Upload
august-rafe-singleton
View
217
Download
0
Tags:
Embed Size (px)
Citation preview
Chapt 3: Managing Healthcare
Case Study of Singapore
Learning Points
Identify the challenges governments face in managing healthcare
Identify some ways that healthcare is paid for in a country
Challenges that Governments Face…
1.Healthcare is considered as a public good - The citizens expect the government to
provide basic healthcare for them- Limited resources
2.The need to provide quality healthcare- Longer lifespan of people- People in more developed countries expect
more & better healthcare services
Challenges that Governments Face…
3. Increasing expenditure on healthcare
- People demand for the better treatments, more effective medicines and better-qualified medical staff
How is healthcare paid for?
Self
Employer-paid
insurance
Personal Insurance
Government taxes
Healthcare
Healthcare in Singapore
Learning Points
1. Identify how the government managed healthcare expenses before the 1980s
2. Identify how the government manages healthcare expenses after the 1980s
Life in Singapore1960s and 1970s
What are the effects of poor housing conditions on people’s health?
Singapore Healthcare In the 1950s and 1960s
Polyclinics were known as health centers. They are mostly located in rural areas. Medical staff brought help to the people
living away from town areas in mobile health centers (vans).
To improve healthcare, government trained a huge no. of nurses and doctors in hospitals.
The government also educate people on how to prevent illness through health programs.
To keep people healthy, students were introduced to physical education.
Video – Singapore Healthcare After the 1960s
Improved healthcare services like having more clinics and medical staff.
Health programs like being healthy at work and going for medical checkups are implemented.
How does the Government managed Healthcare Expenses?
Healthcare expenses comes from the government budget
Government budget isspent on needs of the people E.g. healthcare, education,transportation, housing …
What is govt budget?
The amount of money that the govt plans to spend on meeting the needs of the people
Others – 96%
Healthcare – 4%
Singapore’s Healthcare Expenditure
(2008)
Problems in the early 1980s:rising cost of healthcare → strain on govt spending
due to limited resources
Solution:1. Individuals must have self-reliance & to
maintain good health2. Government will keep healthcare affordable
and will promote healthy living3. Community will provide some healthcare
services and other support services
How does the Government managed Healthcare Expenses after the 1980s
Do you know the cost of healthcare in Singapore?
Charges of Hospital Wards
Class of Ward / Charges per day (SGD)
A (1&2) B (1&1+) B2 C
Restructured Hospitals
AH / CGH / KK / NUH / SGH / TTSH
196 – 295 113 - 177 50 - 57 25 – 29
Private HospitalsESH / GH / MAH /
MEH / TMC 200 – 460 135 – 200 110
Breakdown of Hospital Bill Amount Payable (S$)
Room & Board (5 days)
750
Hospital Miscellaneous Expenses• Prescription drugs • Diagnostic Procedures • Operating Theatre Fees
2,950
Anaesthetist Charge 500
Surgeon’s fee 1,700
ICU (2 days) 2,250
Post-Hospitalisation Treatment 800
Total 8,950
• Assume a person is hospitalized due to inflammation of the appendix and underwent an appendicitis operation.
• Staying a total of 7 days in a private hospital with 2 days in ICU, his total hospital bill came up to S$8,950.
• Assume a person is hospitalized due to Heart Disease and underwent a Coronary Artery Bypass Graft surgery.
• Staying a total of 9 days in a private hospital, his total hospital bill came up to S$18,900.
Breakdown of Hospital Bill Amount Payable (S$)
Room & Board (7 days) 5,870
ICU Charges (2 days) 1,630
Surgical Procedure 9,000
Surgical Implants / Approved Medical Consumables
2,400
Total 18,900
Role of an Individual
To have self-reliance
How?1. Medisave (what is it?)2. Medishield (what is it?)
What is self-reliance?
Citizens to be responsible for themselves and take care of themselves
Central Provident Fund (CPF)
Medisave
Comes from the individual’s CPF Can be used to pay for hospital bills
and medical treatment
MediShield
National healthcare insurance scheme Individuals pay for this through Medisave
Why is it required? Isn’t Medisave sufficient?
- For people who needs long-term treatment who cannot afford their treatment fees or hospitalization fees and Medisave cannot cover the fees.
Advantages of Singaporeans being self-reliant
Singaporeans share the cost of healthcare with the government by paying for their own healthcare
Help lighten the government’s load-> Government does not need to increase taxes
Problem: Does every Singaporean have CPF?
So how are they going to pay for their healthcare costs?
Role of the Government
1. To keep healthcare affordable
How?1. Government subsidies (to who?)2. Medifund (what is it?)3. Restructuring of hospitals4. Means-testing
A total budget of $3,705 million has been allocated to MOH for FY2009 to promote good health and keep healthcare affordable
Government Subsidies Direct subsidies given to govt hospitals,
polyclinics and some nursing homes for elderly.
Lower income group receive the most subsidies.
Govt gives different rates of subsidies to the different classes of wards in hospitals. Class C receive the most in subsidies.
Medifund
A sum of money set aside by the govt Started in 1993 with a fund of $200 million
For people who cannot pay for their medical fees despite Medisave, Medishield and govt subsidies
E.g. low-income workers, self-employed people who do not make any CPF contributions
People who need help apply for the fund at the hospital where they are being treated
Restructuring of Hospitals
Hospital have the freedom to reorganise to meet the needs of the people
Hospital becomes financially independent from the govt where they have their own board of directors therefore govt able to reduce the amount of subsidies to hospitals
Govt belief: Subsidies should benefit patients who need them the most
Govt gives heavy subsidies to polyclinics and government hospitals especially to class B2 and C wards.
Means-testing implemented in Jan 2009 where lower-income group will receive a higher amount of subsidies than the higher-income group
Means testing takes into consideration the patient's monthly income and ownership of private property.
Means-testing
Checking the financial background of a person to see if they are able to afford healthcare
Role of the Government
2. Promote a healthy lifestyle
How?- By having health programmes in schools and workplaces
Good healthWill not need
medical treatment
Save medical expenses
Role of the Community Community needs to provide healthcare
support services as it is not possible for the govt to run all of them
1. Voluntary welfare organizations2. Private organizations
They are given grants to run community hospitals, nursing homes, day rehabilitation centres
Role of the Community
Voluntary welfare organizations
E.g. Ren Ci, St. Andrew’s Community Hospital
Private organizations
E.g. NKF (cater to the needs of specific groups of
people such as the poor or those with a particular illness)
How successful is the healthcare policies in Singapore?
Effective Ineffective
Provided Singaporeans with the money to pay for healthcare
There are still groups of people who are still not able to pay for their own medical expenses:1. Elderly2. People who are unable to
work
How are they going to pay for their own healthcare then?
1. Self-reliance• Medisave• MediShield
2. Maintains good health
1. Keeps healthcare affordable• Govt subsidies• Medifund• Restructuring of hospitals• Means-testing
2. Promoting a healthy lifestyle
Voluntary welfare and private organisations providehealthcareand support services
Singapore:Shared Responsibility in Healthcare
Individual Government Community
http://worldfocus.org/blog/2009/01/27/the-fundamentals-of-singapores-health-care-system/3795/
http://www.geraldtan.com/medaffairs/meanstest.html