A Brief Overview of the Singapore Model of Healthcare as it Stands Today

Singapore healthcare
 
Singapore is admired globally as a nation with one of the best health care systems in the world, with our nation ranked as the healthiest country in the world. 
 
This claim may sound incredulous to the average Singaporean but it makes perfect sense when you look at Singaporean healthcare in broad scope. Singapore has practically eradicated endemic population threats such as malaria, cholera and tuberculosis in our march towards modernity. Infant mortality rates have nosedived while life expectancy rates have soared to the point that we have achieved better healthcare spending results than developed nations such as the US and Germany. 
 
The problem that Singapore faces today is more about equal access to basic healthcare. Most Singaporeans worry that they will not have the means to pay for medical treatment in the event of catastrophic illness. Fear of medical bankruptcy is a very real and common concern that weighs heavily on the Singaporean consciousness. Mounting calls for increased government healthcare spending has led to the announcement of Medishield life last year's national day rally as a precursor to the revamp of the Singaporean healthcare system. 
 
It is in the long shadow of this impeding revamp that led us to decide that now might be an opportune time for us to take a good look at our healthcare system and explain how it works to you our readers. We do this with the intention so you can better understand the system that we have right now and make an informed decision about the healthcare choices you will face as you move forward with your lives. 
 
Healthcare Delivery: Singapore's health care system is a combination of public and private elements with 80% of primary care delivered by over 2,000 private general practitioners who operate either solo or small group practices. 
 
The Singapore government offers primary care through 18 polyclinics dispersed throughout the city state. The public sector treats almost half of all patients afflicted with chronic ailments while the private sector has a larger share of acute minor ailments and wellness health consultations. 
 
The ratio is reversed in  the hospital services sector with public hospitals accounting for 85% of inpatient beds. The public hospital system has different types of wards that range from unsubsidized A class wards (single rooms with air conditioning and other amenities) to the heavily subsidized class B2 and C wards where patients share a room and toilet.
 
Voluntary Welfare Organizations (VWO) and private agencies provide intermediate and long term care such as home, ambulatory and residential care for patients who require such services.  
 
Healthcare Financing: The Ministry of Health maintains that "Singapore offers universal healthcare coverage to our citizens" in spite of the fact that the government only contributes $0.30 to every dollar in healthcare spending.
 
Singapore's healthcare financing model is described as being made up of four layers of protection. The first is provided by government subsidies, which can be up to 80% of C class hospitalization wards. 
 
The second layer is Medisave, a compulsory national individual health savings account scheme. Working Singaporeans and their employers contribute a part of their monthly wages towards the account. Medisave is the world's only national health savings account scheme and it enables Singaporeans to save up for their future medical needs as well as pay premiums for Medishield. Medisave is personal to the holder and hence portable across jobs. It can be used to pay the medical expenses of immediate family members.
 
The third layer of protection within the Singapore healthcare system is provided by Medishield, a low cost catastrophic medical insurance scheme. Medishield allows for risk pooling and mitigation of financial risks of catastrophic illnesses. Medishield premiums increase with age; the premium for a five year old child is $50 while an 85 year old adult's costs $1190 per year. Medishield has high deductibles (currently at $2,000 for people 80 and below) and a co-payment component to encourage individual responsibility for one's healthcare needs. Singaporeans have the option to supplement Medishield (which is meant only for basic coverage) with integrated private insurance policies (known as the Integrated Shield plans offered by private insurers). Integrated Shield Plans can only be bought by Singaporeans enrolled in the Medishield scheme.
 
The fourth and final layer, Medifund, is the ultimate safety net for needy Singaporean patients who can't afford to pay their medical bills despite the aid of available subsidies, Medisave and Medishield. Medifund is structured as an endowment fund that cannot be withdrawn and is deployed to finance care for needy Singaporeans. 
 
We will look at and explain the first of the 3Ms, Medisave, in more detail in our next installment coming up tomorrow.

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