There are five broad measures we propose to overcome the problems of our current healthcare system:
Scrap the 3M system of Medisave, Medifund and Medishield and return the Medisave money to one’s CPF account.
Establish in its place a single-payer system by setting up the National Health Investment Fund (NHIF) where the government and the people contribute into.
Require Singaporeans to contribute an average of $50 a month (depending on one’s level of income) into the NHIF taken from one’s CPF. This amount is lower than the current Medishield Life premiums. The government will pay through the Budget the remainder of the healthcare expenditure.
Cover every Singaporean for basic healthcare including accidents and pregnancy through the NHIF. This eliminates complicated subsidies under the present system. Patients will co-pay medical bills (subject to a cap) to emphasise personal responsibility and reduce abuse by providers.
Introduce single-ward class which provides same treatment for all; treatment is based on clinical need and not on ability to pay.
2. Why have you come up with this plan?
The current system has our hospitals now being run as profit centres where healthcare is treated as a commodity and given out based on ability to pay rather than one clinical need. While basic treatment is available to all, more advanced treatment is available to only those who can pay.
An overhaul is necessary instead of piecemeal remedies which address parts of the overall problem but not the root of the problem caused by the 3M system.
We also want to show that healthcare policy is the people’s concern, not just the government’s. Singaporeans need to know that the current healthcare system does not benefit them and, more importantly, that there is now an alternative.
3. What is wrong with the 3M system?
Singaporeans are paying more out-of-pocket medical expenses in absolute and percentage terms under the 3M system compared to what other peoples in comparable economies pay.
Statistics from the credit bureau show that medical debt is a major reason for high levels of debt held by Singaporeans. Reports also indicate that an increasing number of people in Singapore are turning to crowdfunding to raise money to pay their medical bills. There are many instances where Singaporeans cannot afford treatment and forgo essential primary care.
These have resulted in major inequalities in health outcomes in Singaporeans which cannot be allowed to continue. How is this a “good and affordable” healthcare system as the government claims?
The 3M system is further complicated by additional complex schemes to address emerging medical issues e.g. Merdeka and Pioneer generation packages; Medication Assistance Fund; Community Health Assist Scheme. The need for such schemes and packages shows that 3M system is not able to meet the increasing medical needs of the people.
4. The MOH says that Singapore health system is “one that has received praise and recognition both locally and internationally.” Why is there a need to change it?
As pointed out above, the current system with it’s huge dependence on out-of-pocket expenditure means that significant numbers of Singaporeans are badly affected by healthcare costs. With the world’s fastest aging population, there is an urgent need for a universal, affordable, and sustainable healthcare system to ensure that our elderly are healthy and can enjoy their well-deserved retirement years.
Also, under our plan, the poor and unemployed will receive Full Subsidy (FS) of their healthcare expenses, in other words they do not have to pay for the treatment they receive.
5. How is the SDP Plan funded?
The total cost of the plan is likely to be comparable to the current level of government health expenditure. Government expenditure would be funded by increased corporate tax, increased personal tax for high-income, reinstatement of estate duty etc. Under the SDP Plan, there would also be savings from two sources:
One, administrative costs would be reduced by doing away with all the current complicated medical schemes and simplifying the process to a single-payer NHIF as proposed.
Two, reintroduction of the guideline on fees would help rein in medical inflation driven by providers.
6. What about Medishield Life, Careshield Life and the Merdeka and Pioneer Generation packages?
These complex schemes which are costly to administer still require significant co-payments from the patients. The deductible for Medishield Life is $3,000 which means that the vast majority of C-class hospitalizations don’t qualify for its use.
There are other financially onerous co-payments and restrictions. This problem is exemplified an 83-year-old man who, in 2018, underwent eye surgery and only received $4.50 from Medishield Life for the procedures he had done which cost him $4,477.
7. Do you think the SDP healthcare plan is sustainable over the long-term?
In a word, yes. We recognise that the cost of providing healthcare will continue to rise. This is a worldwide trend and it is inevitable that Singapore will face the same problem.
One key feature in our healthcare proposal is the Healthcare Contingency Fund. This fund functions essentially as an endowment fund; it is set aside from the existing Medifund endowment. With a conservative returns-on-investment of 6% we should be able to finance any future increase in government healthcare expenditure of up to 10% without touching the principal.
Overall, containing healthcare costs requires action on several fronts. Transferring the expenditure to the private individual, as the PAP is doing now, is not sustainable. The SDP plan proposes a framework on how the overall healthcare expenditure can be handled in a fair and just way.
8. How do you prevent abuses of the system?
Those on the FS scheme will be subject to strict audits. No system, however, is fool-proof. When loop-holes are uncovered, steps will be taken to rectify them. But we cannot ignore the needs of the overwhelming majority just because we fear that a tiny minority may abuse the system. Whilst preventing abuse can, and must, be dealt with, we must remember that healthcare is a human issue not a purely monetary one.
9. How does SDP hope to implement this plan since it is not the ruling party?
We are presenting an alternative vision that we believe is in line with the hopes and aspirations of Singaporeans.
Since its introduction in 2012, large sections of our policy have been copied and adopted by the PAP such as the enhanced subsidies for private GP care and the removal of the restriction on pre-existing conditions for Medishield Life. (The PAP’s approach, however, remains focused on profits and not people.)
This happened despite the SDP not represented in Parliament. Now imagine what we can achieve if there are SDP MPs. Not only will we push for the implementation of our ideas, we will hold the government accountable for how Singaporean’s healthcare is protected.
We will demand transparency in the actuarial calculations behind the Medishield Life and Careshield Life premiums and payouts. We will also demand accountability for the spending and markups and cost recovery that take place in public hospitals and healthcare facilities.
We will insist on expansion and implementation of the guideline on fees that cover not just the charges by medical practitioners but also the charges by the institutions. You can be certain that the SDP will not allow the government to treat the health of Singaporeans as a commodity for profit making but rather as a fundamental right to be preserved and protected.
The full policy paper can be read here.