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<TABLE border=0 cellSpacing=0 cellPadding=0 width="100%"><TBODY><TR class=msghead><TD><TABLE border=0 cellSpacing=0 cellPadding=0><TBODY><TR class=msghead vAlign=top><TD class=msgF width="1%" noWrap align=right>From: </TD><TD class=msgFname width="68%" noWrap>kojakbt89 <NOBR></NOBR> </TD><TD class=msgDate width="30%" noWrap align=right>6:15 am </TD></TR><TR class=msghead><TD class=msgT height=20 width="1%" noWrap align=right>To: </TD><TD class=msgTname width="68%" noWrap>ALL <NOBR></NOBR></TD><TD class=msgNum noWrap align=right> </TD></TR></TBODY></TABLE></TD></TR><TR><TD class=msgleft rowSpan=4 width="1%"> </TD><TD class=wintiny noWrap align=right>44085.1 </TD></TR><TR><TD height=8></TD></TR><TR><TD class=msgtxt>Singapore needs health reforms not maybes from Minister Khaw Boon Wan
February 1st, 2011 |
Author: Contributions |
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During the Singapore Economic Policy Conference in 2009, a team of researchers from NUS and Singhealth made a presentation on “Singapore’s Healthcare System: Some Challenges” [URL]http://www.ess.org.sg/Events/Files/2009/Tilakppt.pdf[/URL]. Probably for the
first time ever has the topic of healthcare financing has been looked in such a sincere manner in Singapore. In all the other moments, one can never hear nothing except praises on how the system is one of the best in the world, how healthcare is so affordable and so on.
Minister Khaw Boon Wan, MOH and many others in Singapore constantly will dig up the world Health Organisation ranking excercise in 2000 of health systems across the world where Singapore was ranked as 6th. However experts around the world disputed the manner WHO had computed the final rankings though they found the individual component rankings on different areas of healthcare to be less objectionable. For instance, Singapore despite being ranked 6th on the overall was ranked one of the worst amongst all countries in the world for fairness in financial contribution. That factor itself is a paramount factor of healthcare systems and when a country ranks one of the lowest in that, it is highly debatable how that healthcare system can be given an overall high ranking. There were other similar anomalies and since 2000, there has been no second effort to rank healthcare systems. Then again the WHO report is still useful to look at rankings of countries in the various sub-factors.
The presentation at the Singapore Economic Policy Conference in 2009 was based on Singapore’s dismal global ranking in fairness of financial contribution. The team that presented their findings on a study of elderly patients admitted in 2007 in Singapore. This study revealed what a mess Singapore’s healthcare financing is in, contrary to popular belief and conviction that everything is perfect. The data clearly provided evidence to the popular talk by laymen in Singapore that one should die rather than get sick when old.
About 75% of the financing of hospitalisations of elderly patients was dependent on the patient and the patient’s family with the family being relied on more than the patient. ___________Half the elderly patient population paid their bills from their family members’ Medisave. [/SIZE]This clearly implies Singapore elderly do not have sufficient self means to
finance their healthcare expenditures that they need to heavily depend on their family. This is a catastrophe in itself because despite all the fascinating statistics Singapore can boast about how affluent its citizens are, their elderly are not even financially independent enough to meet their healthcare expenditure needs. This evidence also questions the claim that 3Ms are an enormous success in Singapore. On
the contrary, the evidence seems to suggest the 3Ms has serious failures. Moving forward with such declining fertility, marriage rates, increasing divorce rates and ageing population, the elderly ten years down the road may not have as many family members to pay their hospital bills.
The study also revealed that only 55% of elderly use Medisave to pay for hospitalisation. Majority of elderly also had an average of $5,300 in their Medisave balance falling short of the minimum sum of $27,500. These elderly did not have sufficient years of accumulation after the implementation of Medisave in 1984. However that is about two decades of time PAP had to fix the situation to make sure the elderly do not end up in such a situation in 2007. But they failed.
In terms of Medishield only 22% of elderly patients had Medishield coverage. Patients more than 80 years old had practically no coverage. The evidence for Medifund is even more pathetic. Less than 1% of elderly patients got Medifund assistance. This then raises the question of what is really the use of Medishield and Medifund despite
all that fanfare. The evidence clearly suggests there are serious failures in these two Ms also.
IN terms of private health insurance, only 8% of elderly are covered. It did partly help those elderly patients as it covered 62% of their hospital costs. Then again if only private health insurance had been much higher for the elderly of a population, which boasts of one of the highest per capita GDP in the world, the burden will have been much lower. However Singapore’s private health insurance industry is dominated by companies such as NTUC which are linked to the government. What is required is total liberalisation of the industry. So far only one major international private health insurance provider, AVIVA, is present in Singapore. That single player has already added so much competition to the landscape that if only there is total liberalisation, one can expect to see major leaps in the private health insurance policies offered in Singapore.
Unlike popular belief and rhetoric, there are serious failures in 3Ms. What Singapore requires is major reforms in this area. Unfortunately in a recent forum on healthcare budget Minister Khaw said that Medisave and Medishield coverage may be extended.
[URL]http://www.channelnewsasia.com/stories/singaporelocalnews/view/1107879/1/.html[/URL]
It is rather sad dilemma that while the 3Ms are in such a mess, all the population is receiving from their Minister is praises about how successful it is, constant claims healthcare is affordable and a lot of maybes. The evidence above clearly do not suggest healthcare being affordable.
Yet what Minister promises for the future is maybes. Unfortunately maybes dont reduce financial hardships of patients. Maybes are also nothing innovative. Maybes dont save lives or reduce diseases. If one is to review the health reforms PAP has put in place in the last five years, one can notice it has been nothing important in the area of
healthcare financing.
Means testing was subsequently introduced a few years ago despite promises by Minister Khaw in the last election that he will not introduce it within next two years. Many Singaporeans thought that if they satisfy the means testing they will get government subsidies to cover all their hospitalisation costs. But evidence suggest that the average subsidy received by elderly patients was only 70% in C ward.
During the last five years, PAP has been actively pushing side issues as main issues such as organ donation extentions, building aged care homes in JB, euthanasia etc. What is clear is that PAP will not be bringing the much needed reforms even in future to the healthcare.
PAP is led by beliefs and not evidence. For instance they claim that universal healthcare is free healthcare. It is not clear which textbooks they studied but as far as definitions are concerned, it is very clear that universal healthcare is not free healthcare. PAP also insists for last 50 years that universal healthcare will bankrupt the systems and raise taxes. There are so many successful countries in the world where their coffers have not become bankrupt and their taxes are also not increasing. However critics in Singapore government insist on picking countries around the world that did not do well in their universal healthcare system instead of picking those that succeeded. Even the authors of the above presentation from NUS and Singhealth recommended Singapore to consider universal healthcare.
Unfortunately the world does not revolve on the axis of anyone’s beliefs. Singaporeans must wake up to this hard truth. Evidence is also not what you put together to build your case. Rather evidence is telling as it is. Rejecting that based on one’s belief cannot make one’s belief a truth. For Singapore to see the required health reforms, we Singaporeans need to put aside the beliefs that we behold for five decades which we have built on cliches, rhetoric and propaganda. If Singapore healthcare system is as good as being claimed currently why are evidence about its effectiveness being kept secret and hidden from everyone. We need to study the proven and successful cases of countries which have adopted univeresal healthcare for decades, which are not few. Singapore totally lacks the capacity currently to emuluate such successes. What is required is major investment to build up that capacity over the next two decades.
Contrary to the central belief in PAP that spending generously on people’s health, education will make them lazy, dependent etc, the world’s safest and sustainable economies and countries are those where expenditure on health and education is high. To make a population productive instead of lazy, you need to use productivity improvement approaches and not spend less on health and education. Human capital
also has longer term returns than foreign direct investments and exports.
Unless you build a population that is mighty in the body and mind, it does not matter how much of foreign investment you can attract today or how much of exports you sell today. What propels a country to heights over longer periods of time is determined by how many capable people the country has. Exports and investments just gives some temporary one generation uplifts. So lets stop the maybes
.
Alan Seet
</TD></TR></TBODY></TABLE>
During the Singapore Economic Policy Conference in 2009, a team of researchers from NUS and Singhealth made a presentation on “Singapore’s Healthcare System: Some Challenges” [URL]http://www.ess.org.sg/Events/Files/2009/Tilakppt.pdf[/URL]. Probably for the
first time ever has the topic of healthcare financing has been looked in such a sincere manner in Singapore. In all the other moments, one can never hear nothing except praises on how the system is one of the best in the world, how healthcare is so affordable and so on.
Minister Khaw Boon Wan, MOH and many others in Singapore constantly will dig up the world Health Organisation ranking excercise in 2000 of health systems across the world where Singapore was ranked as 6th. However experts around the world disputed the manner WHO had computed the final rankings though they found the individual component rankings on different areas of healthcare to be less objectionable. For instance, Singapore despite being ranked 6th on the overall was ranked one of the worst amongst all countries in the world for fairness in financial contribution. That factor itself is a paramount factor of healthcare systems and when a country ranks one of the lowest in that, it is highly debatable how that healthcare system can be given an overall high ranking. There were other similar anomalies and since 2000, there has been no second effort to rank healthcare systems. Then again the WHO report is still useful to look at rankings of countries in the various sub-factors.
The presentation at the Singapore Economic Policy Conference in 2009 was based on Singapore’s dismal global ranking in fairness of financial contribution. The team that presented their findings on a study of elderly patients admitted in 2007 in Singapore. This study revealed what a mess Singapore’s healthcare financing is in, contrary to popular belief and conviction that everything is perfect. The data clearly provided evidence to the popular talk by laymen in Singapore that one should die rather than get sick when old.
About 75% of the financing of hospitalisations of elderly patients was dependent on the patient and the patient’s family with the family being relied on more than the patient. ___________Half the elderly patient population paid their bills from their family members’ Medisave. [/SIZE]This clearly implies Singapore elderly do not have sufficient self means to
finance their healthcare expenditures that they need to heavily depend on their family. This is a catastrophe in itself because despite all the fascinating statistics Singapore can boast about how affluent its citizens are, their elderly are not even financially independent enough to meet their healthcare expenditure needs. This evidence also questions the claim that 3Ms are an enormous success in Singapore. On
the contrary, the evidence seems to suggest the 3Ms has serious failures. Moving forward with such declining fertility, marriage rates, increasing divorce rates and ageing population, the elderly ten years down the road may not have as many family members to pay their hospital bills.
The study also revealed that only 55% of elderly use Medisave to pay for hospitalisation. Majority of elderly also had an average of $5,300 in their Medisave balance falling short of the minimum sum of $27,500. These elderly did not have sufficient years of accumulation after the implementation of Medisave in 1984. However that is about two decades of time PAP had to fix the situation to make sure the elderly do not end up in such a situation in 2007. But they failed.
In terms of Medishield only 22% of elderly patients had Medishield coverage. Patients more than 80 years old had practically no coverage. The evidence for Medifund is even more pathetic. Less than 1% of elderly patients got Medifund assistance. This then raises the question of what is really the use of Medishield and Medifund despite
all that fanfare. The evidence clearly suggests there are serious failures in these two Ms also.
IN terms of private health insurance, only 8% of elderly are covered. It did partly help those elderly patients as it covered 62% of their hospital costs. Then again if only private health insurance had been much higher for the elderly of a population, which boasts of one of the highest per capita GDP in the world, the burden will have been much lower. However Singapore’s private health insurance industry is dominated by companies such as NTUC which are linked to the government. What is required is total liberalisation of the industry. So far only one major international private health insurance provider, AVIVA, is present in Singapore. That single player has already added so much competition to the landscape that if only there is total liberalisation, one can expect to see major leaps in the private health insurance policies offered in Singapore.
Unlike popular belief and rhetoric, there are serious failures in 3Ms. What Singapore requires is major reforms in this area. Unfortunately in a recent forum on healthcare budget Minister Khaw said that Medisave and Medishield coverage may be extended.
[URL]http://www.channelnewsasia.com/stories/singaporelocalnews/view/1107879/1/.html[/URL]
It is rather sad dilemma that while the 3Ms are in such a mess, all the population is receiving from their Minister is praises about how successful it is, constant claims healthcare is affordable and a lot of maybes. The evidence above clearly do not suggest healthcare being affordable.
Yet what Minister promises for the future is maybes. Unfortunately maybes dont reduce financial hardships of patients. Maybes are also nothing innovative. Maybes dont save lives or reduce diseases. If one is to review the health reforms PAP has put in place in the last five years, one can notice it has been nothing important in the area of
healthcare financing.
Means testing was subsequently introduced a few years ago despite promises by Minister Khaw in the last election that he will not introduce it within next two years. Many Singaporeans thought that if they satisfy the means testing they will get government subsidies to cover all their hospitalisation costs. But evidence suggest that the average subsidy received by elderly patients was only 70% in C ward.
During the last five years, PAP has been actively pushing side issues as main issues such as organ donation extentions, building aged care homes in JB, euthanasia etc. What is clear is that PAP will not be bringing the much needed reforms even in future to the healthcare.
PAP is led by beliefs and not evidence. For instance they claim that universal healthcare is free healthcare. It is not clear which textbooks they studied but as far as definitions are concerned, it is very clear that universal healthcare is not free healthcare. PAP also insists for last 50 years that universal healthcare will bankrupt the systems and raise taxes. There are so many successful countries in the world where their coffers have not become bankrupt and their taxes are also not increasing. However critics in Singapore government insist on picking countries around the world that did not do well in their universal healthcare system instead of picking those that succeeded. Even the authors of the above presentation from NUS and Singhealth recommended Singapore to consider universal healthcare.
Unfortunately the world does not revolve on the axis of anyone’s beliefs. Singaporeans must wake up to this hard truth. Evidence is also not what you put together to build your case. Rather evidence is telling as it is. Rejecting that based on one’s belief cannot make one’s belief a truth. For Singapore to see the required health reforms, we Singaporeans need to put aside the beliefs that we behold for five decades which we have built on cliches, rhetoric and propaganda. If Singapore healthcare system is as good as being claimed currently why are evidence about its effectiveness being kept secret and hidden from everyone. We need to study the proven and successful cases of countries which have adopted univeresal healthcare for decades, which are not few. Singapore totally lacks the capacity currently to emuluate such successes. What is required is major investment to build up that capacity over the next two decades.
Contrary to the central belief in PAP that spending generously on people’s health, education will make them lazy, dependent etc, the world’s safest and sustainable economies and countries are those where expenditure on health and education is high. To make a population productive instead of lazy, you need to use productivity improvement approaches and not spend less on health and education. Human capital
also has longer term returns than foreign direct investments and exports.
Unless you build a population that is mighty in the body and mind, it does not matter how much of foreign investment you can attract today or how much of exports you sell today. What propels a country to heights over longer periods of time is determined by how many capable people the country has. Exports and investments just gives some temporary one generation uplifts. So lets stop the maybes
.
Alan Seet
</TD></TR></TBODY></TABLE>
