Rethinking healthcare financing in Singapore

[metalslug]

http://yoursdp.org/index.php/perspe...king-healthcare-financing-in-singapore-part-1

Rethinking healthcare financing in Singapore: Part 1
Thursday, 09 June 2011
Singapore Democrats
Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye

Singapore's health care system and the financial system that underpins it are coming under increasing strain with Singaporeans finding it harder and harder to afford health care especially when they require prolonged hospitalisation.

There must be a rethink of our healthcare system if we are going to provide the people with affordable and efficient medical care.

First, universal health care must be the raison d'etre of a First World health care system. That is, legislation must be enacted to ensure that every single citizen is covered by a basic health care policy regardless of age, employment status or gender.

Second, the health tax (or premium) that each citizen contributes to the national health care plan as well as out-of-pocket expenses must always remain affordable.

Everything we discuss about health care reform must spring from and be underpinned by this fundamental principle of universal, affordable coverage.

Affordability vs choice

The main bugbear of many universal health care systems is that citizens are presented with Hobson's choice: Affordable but low-quality health care in run-down state institutions or high-quality care in unaffordable private institutions.

This need not be the case. We can, and should, introduce a health care model with universal health care coverage that allows the patient to choose his health care provider — public institutions, partially subsidized private facilities, private institutions — but the plan will only pay up to the official tariff.

Additional flexibility is ensured by allowing private insurers to sell supplementary insurance to those who want a higher level of service.

Funding Model

Taiwan, the Anglo-Saxon countries of Britain, Canada, Australia, and the Nordic countries have a single-payer system, whereby health care for the entire population is financed from a single pool to which several parties — the state, employers, employees — have contributed.

Contributions from citizens and residents to this pool are collected by way of a flat tax or premium paid to the state. The government administers and disburses funds from this pool to finance health care services for the population.

An alternative model is the multi-payer model used in Switzerland, Holland and Germany, where health care is financed both from a public pool — run by the government — and private insurance. Under this system, everyone is mandated by law to buy basic health insurance from any of a group of nationally appointed private insurers. These insurance plans are provided on a not-for-profit basis.

The premium is standardised for a particular policy regardless of age and is paid out-of-pocket up to a fixed percentage of income; the government tops up the rest. For the unemployed, infirm, aged and handicapped, the government pays the entire premium. A deductible as well as a co-payment fee is charged per treatment.

The single-payer model is easy to implement and administer, but it may involve more government bureaucracy in the long term at taxpayers' expense.

The multi-payer model has the advantages of requiring less government with a correspondingly lower burden on income taxation, and providing a choice of plans for the people. Providing the government audits and regulates the insurers strictly, private insurers may provide sounder actuarial risk management than the state and at the same time act as a check on health care providers to minimise unnecessary treatments and prescriptions of expensive drugs.

However, the downside is that premiums tend to rise over the years as insurers struggle to cope with burgeoning health care costs.

Healthcare Contingency Fund

Despite active cost containment measures, health care spending in practically every developed nation has continued to rise unabated owing to inflation, ageing population, and increasing pharmaceutical costs.

We expect Singapore to follow this trend, and we therefore propose that the government set aside a Healthcare Contingency Fund of $20 bil, to be financed from our national reserves, to deal with future increases in the health care budget. This fund will be professionally managed and invested conservatively for an average return of 6% per annum.

The projected returns on the Healthcare Contingency Fund should be able to finance future annual increases in health care expenditure of up to 10% without dipping into the principal sum.

Part 2 of this article will make more suggestions on how we can reform healthcare financing in Singapore.

Drs Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye are medical doctors. They are also members of the SDP's Healthcare Advisory Panel.

 

[captainxerox]

there is always trade-off. healthcare can be funded by higher taxes, or sdp is proposing moving money from one ministry expenses e..g defence, to healthcare. for me, i rather use the money buy good pvt health insurance then pay higher tax for healthcare. why i subsidise other ppl's health problems? money from mindef can be spent on education instead of widespread healthcare.

 

[annexa]

Produce more doctors and nurses, then you can get good doctors at cheaper salary.

 

[metalslug]

http://yoursdp.org/index.php/news/singapore/4862-rethinking-healthcare-financing-in-singapore-part-2

Rethinking healthcare financing in Singapore: Part 2
Thursday, 16 June 2011
Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye

In Part 1 of this article, we made suggestions for establishing a system where every single citizen is covered by a basic health care policy into which the Government and the people contribute, and which must remain genuinely affordable.

To achieve this we further suggest a single-payer universal health care system in which the Government manages a central healthcare fund.


The annual government healthcare expenditure is currently $4 billion, or about 3.5% of GDP. Based on a total annual health care spending of $12 billion in 2009, the Government's portion is only one-quarter.

This amount should be increased to $10 billion annually and be paid into the central healthcare fund. Singaporeans will contribute $2 billion (or $500 per person) yearly, making the government to private ratio of healthcare spending 83:17.

This fund will be used to operate both public and private health care institutions as well as pay for all health care services.

Singaporeans' contributions will be taken from a $500 flat tax that will be deducted annually from every resident's CPF account. The Government will make up the difference if the CPF funds are inadequate to pay the tax in full. For those without CPF (students, housewives, part-time workers, pensioners) and who cannot afford to pay the tax, the Government will pay the tax for them in full.

In addition, we must legislate compulsory nationwide basic health, accident and pregnancy (for women) coverage for all citizens and permanent residents residing here for more than 3 months. No one may be rejected or excluded from this basic plan on the basis of age, gender, state of health. The usual exclusion clauses will apply: non-essential surgery, dental, alternative medicine, etc.

Private insurance and riders may be purchased from private insurers to cover for conditions not covered under the basic plan (e.g. dental care) and for a higher level of service (e.g. private ward hospitalization).

A table of standardized tariffs will be drawn up for all consultation charges, diagnostics and therapeutics, and ward charges. These charges will be reviewed on a regular basis with consultation with the public. The current means testing for medical subsidies will be abolished.

We propose that a co-payment fee of 10% be charged for medical services at the point of utilization to discourage over-consumption, up to a cap of $3,000 per year. This co-payment fee will be paid out-of-pocket by the healthcare user or by private insurance.

Where health care services are provided by private hospitals, the medical bill will be paid for by the plan at the rates specified for public hospitals. The difference will be topped up out-of-pocket or by private insurance.

Such measures will make redundant the Medisave and MediShield schemes which do not aid in the running of an efficient and economical healthcare system.

We continue to hear of Singaporeans being unable to afford treatment especially when their health concerns are major and require long-term assistance. For a country that boasts of such high GDP, such a situation is unacceptable. Much of the problem that exists stem from the fact that the current system is very much a profit-making scheme.

These ideas that we have put forth will help make our system more transparent, and return medical care in Singapore back to one that is health-centered rather than profit-oriented.

Drs Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye are medical doctors. They are also members of the SDP's Healthcare Advisory Panel.

 

[Taro Ries]

Singapore should take a leaf out of Michael Moore's expose.
http://www.youtube.com/watch?v=xlDAUKSh9CQ

 

[metalslug]

http://yoursdp.org/index.php/news/s...hcare-financing-in-singapore-part-3Rethinking

Rethinking healthcare financing in Singapore: Part 3
Monday, 20 June 2011
Singapore Democrats
Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye

Health care costs have been spiraling in many developed nations. They are driven primarily by hospital fees, physicians' remuneration, and pharmaceutical expenses.

In order for healthcare expenditure, both public and private, to remain under control steps must be taken to manage the costs of the above three areas. In the third and final part of this series, we propose measures on how this can be done.


One, the Government should require drug companies to license their patents to the state for a fee. The government can then manufacture these drugs for the people at sell them at a controlled rate.

Compulsory licensing allows a country to circumvent unfair patent laws in order to combat serious diseases (eg. AIDS) and epidemics by providing affordable medicines to the people. In this way expensive proprietary drugs can be prescribed without ballooning pharmaceutical costs. This approach was adopted under the DOHA Declaration and is practised in countries like Brazil, India and South Africa.

We should also invest in the manufacturing of generic drugs as well as the production of medical devices such as stents, prostheses and other instruments. This will help to cut health care expenses and will have the added advanateg of creating more jobs. Deals with suppliers of such instruments must also be negotiated stringently to control costs.

Three, restructured hospitals should to be converted back to public hospitals and operated on a non-profit basis. At the moment, these state-run hospitals operate on a cost-recovery basis where the hospitals are expected to register profits.

All ward-classes should be removed. This reduces costs incurred by ward differentiation, advertisement for private patients, renovations/refurbishments of non-essential instalments, and marketing expenses. This results in more egalitarian and equitable health care delivery. Just because an A-class patient is richer, why should he get a hip replacement sooner than a C-class one?

Healthcare must not be reduced to merely a commodity to be purchased based on which patient can pay more. It is a service that is rendered to people who fall ill and to the elderly. The service to heal must be one based on care and compassion.

Four, medical practitioners and allied health professionals should be allowed to practice in public hospitals/polyclinics and vice versa. This reduces brain drain, redistributes talent more equitably between the public and private sectors, maximizes economies of scale, improves remuneration and working conditions for physicians.

In order to ensure that physicians don't overcharge and contribute to spiraling costs, clinical practice guidelines should be standardized and formalised in insurance tariff tables.

Additionally there must be legislation to limit damages awarded in malpractice suits. This not only reduces malpractice insurance premiums (which have been rising exponentially for the surgical disciplines) but also discourages defensive medicine where doctors order multiple, and often unnecessary tests to protect themselves from suits.

Finally, we should invest in health education, preventive healthcare and early detection to reduce overall costs, increase life expectancy and quality of life. Screening tests that have been economically evaluated to have a high cost-benefit ratio can be partially subsidized by the government.

Taken together, these measures will control healthcare costs in Singapore and make affordable medical care for all Singaporeans.

Drs Leong Yan Hoi, Tan Lip Hong and Toh Beng Chye are medical doctors. They are also members of the SDP's Healthcare Advisory Panel.

 

[Hans168]

It is really regretable that gahmen abdicated their responsibility from Medishield Plus by palming off to private insurers who are now cherry picking clients////

One rejects outright clients with BMI exceeding 30 while many whack you with exclusions and/or extra loading.

At least half of middle aged citizens are stuck with no insurance willing to accept them for medishield upgrade. What fucking gahmen do we have here? Highly irresponsible! Taxes want to take but social responsibility always avoid....