Healthcare in Singapore

Singapore is a city-state off the southern tip of the Malay Peninsula it's just 276 square miles an area with a population of about 5.4 million people the GDP per capita is over $60,000 a year which is huge and its government is a unitary parliamentary constitutional republic it's also got one of the most interesting health care systems around that's the topic of this week's healthcare triage I'm not an international political expert but sources I trust do not describe Singapore as a dictatorship yeah it only has one political party but control has not been held by force the country remains stable because its government has been unusually responsive to the wishes of its people for instance the Ministry of Health literally doubled its five-year budget a couple years ago in response to citizen concerns just last year it said it would expand its coverage of the poor and those with pre-existing conditions it would reduce out-of-pocket payments and strengthen control of premium increase but I'm getting ahead of myself Singapore's health care system is remarkable it spends far far less than we do it achieves outcomes that would make most experts weep with joy and it does so with the combination of public and private inputs that I think many wonks on both sides of the political spectrum would swoon over life expectancy at birth is 2 to 3 years longer than in the UK or the u.s. its infant mortality rate is among the lowest in the world about half of the US and just over half of the UK Australia Canada and France general mortality rates are awesome compared to pretty much all other countries as well the w-h-o which ranked the u.s. 37th in the world in quality in 2000 ranked singapore 6 france was number 1 remember how the u.s. spent about 18% of GDP on health care remember how France spent about 11.6 percent Singapore spends about 4 percent of GDP on health care in 2009 Singapore spent about $2,000 per person compared to the United States more than 7,000 but the public and private portions of health care spending are very different in Singapore about two thirds of health care spending is private and only about one third is public that's even more private spending than in the United States Singapore is also a mix of private and public health care delivery systems there are private and public hospitals and after that there are lots of tiers of health care if you want to get specific there are five classes a B 1 B 2 plus B 2 and C a get to a private room your own bathroom air conditioning and your choice of doctor C gets you an open ward with seven to eight other patients a shared bathroom and whatever doctors assigned to you if you choose a you pay for everything if you choose C the government pays up to 80 percent of the costs what makes Singapore unique and what makes it beloved among many conservative walks is its reliance on health savings accounts all workers are mandated to put a decent percent of their earnings into savings for the future in 2012 workers up to age 50 had to put 20% of their wages into these accounts matched by another 16 percent of wages from their employer monies are divided amongst three types of accounts there's the ordinary account to be used to buy home pay for insurance against death and disability or to pay for investment or education there's the special account for old-age and investment and retirement related financial products and then there's the Medisave account to be used for health care expenses and approve medical insurance contribution of Medisave is about seven to nine and a half percent of wages depending upon your age it earns interest set by the government and it has a maximum cap at around forty three thousand five hundred dollars at which point you divert your mandatory savings into some other account you can use your Medisave account to pay for inpatient care and some outpatient care there are some gaps in what you're allowed to pay for with it but those are getting smaller if you can't pay for care out of Medisave you pay for it out of your regular savings Singapore's trying to incentivize people to have children if you have a baby with a congenital condition there's now a program to give you additional money there's a marriage and Parenthood package where you get $6,000 cash for each of your first and second children and $8,000 for your third and fourth children the government will also match dollar-for-dollar a fairly large amount that you contribute to a child development account every once in a while the government tops up the Medisave accounts if it thinks costs have gone up faster than expected or if it wants to expand cover in 2011 for instance lower and middle-income people age 45 and above got two to seven hundred dollars each depending upon income and home ownership the second health care program is metashield this is a catastrophic illness program and while it's not mandatory more than 90% of the population is covered it's really cheap from 33 dollars a year for a 29 year old to 372 dollars a year for a 69 year olds MediShield kicks in when you've covered the deductibles for the year and after you've paid your coinsurance those vary by the class of care you choose metashield has an annual benefit limit of fifty thousand dollars and a lifetime limit of two hundred thousand dollars metashield is expected to cover about eighty to ninety percent of a hospitalization and a Class B - or C ward the rest would come out of Medisave or you could buy further coverage if you like this will allow you to get a higher class of care some plans are offered by the government and you can use your Medisave money to pay for those other plans are purely private sometimes they're offered by employers as benefits the third health care program is met a fund which is Singapore safety net program only citizens are eligible and it only covers the lowest class of wards and it's only available after you've depleted your Medisave account and MediShield coverage elderly patients are prioritized the amount of help you get depends on a patient's and a family's income conditions expenses and social circumstances decisions are made about that at a very local level there's also eldershield money for eldershield starts being withdrawn from your wages at age forty and the system is run by three private insurers you're randomly assigned to one of them and you'll pay for until you're 65 when you need the money to help pay for disability care you can take up to four hundred dollars a month out for a maximum of 72 months for nursing home or home care but why is Singapore so cheap some think that it's the strong use of health savings accounts and cost-sharing you may remember from our rant health insurance experiment episode the people who have to use their own money usually spend less than people that don't but that's not the whole story here there's lots of government regulation as well through the tiered care system and its public hospitals the government has a lot of control over in patient care it allows a private system to challenge the public one but the public system plays the dominant role in providing services initially Singapore led hospitals compete more believing that the free market would bring down costs but when the hospitals competed they did so by buying new technology offering expensive services paying more for Docs decreasing services to lower-class wards and focusing more on a-class wards this led to increase spending in other words they found that the market fails in health care as it so often does in the United States so you know what they did they got the government more involved they fixed the proportion of each type of ward in hospitals they kept them from focusing too much on profits and they required approval to buy new expensive technology Singapore heavily regulates the number of physicians and they have some control over salaries as well the country uses bulk purchasing power to spend less on drugs it also has a lot of mandates as I've mentioned before the most frustrating part about Singapore is that as an example it's easily misused by those who want to see their own health care systems change more conservative type so point to the Medisave accounts and the stress on individual contributions but ignore the heavy government involvement in regulation more liberal types will point to the public's ability to hold down cost and achieve quality but ignore the class system or the system's reliance on individual decision making Singapore is very small and very homogenous it's a little easier to run a health care system like that but what makes Singapore really special is that their system seems so open to change they seem to recognize that everything has a trade-off they seem willing to try new things and they seem willing to change when those things don't work they don't seem stuck we could all learn a lot from that

Channel: Healthcare Triage

Views: 302,894

Keywords: Singapore, health, health care, healthcare, insurance, hospital, medishield, eldershield, costs, gdp, medical, medicine, doctor, care, nurse

Id: WtuXrrEZsAg

Length: 8min 13sec (493 seconds)

Published: Mon Jun 16 2014