Part 3 of a 3-part series
Singapore (693 square kilometers) is just slightly bigger than Metro Manila (639 square kilometers). Yet the tiny city-state and island-nation is a David among the world’s economic Goliaths.
Singapore’s economy has been ranked as the most open in the world, least corrupt, most pro-business, with low tax rates and has the third highest Gross Domestic Product (GDP) per capita in the world. (Put simply, GDP per capita is the output of a country’s economy per person.)
Quality, affordable healthcare for all[pq]Not surprisingly, Singapore’s healthcare system is also considered one of the best in the world.[/pq]
In Bloomberg’s 2013 list of countries with the most efficient healthcare systems, Singapore came in a close second to list topper Hong Kong. Other Asian countries in the list are Japan (3), South Korea (8), Malaysia (18), and Thailand (22). China was ranked 37 and the United States 46. The Philippines is not among the 48 countries in the Bloomberg list.
Through its lead agency the Ministry of Health (MOH), Singapore offers universal healthcare coverage, i.e. quality and affordable basic medical services for all its citizens. The MOH also promotes healthy living and preventive health programs as well as maintains high standards of living, clean water and hygiene to achieve better health for the population.
The efficiency of Singapore’s healthcare system is best demonstrated by the good healthcare outcomes achieved through a remarkably low national healthcare expenditure of only about 4% of the GDP.
That Singapore spends so little on health care and yet has a healthier population than the U.S. which spends more than 17% of its GDP on health intrigued William Haseltine, president and founder of the think tank ACCESS Health International. He eventually examined Singapore’s approach to health care and in 2013 published his book, Affordable Excellence: The Singapore Health Story.
“I don’t think there’s a single [healthcare] system in the world that spends as little as Singapore does in terms of percentage of GDP and gets the [health] outcomes that it gets,” said World Bank President Dr. Jim Yong Kim during his visit to Singapore in July 2014.
Multiple tiers of protection
Singapore’s healthcare system has multiple tiers of protection that ensures no Singaporean is denied access to basic healthcare because he or she cannot afford it.
The first tier of protection is provided by heavy government subsidies of up to 80% of the total bill in acute public hospital wards, which all Singaporeans can access.
Medisave, a compulsory individual medical savings account scheme, provides the second tier of protection. Working Singaporeans and their employers contribute a part of the monthly wages into Medisave, which can be used for future medical needs, even after retirement.
The third level of protection is provided by MediShield, a low-cost catastrophic medical insurance scheme that allows Singaporeans to effectively risk-pool the financial risks of major illnesses. Individual responsibility for one’s healthcare needs is promoted through the features of deductibles and co-payment in MediShield.[pq]Singaporeans also have the option of subscribing to ElderShield, a severe disability insurance designed to risk-pool against the financial risks of suffering a severe disability.[/pq]
Many middle- and higher-income Singaporeans supplement their basic coverage with integrated private insurance policies (“Integrated Shield plans”) for treatment in the private sector. However, Singaporeans must subscribe to the basic MediShield product before they can purchase the add-on private Integrated Shield Plans. This safeguard preserves the national risk pool and prevents private insurers from “cherry picking” healthy policyholders. Basic ElderShield policyholders can enhance their disability benefits coverage by purchasing “ElderShield Supplements.
Finally, Medifund is a medical endowment fund set up by the Government to act as the ultimate safety net for Singaporean patients who cannot afford to pay their medical bills despite heavy subsidies, Medisave and MediShield.
Primary healthcare services
In Singapore, general practitioners and nurses provide primary healthcare services through an island network of 18 outpatient polyclinics and about 2,400 private medical clinics.
Common primary healthcare services include outpatient medical treatment, medical follow-ups after discharge from hospital, immunisation, health screening and education, and diagnostic and pharmaceutical services.[pq]Patients who require more specialized treatment and possible admission can be referred from the polyclinics to hospitals.[/pq]
Singapore has (as of 2012) a total of 25 hospitals and specialty centers. The 15 public hospitals and specialty centers with bed complements between 185 to 2,010 beds account for about 85% of the country’s total hospital bed capacity. The 10 private hospitals tend to be smaller, with capacity ranging from 20 to 345 beds. As the dominant healthcare provider, the government is able to influence the supply of hospital beds, the introduction of high-tech/high-cost medicine, and the rate of cost increases in the public sector, which sets the pricing benchmark for the private sector.
Eight public hospitals consist of six general hospitals, a women’s and children’s hospital, and a psychiatric hospital. General hospitals provide multi-disciplinary inpatient and specialist outpatient services, and 24-hour emergency departments. Six national specialty centers provide cancer, cardiac, eye, skin, neuroscience and dental care.
The government has restructured all public hospitals and specialty centres to be run as private companies wholly-owned by the government. This enables public hospitals to have the management autonomy and flexibility to respond more promptly to the needs of patients.
The government has also introduced community hospitals for intermediate healthcare for the convalescent sick and aged who do not require the care of general hospitals.
Other health services
Public dental services are available through the National Dental Center and in some polyclinics and hospitals. Preventive dentistry, targeted mainly at school pupils, is the responsibility of the Health Promotion Board.
Intermediate and Long Term Care (ILTC) facilities are for patients who no longer require the level of care dispensed by a hospital, but nevertheless require continued care. Residential ILTC services care is for patients who stay in these facilities both in the day and at night.
Community-based ILTC Services are center-based and home-based healthcare services provided to patients during the day.
These revelations about the huge contrast between the Philippines’ healthcare system as compared to the best in the world like Singapore’s is a huge wake-up call to the Filipino populace that we are currently being underserved by our government. If we really aspire to raise the economic competence of our nation in the global scene, we must start by assuring our workforce are healthy, fit, and protected. Always remember, a strong nation has a healthy population.
– Eric Michael Santos, Medical Observer
w/ conclusion by MJF