Paul Tambyah highlights need for healthcare reform

May 7, 2013
Singapore Democrats

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Singapore Democrats

“If we cannot cope with 5 million people, how do we expect our healthcare system to support a population of 6.9 million?”$CUT$

Professor Paul Tambyah, a member of SDP’s Healthcare Advisory Panel, posed this question at a recent public forum organised by Transitioning.sg. 

He spoke about the urgent need for healthcare reform in Singapore and how SDP’s National Health Plan:Caring for All Singapore can be the alternative.

Our current healthcare system, like other public services, is severely stretched by the huge population influx. The total health expenditure of Singapore is $12 billion in year 2011, whereas the government’s health expenditure was only $3.5 billion in the same year.

The present system consists of “3Ms”: (1) Medisave for hospitalisation, (2) Medishield for catastrophic illness, and (3) Medifund as a safety net. But the reality is that 3Ms are only a smallpart in financing Singapore’s healthcare financing:

  • Medisave: $761 million
  • Medifund: $84 million (Medifund has limitations)
  • Medishield $386 million (Medishield has many exclusions and premiums are high)

Deductibles and co-payments aresignificant and there are limits, Prof Tambyah pointed out, the 3Ms are primarily for “Inpatient care”.

In the case of Minister Khaw Boon Wan who paid only $8 for his by-pass surgery, private insurance which many Singaporeans cannot afford and there are many limitations, paid the expenses.

Prof Tambyah said that although public expenditure is low, out-of-pocket spending is very high. Singapore has highest out-of-pocket healthcare expenditure in East Asia.

The result is that people avoid recommended screenings and treatment because of the high costs. Singapore public hospitals have $110 million in outstanding patient debts as of end 2011.

He noted that while some effort is being madeto address the costs, the basic problems of the system’s inequality and sustainability arenot addressed and quoted Harvard’s Prof William Hsiao:

Before you can set up a health care system for any country, you have to know that country’s basic ethical values. The first question is: Do people in your country have a right to health care? If the people believe that medical careis a basic right, you design a system that means anybody who is sick can see a doctor. If a society considers medical care to be an economic commodity, then you set up a system that distributes healthcare based on the ability to pay. And then the poor, pretty much,are left out

Prof Tambyah says the current approach places a heavy and unfair burden on the sick, and our healthcare workers struggle to cope with a system that isunsustainable. “We urgently need a new healthcare plan,” he told the audience. “There is an alternative: The SDP’s healthcare plan.”

He proceeded to outline the principles of SDP’s Plan which is designed to ensure that our healthcare system is universal, sustainable and affordable:

  • Universal, affordable healthcare coverage to all Singaporeans

  • Increase government spending on infrastructure and human resources.

  • A sustainable system to contain rising healthcare costs by tightening medical audit and compliance through a central regulatory body

A key feature of the alternative plan is that there will be no more 3Ms. Instead, there will be a:

  • Larger government contribution – closer to developed East Asian norms and standards

  • Single-payer public insurance system

  • Evidence-based regulation of insurance payouts

  • Co-payment with caps for outpatient and inpatient care

 

We have proposed a single-payer universal healthcare system in which the government manages a central healthcare fund. This fund will be run along the lines of a government-subsidised public insurance scheme to finance compulsory basic health, accident and pregnancy (for women) coverage for all citizens and permanent residents (PR) residing here for more than 6 months a year.

Under this plan, the poor are highly subsidized, older people who do not have to pay. There is an additional safety net for the poor.

Singaporeans pay an average of $600 per year. In return, they get a Healthcare Benefits Card which may be used at all polyclinics, GP clinics, all private and public specialist clinics and hospitals that participate in the programme. It entitles the holder to a 90% subsidy on the majority of their healthcare spending (excepting acute illnesses).