
The recent pioneer package in my opinion was probably a test bed to gauge what is going to be the best way to tackle the aging population crisis without a lax in the immigration policy, resulting in increased dissent amongst the population.
Compared to other developing nations, Singapore is still playing catch up. There is still time to perfect policy to ensure the healthcare system is sustainable for a long time to come:
Why is policy important?
I view policy as a nation’s strategy to tackle competitive forces both foreign and domestic. What follows after policy is for the relevant public bodies to interpret the policies and figure out how best to implement them with the least required manpower and resources and minimum amount of time.
The public hospitals are governed by two main companies:
- National Healthcare Group
- Singhealth
For historical reasons, they were split up according to geographic locations and grouped into clusters. I believe the split was to create separate processes to mitigate risks.
In spite of being separate legal entities, the IT architecture is very similar. Both groups have run a gamut of applications such as iPharm, Medinet, Cloverleaf. A SAP backbone supports the integration of the services and billing. SAP also helps to interface directly with MOH to share data such as bed utilization for policy makers to make more informed decisions.
Integrated Healthcare Information System (IHIS) was set up to consolidate all IT efforts across the public healthcare sector in a bid to reduce costs. IHIS helps to consolidate procurement contracts and IT resources such as servers to ensure optimal usage.
For the pioneer generation policy, a few changes had to be implemented within SAP in order to grant the correct patients the extra 50% discount. The business logic within the enterprise resource planning system had to be updated to flag out the correct patients who fulfilled the criteria of being 65 years of age and above as well as obtained their citizenship before 1987.
The subsidy had to be implemented across the various service billings such as outpatient scans, drug subsidies etc. Good policy with poor implementation would be futile.
Impact on Singaporeans
How has it impacted Singaporeans. Policies tend to take a minimum of 2 to 3 years before their impact can be properly assessed.
The Medisave system seems to be working and has helped to keep the healthcare bill stable at around 4% despite an aging population. The amount that is saved through good policy and adoption of technology to implement the policies (and drive productivity) will ensure the healthcare system remains viable for the next decade.
Grassroot Sentiments
In order for the government to stay in power and control the parliament with a majority vote, they must come up with policies that make sense and at the same time, win the hearts of the people. There is no point in having the best policies if the public votes you out of office.
Recent years have seen an increase in alternative media and the tsunami of critical viewpoints on blogs and social media. The recent blogger, Roy Ngerng has very vocally criticized the CPF system. His is just one of the few blogs that present an alternative view including the Real Singapore TREmeritus and the Online Citizen. Despite the growing readership of alternative media, it is difficult to gauge the level of support the people for and against the government.
