2. Lesson Recap
What are the key features of MediShield
scheme?
Which group of people does MediFund serve?
3. Today’s Lesson
By the end of the lesson students should be
able to:
Identify the challenges government’s face in
managing healthcare
State the features of healthcare in Singapore from
the 1960s to the present.
Explain Singapore’s approach to healthcare.
4. Healthcare as a Public Good
Healthcare provision can be grouped under 3 systems.
Governments that provide and subsidize
healthcare. Healthcare is a public good.
Government provides healthcare and subsidizes
part of its cost. The rest of the costs are funded by
citizens.
Healthcare is provided by private companies and
completely paid for by citizens.
5. Which system works best…
Depends on:
Expectations of the citizens
Economic development of the nation
Characteristics of the nation (i.e. ageing, major
illness etc.)
6. Healthcare Provision in
Singapore
1960’s
Healthcare measures linked to public housing –
emphasis on public hygiene
Cleared squatters and slums – relocated to HDB flats
Clinics and hospitals were built to meet growing
pop.
Infectious diseases common – citizens encouraged to
go for vaccination.
7. Healthcare Provision in
Singapore
1970’s
Standard of living improved – now wanted better
quality healthcare.
Polyclinics built conveniently within HDB estates
to replace “out-patient dispensaries”
Better facilities in government hospitals –
sophisticated equipment for more precise medical
tests and examinations.
8. Healthcare Provision in
Singapore
1980s to the present
Government realised Singapore population is
ageing…so healthcare costs will increase.
Government resources would be taken away to pay
for healthcare…solution?
1980s – Govt. introduced new approach to
healthcare:
Healthcare = Shared responsibility between: The
Indivdual, the Government and the Community
9. Healthcare Provision in
Singapore
The Individual
Self-reliance:
1984 Introduced MediSave Account. 8% of monthly
contribution to CPF channelled to MediSave.
Singaporeans encouraged to take charge of their own
healthcare provisions.
Later MediSave further enhanced to include Medishield (for
those who do not have CPF Accounts) and Eldershield (for
those above 40 who have disabilities)
10. Healthcare Provision in
Singapore
The Individual (Self-Reliance):
MediShield scheme is a national healthcare insurance
scheme. Just like insurance – Singaporeans pay for
MediShield from monthly contributions from
MediSave.
Eldershield another insurance scheme for those
above 40. Use CPF MediSave accounts to pay
premiums for Eldershield.
11. Healthcare Provision in
Singapore
The Government
Keeping healthcare affordable (Government Subsidies)
Provide government subsidies to hospitals, polyclinics
and nursing homes.
Government saved $200mill and from the interest it
gets it provides Medifund to subsidize hospital wards.
Hospital authorities decide how to use funds for
individual cases.
12. Healthcare Provision in
Singapore
The Government
Keeping healthcare affordable (Restructured Hosp.)
Restructuring means – Hospitals now have freedom to
reorganise and better meet needs to Singaporeans
Government can reduce the amount of subsidies
Keeping healthcare affordable (Means testing)
Subsidies provided must benefit patients who need them
most. Very low income receive most. Higher income means
get less subsidies.
Very difficult issue…how to know who deserves more??
13. Healthcare Provision in
Singapore
The Government (Promoting Healthy Lifestyle)
A healthy person does not need a lot of medical care
Government encourages the need for citizens to keep healthy
Encourage a well-balanced diet and habit of physical
exercise.
14. Provision of Healthcare in
Singapore
The Community
Community provides healthcare support
After discharge some patients still need support to fully
recover: Voluntary organizations and private
organizations given grants to operate these facilities.
Government gives grants to organizations that provide
specialised healthcare services: NKF and SATA
(Singapore Anti Tuberculosis Assoc.)
15. Lesson Re-cap
What is the challenge of governments in
providing healthcare?
What was Singapore’s healthcare system like
in the 1960s and 70s?
What are the principles healthcare provision
here…since the 1980’s?
16. Welfare State & Healthcare
Provision in UK
Before the 20th Century, the British government did
not provide much medical care for its citizens.
The poor, aged or homeless had to depend on private
charities, friends or family to help them pay for
healthcare.
After the war – Government felt it was necessary to
look after these groups of people. The state would
look after its citizens – for free
17. Welfare State & Healthcare in
the UK
In a Welfare state, the government looks after
its citizens from ‘cradle-to-grave’.
This means that the government would ensure
that every citizen would have a minimum
standard of welfare to live a ‘decent’ life:
Each citizen would have a job
Each citizen would have a home
Each citizen would have access to healthcare.
18. NHS in the initial years
Initial success: It was popular with the people.
The government provided free basic medical
service for all citizens.
Free medical treatments: This means that all
medical services, dental and even optical
treatments were FREE.
19. Buzz Break
What are the advantages and disadvantages of
living under a welfare system?
20. Initial years of NHS
Government expected demand for healthcare
to increase and then stabilize.
However increases went beyond expectations.
Too many people wanted healthcare services
Doctors recommended medical treatment without
consideration for costs.
By 1951 NHS could not meet expectations.
“Free at the point of service” was not working
Now had to charge for some treatments
21. Britain and the NHS now
Britain has to manage healthcare resources.
Rising healthcare costs affects Britain too.
The British approach is to ensure that healthcare
spending is put to good use:
No wastage or unnecessary expenditures.
Resources cater for specific patient needs.
22. Managing healthcare in UK (1980s)
Managing government spending:
The government is expected to provide healthcare
to everyone.
Healthcare costs rise. This means government has
to collect more taxes.
In the 1980s – new government in Britain wanted
to reduce expenditure in healthcare.
23. Managing healthcare-Thatcher’s policies
Prime Minister Thatcher’s approach:
Cut back on government spending on welfare
benefits including healthcare.
Return some services to be provided by private
companies (privatization).
Healthcare should also be the responsibility of the
individual.
24. Challenges faced by UK
Thatcher’s cut-back of the NHS and Welfare
system created challenges for the UK
government of that period:
Challenge 1: Loss of people’s support:
Reduction in healthcare spending would mean that
NHS could not continue to provide free health
services.
Government could lose support from voters.
25. Challenges faced by UK
Challenge 2: Cost increase & increasing tax
contribution:
Healthcare costs are rising.
Britain's National Insurance contributions (which
partly paid for NHS services) also had to increase.
This was not always popular. Increases meant
there would be less money for people to spend on
other things.
26. Challenges faced by UK
Challenge 3: Increasing efficiency
Demand for healthcare grew with an ageing
population.
Numbers of people paying taxes to support the
NHS was declining.
There was still not enough resources to support the
demand.
27. Challenges faced by UK
Challenge 4: Privatization.
The aim was to reduce government subsidies.
To save costs and make NHS more efficient.
Private companies would now provide some services
to the public.
E.g. All non-medical services would be supplied by
private companies under a contract
Cleaning services and catering.
28. Challenges
Challenge 5: Providing Quality Services
By the late 1980s demand for services was high.
NHS system could not cope with this demand
There were poor standards in the NHS.
Providing patients with quality information on their
treatment.
But long queues for services still common.
29. Response of Challenges
NHS Plan (2000)
Based on feedback from patients, staff and doctors
Increase government spending up to 2004
To offer patients more convenient services
Could make use of facilities in private hospitals
without the patients paying for it.
30. UK Response to Challenges
NHS Plan (2004)
Patients had a choice of 4 different healthcare
providers. Treatment paid for by NHS.
Every patient have access to their own records on
the Internet (HealthSpace).
Patient’s with minor illness can get advice from
doctors over the phone (NHS Direct).
31. Let’s Compare
No one system is better than the other. The UK
system works in there because:
people’s expectations are different
Standard of living is high etc.
Singapore system of healthcare works here
because of our different cultural and social
characteristics
32. Comparison 1:
How citizens participate in the system
UK S’pore
Citizens make use of benefits – Promote self-reliance among
Govt. manages costs by citizens – Govt. plans for citizens
carefully controlling to share the costs of their own
government spending. healthcare
Citizens pay two types of taxes: MediSave and Medishield from
Income tax & National citizen’s CPF contributions.
Insurance tax
33. Comparison 2:
Keeping Healthcare affordable
UK S’pore
Privatization to reduce: Government subsidies
given to nursing homes, polyclinics
Operating costs
Govt. subsidies Medifund
Given to hospitals to use to off-set
Increase efficiency
patient’s bill (needy cases)
Every individual encouraged to Restructured hospital
be responsible for welfare and Govt. is able to give less subsidies.
health (except for expectant
mothers, mothers with young
Means Testing
ensure that Govt. subsidies given to
children and students below 19)
patients who need.
34. Comparison 3:
Lifestyle choices and role of community
UK S’pore
Citizens encouraged…but no Government provides support by
government programme or championing healthy lifestyle
policy to promote healthy choices through Health Promotion
lifestyles. Board (a govt. agency)
Community provides nursing Government gives grants (sums of
support, social services etc…but money for specific purposes) to
these are self-funded. VWOs to operate: day
rehabilitation centres, nursing
homes and community hospitals
Government (through NHS)
for discharged patients
still seen as the main provider
of healthcare services and
aftercare
35. Lesson recap
What were the 2 reasons that Beveridge report
cited as the reason for the Welfare State?
List 2 features of the healthcare provision in
the welfare state.
What were some of the challenges that British
governments faced in managing the NHS?