Singapore looksto healthcare changes
By Sonia Kolesnikov,
UPI Business Correspondent
SINGAPORE, (UPI) -- Faced with a rapidlyaging population, Singapore is not relying on its reputation ofhaving one of the best health care systems in the world and insteadis making plans to strengthen and further expand it.
The current health care delivery systemis based on individual responsibility coupled with governmentsubsidies to keep basic health care affordable. Patients are expectedto pay part their medical expenses plus additional monies if theydemand a higher level of services.
"This is not a welfare system and allSingaporeans are encouraged to look after themselves. This iswhy the government has a strong emphasis on savings," saidDr. Lily Neo, a general practitioner and chairman of the GovernmentParliamentary Committee for Health.
In its 2000 World Health report, the WorldHealth Organization ranked Singapore's health system performanceas sixth best in the world, behind France and Italy but well aheadof the United States, which ranked 37th. The organization notedSingapore had successfully maintained a good "level of health"while transferring more responsibility to the population to payfor its own health care.
The country has a dual system of healthcare delivery, with 80 percent of the primary health care servicesprovided by private practitioners, while the government clinicsprovide the remaining 20 percent. For the more costly hospitalcare, it is the exact inverse situation. Patients are free tochoose providers within the dual health care delivery system andwaiting times for elective surgery is far less than experiencedin Great Britain, averaging two weeks to four weeks.
The government ensures affordable basicmedical services are made available to all Singaporeans throughthe provision of heavily subsidized medical services at the publichospitals and government clinics. But the principle of co-paymentapplies even to the most heavily subsidized wards to avoid thepitfalls of providing "free" medical services, the HealthMinistry said. Singaporeans always have to pay part of their medicalexpenses, a ministry spokesman said.
To help people pay for their medical expenses,the government has put in place a three-prong financing framework:Medisave, MediShield and Medifund.
Medisave, introduced in April 1984, is themain national medical savings plan which helps individuals putaside part of their income into Medisave Accounts to meet theirfuture hospitalization, day surgery and certain outpatient expenses.Every working person is required by law to set aside 6 percentto 8 percent of his or her income into their personal MedisaveAccount, depending on their age, which is part of the CentralProvident Fund. Money in a Medisave account earns interest, currentlyat 4 percent a year.
MediShield, introduced in 1990, is voluntary,opt-out low-cost insurance scheme and part of Medisave. It isdesigned to help members meet the medical expenses for major ofprolonged illnesses for which their Medisave balance would notbe sufficient to cover. MediShield operates on a co-payment anddeductibles system to avoid problems associated with pre-paidinsurance.
Finally, Medifund is an endowment fund setup by the government in April 1993 to help needy Singaporeanswho are unable to pay for their medical expenses. This is a safetynet for those who cannot afford the heavily subsidized chargesdespite Medisave and MediShield.
On top of this safety net, many individualswill have private health insurance through their companies, whichwill make up for the difference in expenses or allow them to "upgrade"in an hospital ward. On this front, a shift is underway as thegovernment aims to make individuals, and not companies, more responsiblefor their own medical care.
Andrey Chung, a 35-year old sales manager,said private insurance in Singapore is necessary.
"Medisave and MediShield will workfor you if you are content with basic coverage. But if you wantsomething more, like a telephone or a television (in your hospitalroom), then you will need additional coverage," Chung said.
Illustrating her point, Chung said her 8-month-oldbaby was diagnosed with measles and had to spend three days inhospital.
"When the bill came in I couldn't believeit. It was $1,111 for three nights. I thought Medisave would coverit but it didn't because of the ward she stayed in. In the endif I didn't have private insurance I would have had to pay itfrom my pocket," she said.
The level of national savings is quite high,as each worker has to contribute 40 percent of his or her salaryto the Central Provident Fund. In practice, local salaries arenegotiated excluding CPF, which is added on by the employers.Many have complained the current level of fund contribution makesit difficult to hire new employees, and there is some discussionamong government ministers that legislation could be changed tolower the level of contributions for employees over age 40
"The current healthcare system in Singaporeis quite adequate, though some improvements in certain areas couldbe made," Neo said.
The government's main challenges are preventivecare, social policy for elderly health care and the affordabilityof health care in the long run, Neo added. According to the latestdata available from the Ministry of Health, the percentage ofover 65 years old had increased from 6.9 percent in 1998 to 7.3percent in 2000.
"Home care is not sufficient yet andwe need more community involvement. We need more geriatriciansand trained medical workers not just doctors," Neo said.
The government wants to improve on the existinghealth scheme, however, and Lim Hng Kiang, minister for health,recently indicated it has decided to review the adequacy of Medisave.
"We will study how best to extend Medisaveto cover ambulatory and outpatient treatments, and review theadequacy of Medisave in meeting the health care needs of Singaporeans,"Lim said.
Lim has also proposed to Parliament thatnew MediShield features, such as lifetime coverage and pre-funding,be introduced by 2003 so Singaporeans are better protected againstcatastrophic illnesses. Proposals also call for the governmentto facilitate family coverage for MediShield so non-working spousesare adequately protected.
Meanwhile, ElderShield, a basic severe disabilityinsurance plan for the elderly, is to be launched in the thirdquarter to provide basic financial protection and help defrayout-of-pocket expenses. ElderShield policyholders, eligible betweenthe aged of 40-69, will pay a small regular premium until theyare 65, but they will be covered for the rest of their lives,once they have paid up their premiums in full.
ElderShield will allow a policyholder toclaim $166 a month, in cash, for up to 60 months, or until hisdisability ceases, whichever is earlier.
Chung said she wasn't very familiar withthe new scheme, but when told about the cost and benefits, shelaughed. "Just proves my point. By that time $166 a monthwill barely cover my groceries," she noted.