The future of healthcare in Singapore

March 14, 2012
Singapore Democrats

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Dr Tan Lip Hong, Dr Leong Yan Hoi and Dr Wong Wee Nam

Healthcare is not a commodity, and we believe that market forces have no part to play in the financing or delivery of basic health care to the people in our country.

No one should go bankrupt while seeking medical treatment and no one, especially the poor, should be discriminated against. If healthcare is a basic right, then the system must be designed to ensure that even the poorest among us can afford it.

No one willingly falls sick but when he comes to healthcare consumption, the patient becomes an irrational consumer. This is determined by the demand:

  1. by the patient because of fear or anxiety.
  2. created by the providers.
  3. created by laboratories, pharmaceutical companies, new technologies and a profit-orientated healthcare system.

All these demands do not result in better healthcare. The only way to keep healthcare affordable and good is to find ways to restrict irrational and profit-orientated demands. It can be addressed somewhat with the right healthcare financing and also a more creative form of healthcare delivery.

What is the aim of good healthcare? It is to ensure the physical, mental and social well-being of each and every one of our citizens.

Except for irrational or profit-motivated generated demands, healthcare is a necessity. As such, it is totally unacceptable in a civilised country that any person who is sick be denied access to healthcare. This is a basic human right that must be accorded to everyone, even the poor or those who cannot afford it.

The Government shirks its responsibility

Since the move by the government to turn healthcare into an industry, we have commercialised medical care and patients and diseases have become ways to make money. Medicine has become a business rather than a vocation.

Total expenditure on healthcare in Singapore has hovered around 3% of its GDP, below the average proportion of 5 % in low income and lower middle income countries i.e. the poor and developing countries.

High income countries (of which Singapore is one of fifty countries classified as belonging to this category by the World Health Organisation or WHO) spend a much higher percentage of about 11%. The bulk of the expenditure in Singapore is borne by private individuals and organisations, and only about a third is accounted for by Government compared to the average figure of 61% in high income countries.

The extremely low expenditure by the Government vis-à-vis other countries is a deliberate policy to get healthcare costs to be self-funded as much as possible by citizens through contributory schemes such as the Medisave and the Medishield, the latter being an insurance scheme.

These schemes are usually not adequate to pay for the full costs, and individuals invariably end up digging into their pocket, with these out-of-pocket expenses accounting for a significant proportion of total costs.

In absolute terms total health care expenditure in Singapore rose from $0.1billion in 1961 to $5 billion (at current market price) in 2001, and government health care operating expenditure rose from $0.05 billion to $1.2 billion (at current market price) in 1961 and 2001 respectively.

Government spending over the years, despite rising health costs, an ageing population, more chronic illnesses, has actually not only not kept pace with inflation nor remained constant, but actually fallen, in relation to total healthcare expenditure (50% in 1965 to 20% in 2000) and as a percentage of GDP.

This means that more people are paying more for their healthcare out of their own pockets, whilst the government has been subsidizing less.

In fact, more shockingly, the WHO has reported that Singapore’s per capita government expenditure on health actually fell from US$365 in 1997 to US$274 in 2001! As a percentage of GDP, government health spending fell below 1% from 1986 – 2001.

In 2007 and 2008, the Government expenditure expenditure on healthcare was 0.8% and 1% of GDP respectively.

In his budget speech in 2007, then Finance Minister Lee Hsien Loong stated: “The Government will be ramping up our healthcare expenditure over the next five to 15 years. Over the next five years alone, we expect to increase spending to reach about $3 billion a year by 2012, compared to $2 billion today.”

However, by 2009, healthcare costs had increased exponentially, and Government spending on healthcare had already reached about $3.63 billion per year or about $1000 per citizen/PR, although it remained at only 1.3% of GDP, a figure that was repeated in 2010.

Such an approach has left many Singaporeans unable to afford medical treatment. As a result, many have had to cross over to Malaysia to seek medical assistance. The SDP National Healthcare Plan: Caring for All Singaporeans will address this issue, as well as others, and layout an alternative to make healthcare in Singapore truly caring and affordable.

We hope to see you at the launch to get your input. Please note that the venue is Peninsula-Excelsior Hotel, Orchid Room and not the Medical Alumni as originally announced.

Drs Tan Lip Hong, Leong Yan Hoi and Wong Wee Nam are members of the SDP’s Healthcare Advisory Panel which authored The SDP National Healthcare Plan. 

Launch of The SDP National Healthcare Plan: Caring for All Singaporeans

Venue: Peninsula-Excelsior Hotel [map]
           Orchid Room, Excelsior Tower
Date:   17 March 2012, Saturday
Time:   2pm to 5pm

Admission is free, all are welcome