A great healthcare system is vital to the nation’s well-being.
Healthy people will work harder, happier and have less medical leaves.
That, in turn, powers the GDP growth and theoretically allows more government spending (absolute amount) to be placed in healthcare.
What constitutes a good healthcare regime?
There are many indicators such as life expectancy, infant mortality rate, ratio of doctors and nurse to the population, etc.
At the same time, we believe that cost of obtaining the healthcare matters.
How much Singaporeans are spending on healthcare?
Is the government helping us much?
On the surface
Whether is it from our own Straits Times or independent reviewers such as this and this, it is irrefutable that our healthcare systems are one of the top ones in the world.
The quality of healthcare is definitely world-class in terms of results.
We have one of the longest life expectancies in the world at an average of 85 years old.
It is ranked either 2nd or 3rd, with Monaco being a clear numero uno.
Singaporean male babies are expected to live till 80.4 and female till 84.9 years.
We are at the bottom 5 in term of infant mortality rate (which is great).
The city-state is clean and hygienic which is a factor in healthcare system evaluation.
In fact, Singaporeans are ranked as the healthiest people in the world.
By now, you may infer that we have little to worry about.
You are not wrong – we are doing great as a nation in healthcare.
Nevertheless, let’s look at some details from the good ones to the not-so-good ones
According to World Bank statistics, Singapore spends US$2,752 per capita on healthcare.
France which is touted as a nation in healthcare, spent US$4,959 and the USA expended almost twice as much as the French.
Our use of healthcare money is more efficient than others as we are enjoying excellent healthcare with much less money spent
What we do not so well is the ratio of physicians and hospital bed to the population.
We have 2 doctors and 2 beds per 1,000 people which are ranked #72 and #107 worldwide.
The redeeming factor is that we have 5.8 nurses per 1,000 people which are ranked #46.
The really depressing statistic is that Singaporeans foot more than half of the healthcare expenses.
The government only contribute 41.9% of our medical expenses.
This is a stingy amount when compared to developed nations such as UK (83.1%), France (78.2%), Germany (77%) and Japan (83.6%).
Even our neighbours, Malaysia (55.2%) and Thailand (86%) pays a higher percentage than us.
It means that in Singapore, we are largely responsible for our own medical cost.
How did the system work in Singapore that result in this outcome?
The Singapore system
Our system revolves around 3M – Medisave, Medishield & Medifund.
Instinctively, you can see why our healthcare burden is placed on our shoulders.
Medisave & Medishield are two components that come out from our own pockets.
To add to our woes, Medishield itself is inadequate to cater to our hospitalization cost.
We have to top up with more of our Medisave and some cash to make it a better, more comprehensive hospitalization plan.
In addition, non-hospitalization medical expenses often are paid not by any of these 3Ms but by the patient himself.
These includes GP consultation, specialists visits, and alternative medicine.
If your employers do not cover for your GP and specialist consultation, you will find yourself burdened by many of these medical costs.
Residents that belong to the lower income class are being subsidized by various schemes and Medifund.
The middle class is the one that suffers the most from this 3M scheme.
Not entitled to subsidies yet not rich enough to pay the bills, the sandwich class is the one that is crying out more healthcare relief.
Learning from others
UK is one of the nations that provides universal healthcare via its National Health Service (NHS).
Most of the basic healthcare cost are footed by the government while certain expenses such as eye service and prescriptions are paid by the residents.
It is one of the oldest healthcare systems that is emulated by top healthcare nations such as San Marino, Malta & Italy.
Other from universal healthcare, the alternative is via insurance.
Healthcare insurance is compulsory or subsidized in some of these nations.
Some examples are France, Germany, and Japan.
France’s medical system is well recognized as one that is superior in its delivery.
It is also somehow similar to Singapore as health insurance is compulsory
The French have to pay a consultation fee when visiting a GP.
However, it will be subsidized heavily by the healthcare system La Sécurité Sociale.
Typically one has to pay between 0-6 Euros for a GP visit.
Specialist visits are fully subsidized if you are referred by your personal doctor.
Hospitalization and medicine are also funded heavily by the system.
All in all, the patient pays either nothing or a small amount when it comes to healthcare.
Improvements that we love to see
Before you go into “raiding on reserves” argument, one point to highlight is that we are merely spending 4.9% of our GDP on healthcare expenses.
It is an unusually low figure that is made possible by efficient use of money (credit to the government) as well our own contribution to our medical expenses.
For sake of comparison, the most developed nations spent about 10% of their GDP on healthcare.
There are two areas that we probably can do better.
GP visits and catastrophic cover.
As mentioned previously, GP visits are not covered by the Medishield.
While Pioneer Generation card and the presence of polyclinics helped in this area, more can be done for the middle-income class.
Our healthcare system can help to defray these out-of-pocket costs.
One area of concern is the possibility of abuse.
If Singapore funds GP visits, many may take the opportunity to take advantage.
A viable way to solve this is to adopt a personal doctor like how the French system does.
A personal doctor will know your medical history and the frequency of your visits.
He/she will be in better position to judge if you are really ill or not.
The government will fund these personal doctor clinics and one must visit the same personal doctor in order to enjoy subsidies.
Secondly, we will like to see fully paid medical journey for patients who contract serious health conditions such as organ failures or some hereditary conditions such as Down Syndrome.
For such catastrophic events, it would drain out a family’s fund entirely.
We are betting that not many will begrudge the usage of tax money on people who encounter such medical conditions.
Completing the prescription
We have acknowledged that the current 3M system is the reason for the efficiency of our healthcare delivery and superior healthcare outcome.
By making the citizens responsible for their own health, we can see the fruits of the system from reports all over the world on our top notch healthcare.
While our system is working fine, tweaks can be made to improve it.
As our population ages, healthcare burden will increase.
It is inequitable for the citizens who have contributed to nation building, to be shouldering the load ourselves.
Individually, we have to be aware of our own medical plans so that we can prepare for the gaps of our healthcare regime.
Get a hospitalization plan, join the employer’s outpatient insurance program and keep yourself healthy.
At the end of the day, our health is ultimately our own duty.
Until the day our healthcare system is so comprehensive that we only need to worry about our own health, do make sure that you are insured adequately.
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