Health care under the PAP government has been one that has been profit motivated. Its 3Ms (Medisave, MediShield, Medifund) approach to financing healthcare has not been effective in meeting the rising of cost healthcare.
As of June 2010, about 9% of our population of over 5 million is above the age 65. Singapore has the highest percentage of elderly people among Southeast Asian countries. As a result, rising health care costs remain one of the most serious concerns among Singaporeans, especially among senior citizens.
There is a saying among older Singaporeans – in Singapore, you can afford to die but not to get sick. To add to this foreign patients have also triggered rises in medical costs and diverted resources in public hospitals from the people. Collectively all of this has put pressure on both patient care and public health care professionals.
SDP Shadow Health Plan: Healing with Care is aimed at relieving the existing pressures on patient care and public health care professional and to shift health care focus on healing with care as opposed to profit motivations. It has been endorsed by SDP’s internal panel of doctors.
Cost of healthcare is too high
The situation is so drastic that patients have to sell their homes, risk being made bankrupt because of healthcare bills or simply choose not to have to treatment because they cannot pay for it. In particular, the cost of C class wards have become very high in the last few years. The costs of hospitalisation in C class have almost doubled in the last few years.
A key component driving the high cost of the C class-bills is the non-subsidised items. Because some key diagnostics, drugs and therapeutic procedures are not subsidized, needy patients cannot afford them even though they are recommended in Ministry of Health guidelines.
Medisave not effective
Medisave is a compulsory savings account which is part of your CPF. Although it is your own money, there are countless rules about how this money can be used. You cannot use it for any outpatient procedure except some very limited treatments such as some chemotherapy, dialysis among others.
Medisave is not effective in funding healthcare in the long term. Many patients in hospitals have their hospital bills covered by their children’s Medisave. Almost 50% of Medisave withdrawals in 2009 went to pay for dependents? Medical expenses, implying that the current generation is depleting its own savings to fund the needs of the older generation.
This has worked thus far when there are large families with many people to cover their parent’s bills. Now with families getting smaller and costs going up, Medisave can no longer continue to be such a large proportion of healthcare financing.
In fact we are coming into a situation where those who are paying for their parent via Medisave may not have adequate funds for their own health. When this basic tier of funding is at risk, the other complementary elements of Medishield and Medifund cannot work well, even though they are also problematic in their own way.
Medishield is inadequate
Medishield is a compulsory health insurance plan which all Singaporeans are enrolled in and start paying for the minute that they are born. Medishield covers only catastrophic illness requiring hospitalisation and has a high deductible and numerous exclusions.
The compulsory health insurance has restrictions that deliberately exclude children born with congenital illnesses. It must be remembered that if one does not actively seek to opt out of the scheme, the government automatically deducts funds from one’s CPF to pay for the premiums from the day that you are born.
Medifund too limited
This pool of funds is a state endowment reserved for covering the costs of health-care for the destitute poor. Last year, $64 million was given out for 393,980 applications. This makes it an average sum of $162 per person.
Access to MEdifund is also limited – in practical terms, you have to sell your home, and have depleted all your children’s medisave before you are considered eligible for Medifund.
Impact of PAP’s healthcare system
Disparities are increasing between subsidized and non-subsidised patient care within the same public hospital. One example is the long appointment waiting-time for consultation and procedures. It breeds among public hospital senior management a conflict of priorities between provision of class-free public healthcare and boosting the corporate bottom-line.
There seems to be two classes of patients in Singapore hospitals – wealthy foreigners who get VIP hospitality services and ordinary Singaporeans who are served by hararassed, overworked doctors and nurses in crowded public wards.
Public health care professionals
Due to the service differentiation between subsidized and non-subsidised patient-care, front-line staff are constantly caught in the public relations crossfire between the corpratized hospital’s bottom line and patients and their families.
Additionally, care professionals are also under increased pressure to undertake additional responsibilities other than the primarily attention to patient-care. These increase the stress level of our health care professionals and draws them away from their primarily duties.
Key SDP Recommendations
When elected, the SDP MPs will be taking up the following recommendations in Parliament.
Expand healthcare budget
In the 2011, $4.08 billion was allocated to the Ministry of Health, this not to keep pace with the rising cost of healthcare. We advocate that government expenditure for healthcare should be tripled or at least be $10 billon. This is not profligate spending – it is investing in the health of our people. When your parents healthcare bills are taken care of, you will be able to enjoy a lifestyle that is more secure and less fraught with stress and misery.
Use void decks
New hospitals have been announced to be ready over the next 5 to 10 years but these do not resolve the current problems of long queues and waiting time for appointments, and insufficient healthcare facilities and hospital beds. They also focus on the more expensive high tech medicine rather than delivering good quality primary healthcare to patients.
We suggest exploring void deck spaces for the provision of health care for acute and chronic illnesses at the constituency level to ease the current burden. Ultimately we want to ensure that there are more hospitals and there is a 25-50% increase in hospital beds in keeping with the numbers in other First World countries.
Increase healthcare personnel
Public health care professional should focus on providing patient care, other duties related to administration and other responsibilities can be taken up by health care administrators. We recommend looking into providing health care administrators to support our care givers in their work.
Overall we recommend that healthcare personnel be increased. To lower cost and to increase the efficient usage of healthcare workers, general practitioners and senior consultants in private practice will also be encouraged to perform sessional work in public hospitals. This will reduce the dependence of public hospitals on doctors from regional countries and will maximise the contributions of our hard working general practitioners.
Make health insurance universal
As it stands, Singapore has one of the lowest proportions of people covered by medical insurance in the developed world. But as our demographics change and more Singaporeans study and work for periods abroad, we need to look into universal health care coverage/insurance.
SDP proposes a model where this type of healthcare coverage is jointly managed by the Government and appointed national insurers. It will not be a catastrophic policy with myriad exclusions like Medishield, it will be a truly comprehensive national health insurance policy that benefits from economies of scale and covers preventive healthcare rather than simply the expensive treatments at the end of life. We want to improve the quality of life rather than just the quantity.
SDP’s healthcare plan: Patients before profit
The cost of healthcare has naturally pushed us abroad in search of cheaper options, in particular across the Causeway. Singaporeans have resorted to buying their medications from neighbouring Malaysia because of the high prices of drugs in Singapore. Some are even travelling to Malaysia and further to Thailand for simple surgeries, such as appendectomies, and to fill prescriptions for chronic illnesses such as diabetes and hypertension.
It is this desperation among Singaporeans about healthcare cost that has prompted some to send to say that is cheaper to send our elderly abroad for aged care.
We the Singapore Democrats believe that healthcare cannot and must not be turned into a commodity for extreme profit making. We reiterate our position that medical costs must remain financially within easy reach of all Singaporeans.
We are prepared to support the notion of co-payment between the healthcare user and government to assume responsibility for the cost of treatment. At the moment, however, the PAP government has pushed the bulk of the financing on to the people. This must change.
The Prime Minister said that this is a watershed election – Singapore will be different if you give them an unfettered mandate. Yes, we do not want to see a Singapore with hospitals that are more concerned with the bottom line, where they cannot pay Singaporean doctors and nurses a decent living wage so they have to hire from overseas, where resources are diverted to wealthy foreigners who could very well be treated in private hospitals in Orchard Rd.
We want a Singapore where your neighbourhood GP, working in partnership with the health center run by the nurse in your block keeps you and your family healthy and fit.
If you do get struck by a serious illness, you will not have to sell your home if the SDP is in Parliament, we will make sure that all the money you have paid in GST, ERP and all the other taxes and levies go towards giving you the best medical care in the most appropriate manner.
The choice is yours.