bmc social studies_chapter3_healthcare(spore&uk systems)

Healthcare ProvisionHealthcare Provision(Singapore and UK)(Singapore and UK)

Should the State provide…?Should the State provide…?

Lesson AgendaLesson Agenda

After the lesson, students would be able to:After the lesson, students would be able to:

Appreciate the various stages of healthcare provision in Appreciate the various stages of healthcare provision in Singapore.Singapore.

Understand the various schemes to support healthcare Understand the various schemes to support healthcare in Singapore.in Singapore.

Practice an approach to Comparison questions (SBQ).Practice an approach to Comparison questions (SBQ).

Healthcare Provision in Healthcare Provision in SingaporeSingapore

1960’s 1960’s

Healthcare measures linked to public housing Healthcare measures linked to public housing because Singapore was overcrowded.because Singapore was overcrowded.

Healthcare programmes focussed on public hygieneHealthcare programmes focussed on public hygiene

Eg. govt. cleared squatters and slums – citizens Eg. govt. cleared squatters and slums – citizens relocated to HDB flats. Clinics and hospitals were relocated to HDB flats. Clinics and hospitals were built to meet growing pop.built to meet growing pop.

Effects of overcrowding reduced - public health Effects of overcrowding reduced - public health improved and spread of major diseases minimized. improved and spread of major diseases minimized.


1970’s1970’s

Economy improved & standard of living went up – Economy improved & standard of living went up – citizens now wanted better quality healthcare. citizens now wanted better quality healthcare. (F)(F)

Polyclinics built conveniently within HDB estates Polyclinics built conveniently within HDB estates to replace “out-patient dispensaries” to replace “out-patient dispensaries” (E1 + E2)(E1 + E2)

Better facilities in government hospitals – Better facilities in government hospitals – sophisticated equipment and treatment. Healthcare sophisticated equipment and treatment. Healthcare costs rising. costs rising. (L)(L)


1980s to the present1980s to the present

Government observed - population is ageing. Government observed - population is ageing. healthcare costs will rise. healthcare costs will rise.

Government resources would be taken away to pay Government resources would be taken away to pay for healthcare.for healthcare.

1980s, Govt. developed a new approach to 1980s, Govt. developed a new approach to healthcare:healthcare:

National Health PlanNational Health Plan

Healthcare = Shared responsibility.Healthcare = Shared responsibility.

The Individual + the Government + the The Individual + the Government + the Community = Healthcare provision in Community = Healthcare provision in SingaporeSingapore


The IndividualThe Individual

Self-relianceSelf-reliance::

1984 Introduced MediSave Account. 8% of monthly 1984 Introduced MediSave Account. 8% of monthly contribution to CPF channelled to MediSave.contribution to CPF channelled to MediSave.

Singaporeans to take charge of their own healthcare. Singaporeans to take charge of their own healthcare.

MediSave further enhanced - includes Medishield (for those MediSave further enhanced - includes Medishield (for those who do not have CPF Accounts) and Eldershield (for those who do not have CPF Accounts) and Eldershield (for those above 40 who have disabilities) above 40 who have disabilities)

The Individual (Self-Reliance) - MediShield:The Individual (Self-Reliance) - MediShield:

This is a national healthcare insurance scheme.This is a national healthcare insurance scheme.

Just like insurance – Singaporeans pay for Just like insurance – Singaporeans pay for MediShield from monthly contributions from MediShield from monthly contributions from MediSave.MediSave.

Allows greater financial cover for rising Allows greater financial cover for rising healthcare costs.healthcare costs.


The Individual (Self-reliance) - EldershieldThe Individual (Self-reliance) - Eldershield

This is another insurance scheme. Targeted for those above 40.This is another insurance scheme. Targeted for those above 40.

It uses CPF MediSave accounts to pay premiums. It uses CPF MediSave accounts to pay premiums. Caters for Caters for those who have not built up enough savings in their MediSave those who have not built up enough savings in their MediSave accounts.accounts.

Provides assistance for those who cannot pay for high Provides assistance for those who cannot pay for high Medishield premiums. Medishield premiums.



The GovernmentThe Government

Keeping healthcare affordable Keeping healthcare affordable (Government Subsidies)(Government Subsidies)

Provide government subsidies to hospitals, polyclinics Provide government subsidies to hospitals, polyclinics and nursing homes.and nursing homes.

Government saved $200mill and from the interest it Government saved $200mill and from the interest it gets it provides Medifund to subsidize hospital wards. gets it provides Medifund to subsidize hospital wards.

Hospital authorities decide how to use funds for Hospital authorities decide how to use funds for individual cases.individual cases.


The Government The Government Keeping healthcare affordable Keeping healthcare affordable (Restructured Hosp.)(Restructured Hosp.)

Restructuring means – Hospitals now have freedom to Restructuring means – Hospitals now have freedom to reorganise to better meet needs to Singaporeansreorganise to better meet needs to Singaporeans

Government has flexibility to reduce the amount of subsidies Government has flexibility to reduce the amount of subsidies when necessarywhen necessary

Keeping healthcare affordable Keeping healthcare affordable (Means testing)(Means testing) Govt must ensure fairness in subsidies.Govt must ensure fairness in subsidies. Lowest income receive most. Higher income receive less.Lowest income receive most. Higher income receive less. Important because - Subsidies must benefit patients who are Important because - Subsidies must benefit patients who are

in most need of them. in most need of them.


The Government (Promoting Healthy Lifestyle)The Government (Promoting Healthy Lifestyle)

A healthy person does not need a lot of medical careA healthy person does not need a lot of medical care

Government encourages citizens to keep healthy.Government encourages citizens to keep healthy.

This means a well-balanced diet & habit of physical This means a well-balanced diet & habit of physical exercise.exercise.

This will reduce the reliance on healthcare provision in This will reduce the reliance on healthcare provision in the later years. This keeps healthcare affordable.the later years. This keeps healthcare affordable.

Provision of Healthcare in Provision of Healthcare in SingaporeSingapore

The Community- healthcare supportThe Community- healthcare support Some patients require help to fully recover after Some patients require help to fully recover after

discharge.discharge.

Voluntary & private organizations given grants to operate Voluntary & private organizations given grants to operate these facilities.these facilities.

Grants given to provide specialised healthcare services: Grants given to provide specialised healthcare services: NKF and SATA (Singapore Anti Tuberculosis Assoc.) NKF and SATA (Singapore Anti Tuberculosis Assoc.)

Eases the burden of healthcare costs to the Govt as many Eases the burden of healthcare costs to the Govt as many agencies are providing these services.agencies are providing these services.

Making ComparisonsMaking Comparisons What is a comparison?

It is a way of evaluating two (or three) items or subjects

using a category or classification. For example: You can compare two bags according to their colour (one

classification) or

according to their prices (second classification).

You are not describing the differences or similarities! You are stating what makes them different or similar

Making ComparisonsMaking Comparisons

Note: The two bags are different in colour. (Inference). Bag A has a bright red colour while Bag B has a dull blue colour. (Support)

Let’s practice!Let’s practice!

Alfred always kept to himself and never spoke Alfred always kept to himself and never spoke to anyone. Melissa spoke only when spoken toto anyone. Melissa spoke only when spoken to

Inference?Inference?

Support: Support:

Alfred & Melissa are similar in the Alfred & Melissa are similar in the way they deal with othersway they deal with others

I know this because, Source A tells me that “Alfred kept to himself…” Similarly, Source B tells me that Melissa “…only spoke when spoken to…”

Let’s PracticeLet’s Practice

Can you come up with your own examples? Can you come up with your own examples? Come up with two sources and figure out how you Come up with two sources and figure out how you

are going to compare themare going to compare them Present to the class…Present to the class…

Lesson Re-capLesson Re-cap

What is the challenge of governments in What is the challenge of governments in providing healthcare?providing healthcare?

What was Singapore’s healthcare system like What was Singapore’s healthcare system like in the 1960s and 70s?in the 1960s and 70s?

What are the principles healthcare provision What are the principles healthcare provision here…since the 1980’s?here…since the 1980’s?

Welfare State & Healthcare Welfare State & Healthcare Provision in UKProvision in UK

Before the 20Before the 20thth Century, the British government did Century, the British government did not provide much medical care for its citizens.not provide much medical care for its citizens.

The poor, aged or homeless had to depend on private The poor, aged or homeless had to depend on private charities, friends or family to help them pay for charities, friends or family to help them pay for healthcare.healthcare.

After the war – Government felt it was necessary to After the war – Government felt it was necessary to look after these groups of people. The state would look after these groups of people. The state would look after its citizens – for free look after its citizens – for free

Welfare State & Healthcare in Welfare State & Healthcare in the UKthe UK

In a Welfare state, the government looks after In a Welfare state, the government looks after its citizens from its citizens from ‘cradle-to-grave’.‘cradle-to-grave’.

This means that the government would ensure This means that the government would ensure that every citizen would have a minimum that every citizen would have a minimum standard of welfare to live a ‘decent’ life:standard of welfare to live a ‘decent’ life:

Each citizen would have a jobEach citizen would have a job Each citizen would have a homeEach citizen would have a home Each citizen would have access to healthcare.Each citizen would have access to healthcare.

NHS in the initial yearsNHS in the initial years

Initial successInitial success: It was popular with the people. : It was popular with the people. The government provided free basic medical The government provided free basic medical service for all citizens.service for all citizens.

Free medical treatmentsFree medical treatments: This means that all : This means that all medical services, dental and even optical medical services, dental and even optical treatments were FREE.treatments were FREE.

Buzz BreakBuzz Break

What are the advantages and disadvantages of What are the advantages and disadvantages of living under a welfare system?living under a welfare system?

AdvantagesAdvantages DisadvantagesDisadvantages

Initial years of NHS Initial years of NHS

Govt. expected demand to increase & then Govt. expected demand to increase & then stabilize.stabilize.

However increases went beyond expectations.However increases went beyond expectations. Too many people wanted healthcare servicesToo many people wanted healthcare services Treatments prescribed without consideration for costs.Treatments prescribed without consideration for costs.

By 1951 NHS could not meet expectations.By 1951 NHS could not meet expectations.

““Free at the point of service” was not workingFree at the point of service” was not working Now had to charge for some treatmentsNow had to charge for some treatments

Britain and the NHS nowBritain and the NHS now

Ageing pop & rising health costs affects Britain Ageing pop & rising health costs affects Britain too.too.

The British approach is to ensure that healthcare The British approach is to ensure that healthcare spending is put to good use:spending is put to good use:

No wastage or unnecessary expenditures.No wastage or unnecessary expenditures. Resources cater for specific patient needs.Resources cater for specific patient needs.

Managing healthcare in UK (1980s)Managing healthcare in UK (1980s)

Managing government spendingManaging government spending: :

The government is expected to provide healthcare The government is expected to provide healthcare to everyone.to everyone.

Healthcare costs rise. This means government has Healthcare costs rise. This means government has to collect more taxes.to collect more taxes.

In the 1980s – new government in Britain wanted In the 1980s – new government in Britain wanted to reduce expenditure in healthcare.to reduce expenditure in healthcare.

Managing healthcare-Thatcher’s policiesManaging healthcare-Thatcher’s policies

Prime Minister Thatcher’s approachPrime Minister Thatcher’s approach::

Cut back on government spending on welfare Cut back on government spending on welfare benefits including healthcare.benefits including healthcare.

Return some services to be provided by private Return some services to be provided by private companies (privatization).companies (privatization).

Healthcare should also be the responsibility of the Healthcare should also be the responsibility of the individual.individual.

Challenges faced by UKChallenges faced by UK Challenge 1: Loss of people’s supportChallenge 1: Loss of people’s support::

Reduction in healthcare spending = NHS could not Reduction in healthcare spending = NHS could not continue to provide free health services.continue to provide free health services.

Citizens used to receiving free healthcare – now Citizens used to receiving free healthcare – now very unhappy. very unhappy.

Government concerned about losing the support Government concerned about losing the support from citizens.from citizens.

Healthcare policy needed to be carefully balanced Healthcare policy needed to be carefully balanced to meet citizens’ expectations & managing coststo meet citizens’ expectations & managing costs

Challenge 2: Cost increase & increasing tax Challenge 2: Cost increase & increasing tax contributioncontribution::

Healthcare costs are rising.Healthcare costs are rising.

Britain's National Insurance contributions (which Britain's National Insurance contributions (which partly paid for NHS services) also had to increase.partly paid for NHS services) also had to increase.

This was not always popular. Increases meant This was not always popular. Increases meant there would be less money for people to spend on there would be less money for people to spend on other things. other things.

Challenges faced by UKChallenges faced by UK

Challenges faced by UKChallenges faced by UK

Challenge 3: Increasing efficiencyChallenge 3: Increasing efficiency

Demand for healthcare grew with an ageing Demand for healthcare grew with an ageing population.population.

Numbers of people paying taxes to support the Numbers of people paying taxes to support the NHS was declining.NHS was declining.

Despite cuts to healthcare spending - still not Despite cuts to healthcare spending - still not enough resources to support the demand.enough resources to support the demand.

Challenges faced by UKChallenges faced by UK Challenge 4: Privatization.Challenge 4: Privatization.

The aim was to reduce government subsidies.The aim was to reduce government subsidies.

To save costs and make NHS more efficient.To save costs and make NHS more efficient.

Private companies would now provide some services Private companies would now provide some services to the public.to the public.

E.g. All non-medical services would be supplied by E.g. All non-medical services would be supplied by private companies under a contractprivate companies under a contract

Cleaning services and catering.Cleaning services and catering.

ChallengesChallenges

Challenge 5: Providing Quality ServicesChallenge 5: Providing Quality Services

By the late 1980s demand for services was high.By the late 1980s demand for services was high.

NHS system could not cope with this demand. NHS system could not cope with this demand. Lead to declining standards in the NHS.Lead to declining standards in the NHS.

Govt responded by providing patients with info on Govt responded by providing patients with info on their treatment - they can monitor rising costs their treatment - they can monitor rising costs themselves. But long queues still common.themselves. But long queues still common.

Response of ChallengesResponse of Challenges

NHS Plan (2000)NHS Plan (2000)

Based on feedback from patients, staff and doctors.Based on feedback from patients, staff and doctors. Increase government spending up to 2004.Increase government spending up to 2004. To offer patients more convenient servicesTo offer patients more convenient services Could make use of facilities in private hospitals Could make use of facilities in private hospitals

without the patients paying for it.without the patients paying for it.

Response to ChallengesResponse to Challenges

NHS Plan (2004)NHS Plan (2004)

Patients had a choice of 4 different healthcare Patients had a choice of 4 different healthcare providers. Treatment paid for by NHS.providers. Treatment paid for by NHS.

Every patient have access to their own records on Every patient have access to their own records on the Internet (HealthSpace).the Internet (HealthSpace).

Patient’s with minor illness can get advice from Patient’s with minor illness can get advice from doctors over the phone (NHS Direct). doctors over the phone (NHS Direct).

Let’s CompareLet’s Compare No one system is better than the other. The UK No one system is better than the other. The UK

system works in there because:system works in there because:

people’s expectations are differentpeople’s expectations are different Standard of living is high etc.Standard of living is high etc.

Singapore system of healthcare works here Singapore system of healthcare works here because of our different cultural and social because of our different cultural and social characteristicscharacteristics

UKUK Citizens make use of benefits –

Govt. manages costs by carefully controlling government spending.

Citizens pay two types of taxes: Income tax & National Insurance tax

Promote self-reliance among Promote self-reliance among citizens – Govt. plans for citizens citizens – Govt. plans for citizens to share the costs of their own to share the costs of their own healthcare healthcare

MediSave and Medishield from MediSave and Medishield from citizen’s CPF contributions.citizen’s CPF contributions.

Comparison 1: Comparison 1: How citizens participate in the systemHow citizens participate in the system

S’poreS’pore

Comparison 2:Comparison 2:Keeping Healthcare affordableKeeping Healthcare affordable

UKUK Privatization to reduce:Privatization to reduce:

Operating costsOperating costs Govt. subsidiesGovt. subsidies Increase efficiencyIncrease efficiency

Every individual encouraged to Every individual encouraged to be responsible for welfare and be responsible for welfare and health (except for expectant health (except for expectant mothers, mothers with young mothers, mothers with young children and students below 19)children and students below 19)

S’poreS’pore Government subsidiesGovernment subsidies

given to nursing homes, polyclinicsgiven to nursing homes, polyclinics

MedifundMedifund Given to hospitals to use to off-set Given to hospitals to use to off-set

patient’s bill (needy cases)patient’s bill (needy cases)

Restructured hospitalRestructured hospital Govt. is able to give less subsidies.Govt. is able to give less subsidies.

Means TestingMeans Testing ensure that Govt. subsidies given to ensure that Govt. subsidies given to

patients who need.patients who need.

Comparison 3:Comparison 3:Lifestyle choices and role of communityLifestyle choices and role of community

UKUK Citizens encouraged…but no Citizens encouraged…but no

government programme or government programme or policy to promote healthy policy to promote healthy lifestyles.lifestyles.

Community provides nursing Community provides nursing support, social services etc…but support, social services etc…but these are self-funded. these are self-funded.

Government (through NHS) Government (through NHS) still seen as the main provider still seen as the main provider of healthcare services and of healthcare services and aftercareaftercare

S’poreS’pore Government provides support by Government provides support by

championing healthy lifestyle championing healthy lifestyle choices through Health Promotion choices through Health Promotion Board (a govt. agency)Board (a govt. agency)

Government gives grants (sums of Government gives grants (sums of money for specific purposes) to money for specific purposes) to VWOs to operate: day VWOs to operate: day rehabilitation centres, nursing rehabilitation centres, nursing homes and community hospitals homes and community hospitals for discharged patientsfor discharged patients

The Comparison QuestionThe Comparison Question

3 Steps to answering the question:3 Steps to answering the question:

Step 1: Identify the type of comparison requiredStep 1: Identify the type of comparison required

Step 2: locate similarities and/or differencesStep 2: locate similarities and/or differences

Step 3: Write out the answer – do not describe Step 3: Write out the answer – do not describe differences or similarities.differences or similarities.

Comparison QuestionsComparison Questions Type 1 (Similarities or Differences ONLY):

Provide, support & explain similarities only; or Provide, support & explain differences only

Possible question words:

What are the similarities between these 2 sources? In what ways are Sources A and B similar? How do the 2 sources differ? What are the differences between the 2 sources?

Comparison QuestionComparison Question Type 2 (Similarity & Differences):Type 2 (Similarity & Differences):

Provide, Support & Explain 2 Similarities + 1 Diff.Provide, Support & Explain 2 Similarities + 1 Diff. Provide, Support & Explain 2 Differences + 1 SimProvide, Support & Explain 2 Differences + 1 Sim

Possible question words:Possible question words:

How similar are these 2 sources?How similar are these 2 sources? How different are Sources A and B?How different are Sources A and B? To what extent are the 2 sources similar?To what extent are the 2 sources similar? How far are these 2 sources different?How far are these 2 sources different? How far does Source A support/differ from Source B? How far does Source A support/differ from Source B?

Comparison QuestionComparison Question Step 2: “locate” similarities and/or differences.Step 2: “locate” similarities and/or differences.

Read the sources – search for:Read the sources – search for: What the sources have in commonWhat the sources have in common What makes the sources differentWhat makes the sources different look for POV (point-of-view), look for POV (point-of-view), tone (Negative tone, positive tone etc.)tone (Negative tone, positive tone etc.)

Don’t Don’t describedescribe the differences! the differences!

Common mistakeCommon mistake: A is red in colour and B is blue in : A is red in colour and B is blue in colour, therefore they are different. colour, therefore they are different.

TryTry: The difference bet. A and B is colour.: The difference bet. A and B is colour.

Comparison Question – Type 1 Comparison Question – Type 1 Template and guiding wordsTemplate and guiding words

Common factor Support Explain

Both sources differ or are similar in (state criteria for comparison)

This is shown in Source A, “…” However as seen in Source B, “…”

Source A (Make explanation linking inference of Source A to the issue of the question)

…However, Source B highlights/comments that (Make explanation linking inference of Source B to the issue of question)

Infer

Source A shows that (state inference) …whereas Source B comments (state inference)

Repeat Infer, Support and Explain (ISE) for every similarity/difference inference that has been identified.

Comparison QuestionsComparison Questions

Conclusion for comparison questions:Conclusion for comparison questions:

Link similarities/differences back to the Link similarities/differences back to the question issue question issue

and; and;

Highlight the connection difference or Highlight the connection difference or similarity) with the issue.similarity) with the issue.

Lesson recapLesson recap

Are there any differences between the Are there any differences between the Singapore healthcare system and that of the Singapore healthcare system and that of the UK?UK?

What are the features of Singapore’s National What are the features of Singapore’s National Healthcare Plan?Healthcare Plan?

What were some of the challenges that British What were some of the challenges that British governments faced in managing the NHS? governments faced in managing the NHS?

bmc social studies_chapter3_healthcare(spore&uk systems)

Documents

provision of healthcare

community healthcare

healthcare provisionsingapore

healthcare programmes

payfor healthcare

healthcare affordable

s healthcare measures

better quality healthcare