social studies chapter 3
DESCRIPTION
Healthcare in Singapore and NHSTRANSCRIPT
What is healthcare?
• Psychological, Medical and Dental needs
• Infrastructure
• Personnel
• Monetary provisions
2
Points to Ponder
• To what extent is healthcare the responsibility
of the government?
• What makes a healthcare system effective?
3
What challenges do governments face in
managing healthcare?
• Costs
• Peoples’ Expectations
• Quality of Service
• Quality of Care
• Infrastructural
• What else?
4
How is healthcare paid for?
• Individual
– Self: People can pay for healthcare services when
they receive treatment (e.g. patients pay the
doctor directly after each visit).
– Personal Insurance: People can buy medical
insurance. They can make claims from the
insurance company to pay for certain medical
treatment such as surgery.
5
How is healthcare paid for?
• Employer
– Employer-paid Insurance: Employers pay a certain
sum of money for insurance for their workers.
Employers can claim medical fees from the
insurance company when medical services are
used by their workers.
– Government Taxes: Government collects taxes
from the people and uses a percentage of the
taxes to pay for medical services used.
6
Healthcare in Singapore
• 1960s
– Part of overall plan for post-independence improvement and development
– Squatters and overcrowded areas were cleared
– People moved to HDB flats
– Hospitals, clinics and outpatient dispensaries were built to provide healthcare to the growing population
– Vaccination en masse
– Medical officers and nurses sent to schools
8
Healthcare challenges in 1960s Singapore
• Infectious diseases such as tuberculosis were
common and spread easily
9
Healthcare in Singapore
• 1970s
– Singapore’s economy had improved
– Singaporeans now wanted better healthcare services
– Polyclinics replaced the old outpatient dispensaries
– Polyclinics provided a wider range of healthcare, i.e.
medical check-ups for babies.
– Conveniently located, i.e. town centres.
– Facilities in government hospitals improved
– Quality of healthcare improved
10
Where did the money come from?
• Government Budget
• In 2004, healthcare accounted for 5.9% of the
national budget.
12
Healthcare in Singapore
• 1980s
– Key concern: Rising Cost of healthcare
– Then - Health Minister, Mr. Goh Chok Tong, raised
this concern several times.
– “Resources are finite (absolute, fixed, inflexible) in
terms of funds, doctors and nurses. Providing
welfare in healthcare will affect people’s incentive
to work. It is necessary to pay for the services that
you want.” – GCK
13
Healthcare in Singapore
• 1980s
– In 1983, MOH published the NATIONAL HEALTH
PLAN.
– Public debate was encouraged on how to manage
the long-term healthcare needs of the people.
– 20-year plan to improve Singapore’s healthcare
system
14
NATIONAL HEALTH PLAN
• Aims:
– Build a healthy and physically fit population
– Encourage Singaporeans to stay well and reward
those who do so
– Build up individual financial resources so that
those who fall sick will be able to pay
15
Key Points of the NHP
• Healthcare policies should not put a strain on
government spending
• They should encourage:
– Self-responsibility
– Community support
• Government would maintain policies to keep
healthcare affordable
16
NHP
Individual
17
Government Community
• Encourages
self-
reliance
• Maintains
good health
• Keeps
healthcare
affordable
• Promotes
healthy
lifestyle
• Provides
some
healthcare
services
• Provides
support
services
Encouraging Self-Reliance
• Medisave
– Introduced in 1984
– Encourages Singaporeans to be responsible for
their own health
– 6 – 8% of workers’ monthly CPF contributions
channelled into their Medisave accounts
– Can be used to pay hospital bills and certain
medical treatment
18
Other benefits of Medisave
• Singaporeans share the costs of healthcare
with the government.
– Shared responsibility
– Government need not raise taxes to pay for
healthcare costs
19
But…
• Not all Singaporeans make CPF contributions,
therefore do not have Medisave.
• People who required long-term treatment of
more serious illnesses were not able to pay for
their hospitalisation
20
Medishield
• National healthcare insurance scheme
• Singaporeans pay using their Medisave
• Can make claims for large medical bills that
Medisave does not cover
– e.g. dialysis
• Constantly evolving
– e.g. Eldershield
21
Medishield Timeline
• 1990: Introduction of Medishield
• 1994: Medishield Plus to cover hospitalisation
in A and B1 wards
• 2002: Eldershield to cover disabilities for
people above 40 years old
• 2005: Reformed Medishield to cover larger
hospitalisation bills for patients in B2 and C
wards
22
Government Subsidies• Direct subsidies are given to government
hospitals, polyclinics, and nursing homes
– To ensure that basic healthcare services are
available for all Singaporeans
• In 2000, subsidies make up ¼ of government
spending on healthcare
• Hospital Subsidies
23
Ward Class Subsidy Rate Individual
A No Subsidy 100%
B1 20% 80%
B2 65% 35%
C 80% 20%
Medifund
• Set up in 1993
• Provides help for those who are not able to
pay for healthcare
• Government started with a fund of $200m
• The interest earned from this fund is given to
public hospitals to provide help for needy
patients
• Patients apply directly to their hospitals
24
Other measures
• Restructuring of hospitals
• Means-testing
• Promoting a healthy lifestyle
• Working with organisations
25
HEALTHCARE IN BRITAIN
• Healthcare is a public good that is provided by
the National Health Service (NHS)
27
Beginnings of the NHS
• Before the 20th C, the British government did
not provide much medical care for its citizens.
• In the 1940s, the government felt that it was
their responsibility to look after its citizens.
• 1942, William Beveridge delivered the
Beveridge Report
– Recommended that the government put an end to
poverty, disease, and unemployment.
28
Beginnings of the NHS
• This was to help rebuild people’s lives after
WWII
• To reward the people for the sacrifices they
made during the war
• People contribute to a national fund to help
the more needy people in their country
• Set up as part of the welfare system to provide
free healthcare for its people at the point of
need29
What does this mean?
• People do not have to pay for the medical
treatments that they receive when they are
attended to by doctors at clinics or hospitals
30
Result?
• Very popular
• Free for all citizens
• The British government expected demand for
healthcare to increase and then stabilise after
a while
• Problem:
– Too many people wanted to use the free medical
care
– Doctors used or recommended medical treatment
freely without much consideration for cost31
How has the British government
managed the NHS over the years?
• Managing government spending
• Increasing efficiency
• Providing quality service
33
Managing Government Spending
• 1980s, under PM Margaret Thatcher, tried to
cut back on healthcare.
• 2000, PM Tony Blair promised that the
government would increase public spending
on healthcare and improve the NHS.
• However, there was a corresponding increase
in the National Insurance contributions in
2003.
34
Increasing Efficiency
• 1980s, increasing demand for healthcare due
to the rise in the numbers of elderly.
• Population growth slowed, and number of tax-
payers would reduce.
• People expect more and better treatments
• NHS has ballooned, but still not enough
resources to cope with the demand.
35
How?
• Margaret Thatcher introduced the policy of
privatisation within the NHS
• Citizens also encouraged to take responsibility
for their own welfare and health
• Only a few groups of people had the privilege
of receiving free medicine, treatment, and
services.
36
Privatisation
• Aims: Reduce government subsidies, save
costs, and make the NHS more efficient.
• Private companies had to be efficient to make
profits
• Patients have more choices
• Hospitals would improve their services
37
Providing Quality Service
• NHS Plan 2000
– Made changes based on feedback
– Provided for increase in amount of government
spending till 2004
– Planned to work towards offering patients faster
and more convenient services
• NHS Improvement Plan 2004
– Patients can choose from 4 providers
– NHS pay for treatment
– Patients can access their own records online38
More
• Under the NHS IP (2004), NHS Direct was
introduced so patients could communicate
with doctors over the phone.
• Save resources
• Save patients an unnecessary trip
39
Questions
• Have British healthcare policies met the needs
of the people?
• How has the NHS performed over the years?
• How different is this system and policy from
Singapore’s?
40
Similar problems, different approaches
Singapore’s Approach: Shared Responsibility in
Healthcare
41
Encourage
self-reliance
by having
Medisave and
Medishield
for all
Singaporeans
Promote a
healthy
lifestyle
among
Singaporeans
by raising
awareness
about the
importance
of good
health
Keep
healthcare
affordable by
maintaining
government
subsidies,
providing
Medifund,
restructuring
hospitals and
introducing
means-testing.
Work with
organisations
by supporting
community
groups that
provide
healthcare
support
services
Similar problems, different approaches
Britain’s Approach: Free Healthcare at the Point
of Need
42
Increase efficiency
by privatising some
areas in NHS
Manage
government
spending by
balancing
spending and
increasing taxes
Provide quality
service by
reducing waiting
time and giving
choices to patients