Sec3 chapter3 managing_healthcare(intro&singapore's system)_slideshare

Healthcare ProvisionHealthcare Provision(Singapore and UK)(Singapore and UK)

Should the State provide…?Should the State provide…?

Lesson RecapLesson Recap What are the key features of MediShield What are the key features of MediShield

scheme?scheme?

Which group of people does MediFund serve? Which group of people does MediFund serve?

Today’s LessonToday’s Lesson By the end of the lesson students should be By the end of the lesson students should be

able to:able to:

Identify the challenges government’s face in Identify the challenges government’s face in managing healthcaremanaging healthcare

State the features of healthcare in Singapore from State the features of healthcare in Singapore from the 1960s to the present.the 1960s to the present.

Explain Singapore’s approach to healthcare. Explain Singapore’s approach to healthcare.

Healthcare as a Public GoodHealthcare as a Public Good Healthcare provision can be grouped under 3 systems.Healthcare provision can be grouped under 3 systems.

Governments that provide and subsidize Governments that provide and subsidize healthcare. Healthcare is a public good.healthcare. Healthcare is a public good.

Government provides healthcare and subsidizes Government provides healthcare and subsidizes part of its cost. The rest of the costs are funded by part of its cost. The rest of the costs are funded by citizens.citizens.

Healthcare is provided by private companies and Healthcare is provided by private companies and completely paid for by citizens.completely paid for by citizens.

Which system works best…Which system works best…

Depends on:Depends on: Expectations of the citizensExpectations of the citizens Economic development of the nationEconomic development of the nation Characteristics of the nation (i.e. ageing, major Characteristics of the nation (i.e. ageing, major

illness etc.)illness etc.)

Healthcare Provision in Healthcare Provision in SingaporeSingapore

1960’s 1960’s

Healthcare measures linked to public housing – Healthcare measures linked to public housing – emphasis on public hygieneemphasis on public hygiene

Cleared squatters and slums – relocated to HDB flatsCleared squatters and slums – relocated to HDB flats

Clinics and hospitals were built to meet growing Clinics and hospitals were built to meet growing pop.pop.

Infectious diseases common – citizens encouraged to Infectious diseases common – citizens encouraged to go for vaccination.go for vaccination.


1970’s1970’s Standard of living improved – now wanted better Standard of living improved – now wanted better

quality healthcare.quality healthcare.

Polyclinics built conveniently within HDB estates Polyclinics built conveniently within HDB estates to replace “out-patient dispensaries”to replace “out-patient dispensaries”

Better facilities in government hospitals – Better facilities in government hospitals – sophisticated equipment for more precise medical sophisticated equipment for more precise medical tests and examinations.tests and examinations.


1980s to the present1980s to the present Government realised Singapore population is Government realised Singapore population is

ageing…so healthcare costs will increase. ageing…so healthcare costs will increase.

Government resources would be taken away to pay Government resources would be taken away to pay for healthcare…solution?for healthcare…solution?

1980s – Govt. introduced new approach to 1980s – Govt. introduced new approach to healthcare:healthcare:

Healthcare = Shared responsibility between: The Healthcare = Shared responsibility between: The Indivdual, the Government and the CommunityIndivdual, the Government and the Community


The IndividualThe Individual

Self-relianceSelf-reliance::

1984 Introduced MediSave Account. 8% of monthly 1984 Introduced MediSave Account. 8% of monthly contribution to CPF channelled to MediSave.contribution to CPF channelled to MediSave.

Singaporeans encouraged to take charge of their own Singaporeans encouraged to take charge of their own healthcare provisions. healthcare provisions.

Later MediSave further enhanced to include Medishield (for Later MediSave further enhanced to include Medishield (for those who do not have CPF Accounts) and Eldershield (for those who do not have CPF Accounts) and Eldershield (for those above 40 who have disabilities) those above 40 who have disabilities)

The Individual (Self-Reliance):The Individual (Self-Reliance):

MediShieldMediShield scheme is a national healthcare insurance scheme is a national healthcare insurance scheme. Just like insurance – Singaporeans pay for scheme. Just like insurance – Singaporeans pay for MediShield from monthly contributions from MediShield from monthly contributions from MediSave.MediSave.

EldershieldEldershield another insurance scheme for those another insurance scheme for those above 40. Use CPF MediSave accounts to pay above 40. Use CPF MediSave accounts to pay premiums for Eldershield. premiums for Eldershield.



The GovernmentThe Government Keeping healthcare affordable Keeping healthcare affordable (Government Subsidies)(Government Subsidies)

Provide government subsidies to hospitals, polyclinics Provide government subsidies to hospitals, polyclinics and nursing homes.and nursing homes.

Government saved $200mill and from the interest it Government saved $200mill and from the interest it gets it provides Medifund to subsidize hospital wards. gets it provides Medifund to subsidize hospital wards.

Hospital authorities decide how to use funds for Hospital authorities decide how to use funds for individual cases.individual cases.


The Government The Government Keeping healthcare affordable Keeping healthcare affordable (Restructured Hosp.)(Restructured Hosp.)

Restructuring means – Hospitals now have freedom to Restructuring means – Hospitals now have freedom to reorganise and better meet needs to Singaporeansreorganise and better meet needs to Singaporeans

Government can reduce the amount of subsidiesGovernment can reduce the amount of subsidies

Keeping healthcare affordable Keeping healthcare affordable (Means testing)(Means testing) Subsidies provided must benefit patients who need them Subsidies provided must benefit patients who need them

most. Very low income receive most. Higher income means most. Very low income receive most. Higher income means get less subsidies.get less subsidies.

Very difficult issue…how to know who deserves more??Very difficult issue…how to know who deserves more??


The Government (Promoting Healthy Lifestyle)The Government (Promoting Healthy Lifestyle) A healthy person does not need a lot of medical careA healthy person does not need a lot of medical care

Government encourages the need for citizens to keep healthyGovernment encourages the need for citizens to keep healthy Encourage a well-balanced diet and habit of physical Encourage a well-balanced diet and habit of physical

exercise.exercise.

Provision of Healthcare in Provision of Healthcare in SingaporeSingapore

The CommunityThe Community Community provides healthcare supportCommunity provides healthcare support

After discharge some patients still need support to fully After discharge some patients still need support to fully recover: Voluntary organizations and private recover: Voluntary organizations and private organizations given grants to operate these facilities.organizations given grants to operate these facilities.

Government gives grants to organizations that provide Government gives grants to organizations that provide specialised healthcare services: NKF and SATA specialised healthcare services: NKF and SATA (Singapore Anti Tuberculosis Assoc.) (Singapore Anti Tuberculosis Assoc.)

Lesson Re-capLesson Re-cap

What is the challenge of governments in What is the challenge of governments in providing healthcare?providing healthcare?

What was Singapore’s healthcare system like What was Singapore’s healthcare system like in the 1960s and 70s?in the 1960s and 70s?

What are the principles healthcare provision What are the principles healthcare provision here…since the 1980’s?here…since the 1980’s?

Welfare State & Healthcare Welfare State & Healthcare Provision in UKProvision in UK

Before the 20Before the 20thth Century, the British government did Century, the British government did not provide much medical care for its citizens.not provide much medical care for its citizens.

The poor, aged or homeless had to depend on private The poor, aged or homeless had to depend on private charities, friends or family to help them pay for charities, friends or family to help them pay for healthcare.healthcare.

After the war – Government felt it was necessary to After the war – Government felt it was necessary to look after these groups of people. The state would look after these groups of people. The state would look after its citizens – for free look after its citizens – for free

Welfare State & Healthcare in Welfare State & Healthcare in the UKthe UK

In a Welfare state, the government looks after In a Welfare state, the government looks after its citizens from its citizens from ‘cradle-to-grave’.‘cradle-to-grave’.

This means that the government would ensure This means that the government would ensure that every citizen would have a minimum that every citizen would have a minimum standard of welfare to live a ‘decent’ life:standard of welfare to live a ‘decent’ life:

Each citizen would have a jobEach citizen would have a job Each citizen would have a homeEach citizen would have a home Each citizen would have access to healthcare.Each citizen would have access to healthcare.

NHS in the initial yearsNHS in the initial years

Initial successInitial success: It was popular with the people. : It was popular with the people. The government provided free basic medical The government provided free basic medical service for all citizens.service for all citizens.

Free medical treatmentsFree medical treatments: This means that all : This means that all medical services, dental and even optical medical services, dental and even optical treatments were FREE.treatments were FREE.

Buzz BreakBuzz Break

What are the advantages and disadvantages of What are the advantages and disadvantages of living under a welfare system?living under a welfare system?

Initial years of NHS Initial years of NHS

Government expected demand for healthcare Government expected demand for healthcare to increase and then stabilize.to increase and then stabilize.

However increases went beyond expectations.However increases went beyond expectations. Too many people wanted healthcare servicesToo many people wanted healthcare services Doctors recommended medical treatment without Doctors recommended medical treatment without

consideration for costs.consideration for costs.

By 1951 NHS could not meet expectations.By 1951 NHS could not meet expectations.

““Free at the point of service” was not workingFree at the point of service” was not working Now had to charge for some treatmentsNow had to charge for some treatments

Britain and the NHS nowBritain and the NHS now

Britain has to manage healthcare resources.Britain has to manage healthcare resources.

Rising healthcare costs affects Britain too.Rising healthcare costs affects Britain too.

The British approach is to ensure that healthcare The British approach is to ensure that healthcare spending is put to good use:spending is put to good use:

No wastage or unnecessary expenditures.No wastage or unnecessary expenditures. Resources cater for specific patient needs.Resources cater for specific patient needs.

Managing healthcare in UK (1980s)Managing healthcare in UK (1980s)

Managing government spendingManaging government spending: :

The government is expected to provide healthcare The government is expected to provide healthcare to everyone.to everyone.

Healthcare costs rise. This means government has Healthcare costs rise. This means government has to collect more taxes.to collect more taxes.

In the 1980s – new government in Britain wanted In the 1980s – new government in Britain wanted to reduce expenditure in healthcare.to reduce expenditure in healthcare.

Managing healthcare-Thatcher’s policiesManaging healthcare-Thatcher’s policies

Prime Minister Thatcher’s approachPrime Minister Thatcher’s approach::

Cut back on government spending on welfare Cut back on government spending on welfare benefits including healthcare.benefits including healthcare.

Return some services to be provided by private Return some services to be provided by private companies (privatization).companies (privatization).

Healthcare should also be the responsibility of the Healthcare should also be the responsibility of the individual.individual.

Challenges faced by UKChallenges 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 supportChallenge 1: Loss of people’s support::

Reduction in healthcare spending would mean that Reduction in healthcare spending would mean that NHS could not continue to provide free health NHS could not continue to provide free health services.services.

Government could lose support from voters.Government could lose support from voters.

Challenge 2: Cost increase & increasing tax Challenge 2: Cost increase & increasing tax contributioncontribution::

Healthcare costs are rising.Healthcare costs are rising.

Britain's National Insurance contributions (which Britain's National Insurance contributions (which partly paid for NHS services) also had to increase.partly paid for NHS services) also had to increase.

This was not always popular. Increases meant This was not always popular. Increases meant there would be less money for people to spend on there would be less money for people to spend on other things. other things.

Challenges faced by UKChallenges faced by UK

Challenges faced by UKChallenges faced by UK

Challenge 3: Increasing efficiencyChallenge 3: Increasing efficiency

Demand for healthcare grew with an ageing Demand for healthcare grew with an ageing population.population.

Numbers of people paying taxes to support the Numbers of people paying taxes to support the NHS was declining.NHS was declining.

There was still not enough resources to support the There was still not enough resources to support the demand.demand.

Challenges faced by UKChallenges faced by UK Challenge 4: Privatization.Challenge 4: Privatization.

The aim was to reduce government subsidies.The aim was to reduce government subsidies.

To save costs and make NHS more efficient.To save costs and make NHS more efficient.

Private companies would now provide some services Private companies would now provide some services to the public.to the public.

E.g. All non-medical services would be supplied by E.g. All non-medical services would be supplied by private companies under a contractprivate companies under a contract

Cleaning services and catering.Cleaning services and catering.

ChallengesChallenges

Challenge 5: Providing Quality ServicesChallenge 5: Providing Quality Services

By the late 1980s demand for services was high.By the late 1980s demand for services was high.

NHS system could not cope with this demandNHS system could not cope with this demand

There were poor standards in the NHS.There were poor standards in the NHS. Providing patients with quality information on their Providing patients with quality information on their

treatment.treatment.

But long queues for services still common.But long queues for services still common.

Response of ChallengesResponse of Challenges

NHS Plan (2000)NHS Plan (2000)

Based on feedback from patients, staff and doctorsBased on feedback from patients, staff and doctors Increase government spending up to 2004Increase government spending up to 2004 To offer patients more convenient servicesTo offer patients more convenient services Could make use of facilities in private hospitals Could make use of facilities in private hospitals

without the patients paying for it.without the patients paying for it.

UK Response to ChallengesUK Response to Challenges

NHS Plan (2004)NHS Plan (2004)

Patients had a choice of 4 different healthcare Patients had a choice of 4 different healthcare providers. Treatment paid for by NHS.providers. Treatment paid for by NHS.

Every patient have access to their own records on Every patient have access to their own records on the Internet (HealthSpace).the Internet (HealthSpace).

Patient’s with minor illness can get advice from Patient’s with minor illness can get advice from doctors over the phone (NHS Direct). doctors over the phone (NHS Direct).

Let’s CompareLet’s Compare No one system is better than the other. The UK No one system is better than the other. The UK

system works in there because:system works in there because:

people’s expectations are differentpeople’s expectations are different Standard of living is high etc.Standard of living is high etc.

Singapore system of healthcare works here Singapore system of healthcare works here because of our different cultural and social because of our different cultural and social characteristicscharacteristics

UKUK Citizens make use of benefits –

Govt. manages costs by carefully controlling government spending.

Citizens pay two types of taxes: Income tax & National Insurance tax

Promote self-reliance among Promote self-reliance among citizens – Govt. plans for citizens citizens – Govt. plans for citizens to share the costs of their own to share the costs of their own healthcare healthcare

MediSave and Medishield from MediSave and Medishield from citizen’s CPF contributions.citizen’s CPF contributions.

Comparison 1: Comparison 1: How citizens participate in the systemHow citizens participate in the system

S’poreS’pore

Comparison 2:Comparison 2:Keeping Healthcare affordableKeeping Healthcare affordable

UKUK Privatization to reduce:Privatization to reduce:

Operating costsOperating costs Govt. subsidiesGovt. subsidies Increase efficiencyIncrease efficiency

Every individual encouraged to Every individual encouraged to be responsible for welfare and be responsible for welfare and health (except for expectant health (except for expectant mothers, mothers with young mothers, mothers with young children and students below 19)children and students below 19)

S’poreS’pore Government subsidiesGovernment subsidies

given to nursing homes, polyclinicsgiven to nursing homes, polyclinics

MedifundMedifund Given to hospitals to use to off-set Given to hospitals to use to off-set

patient’s bill (needy cases)patient’s bill (needy cases)

Restructured hospitalRestructured hospital Govt. is able to give less subsidies.Govt. is able to give less subsidies.

Means TestingMeans Testing ensure that Govt. subsidies given to ensure that Govt. subsidies given to

patients who need.patients who need.

Comparison 3:Comparison 3:Lifestyle choices and role of communityLifestyle choices and role of community

UKUK Citizens encouraged…but no Citizens encouraged…but no

government programme or government programme or policy to promote healthy policy to promote healthy lifestyles.lifestyles.

Community provides nursing Community provides nursing support, social services etc…but support, social services etc…but these are self-funded. these are self-funded.

Government (through NHS) Government (through NHS) still seen as the main provider still seen as the main provider of healthcare services and of healthcare services and aftercareaftercare

S’poreS’pore Government provides support by Government provides support by

championing healthy lifestyle championing healthy lifestyle choices through Health Promotion choices through Health Promotion Board (a govt. agency)Board (a govt. agency)

Government gives grants (sums of Government gives grants (sums of money for specific purposes) to money for specific purposes) to VWOs to operate: day VWOs to operate: day rehabilitation centres, nursing rehabilitation centres, nursing homes and community hospitals homes and community hospitals for discharged patientsfor discharged patients

Lesson recapLesson recap

What were the 2 reasons that Beveridge report What were the 2 reasons that Beveridge report cited as the reason for the Welfare State?cited as the reason for the Welfare State?

List 2 features of the healthcare provision in List 2 features of the healthcare provision in the welfare state.the welfare state.

What were some of the challenges that British What were some of the challenges that British governments faced in managing the NHS? governments faced in managing the NHS?

Education

Sec3 chapter3 managing_healthcare(intro&singapore's system)_slideshare