We can afford universal healthcare

Paul Tambyah

The SDP has always felt that healthcare is a basic human right. Human rights are not something that belong to western countries, they belong to all of us. We are just as human as anybody else. The basic principles of the SDP healthcare plan are universal, affordable, healthcare coverage for all Singaporeans and we want to see a sustainable system which involves medical audit.

First of all, Singapore has very good healthcare. The healthcare facilities are good. The doctors are good, the hospitals are excellent. The problem is, it’s not very affordable.

Singapore’s very good healthcare has been there since the 1980s at the time when the government owned all the hospitals and the government ran all the hospitals and the government’s share of healthcare spending in 1980s was close to 40 percent. So when the government talks about going to 40 percent, they are talking about going back to where it was not too long ago.

The current total health expenditure is about $12 billion dollars, government health expenditure is about 4 billion dollars. The reality is that the 3M system accounts for only about 10 percent of total health expenditure. Medisave is about $800 million, Medifund about $80 million, and Medishield about $400 million. So where does the rest come from? It is actually out of pocket expenditure by us and out-of-pocket expenditure by businesses. I’m covered by the university. A lot of us are covered by our jobs. We go and see our panel doctor, the panel doctor may refer you to a specialist, which is covered by your company.

And the rate of healthcare inflation in Singapore is just ridiculously high, it’s about twice the rate of inflation. So when we talk about healthcare reform, we’re not just talking about the need to care about ourselves, but we also need to care about the economy because this high healthcare cost places a huge burden on employers.

We have heard it many times before. The cost of doing business in Singapore is very high and a large contributor to this is this unbridled healthcare inflation which has been triggered by the fact that so much of the cost of healthcare is borne by employers.

So what is the solution to this? The solution that the SDP has proposed is actually a new healthcare plan and this is very simple:

The current healthcare system is very complicated. Medisave, Medifund, Medishield, CDMP, CHAS, there are so many different schemes. It is very confusing. But what we propose is a single-payer public insurance system. It is an insurance system so it is not the same as the National Health Service in the UK. It is closer to the French or the Australian systems which were rated by the World Health Organization as No. 1 (France). There is also some co-payment but there are caps to the co-payment.

Basically, we do away with the 3Ms, we do away with CDMP and we do away with CHAS. Everybody who is earning a decent income pays $600 a year out of their Medisave. And this is less than what they are paying in their current Medisave contribution so that the balance is refunded to them. But this is going into an insurance policy which provides for 90 percent of subsidy for all acute hospitalisation.

We have done our sums. It can be afforded.

If you are poor you get subsidised rate or you get full subsidy if you are disabled or if you are unemployed. Children pay a pro-rated amount. Basically, its $600/- a year out of your CPF. You will get a Healthcare Benefits Card and this Card can be used at polyclinics and GPs.

Singapore is not really short of doctors. Everybody thinks we are short of doctors. When you go to every HDB block there’s a GP clinic. A lot of the GPs have nothing to do. You see they are forced to do cosmetic procedures. Whereas if you go to a polyclinic, you try this, a polyclinic referral to the Renal Unit at SGH, the waiting time is one year. As the public sector is very stressed, the private sector has got too much capacity. So this Card is going to break the barrier between the public and private areas because you can use it equally on either side.

We do recognise that some people who like to go to their GPs and tell such long stories because their GP is such a nice and friendly person. So we put a fixed co-payment for non-urgent, acute cases. So if you come to a GP and you spend a lot of time, then you will have to pay a certain, fixed amount for the cost. The reality is that nobody is going to choose to get diabetes or choose to get cancer just because healthcare is subsidised.

So the key features of the SDP’s plan are:

Larger govt contribution because the govt has to pay for those who cannot afford it;
A public insurance system with regulation of the insurance system, co-payment but co-payment with caps. So there is a maximum amount that you pay and, in return you get responsive care at the point of need.

Healthcare is basic human right. If we all feel that we have the right to defence, the right to housing, the right to a safe and secure environment, we should also have the right to decent healthcare.

This is an excerpt of the speech Professor Paul Tambyah made at the TOC’s Face2Face healthcare forum. Prof Tambyah is a member of the SDP’s Healthcare Advisory Panel.

We can afford universal healthcare

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