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From the way I see it, you can tax the people, or you can get bonds from other countries such as China. But, i think the customers’ confidence from China’s investors are dropping
These indicators fail to inform us whether the healthcare service is relevant to the population’s need. The missing information here includes the leading causes of death, the significance of lifestyle diseases on public healthcare, etc differentiated on the basis of income groups.
We do very well on this count. Health care appears to be an industry where a high level of government provision + government financing actually works better than leaving it to the market. Singapore has focused mostly on government provision. The UK and France have focused on government financing. The US does government financing for aged 65+ only, and does rather little government provision.
We have also benefited from being a relatively young population that doesn’t need to spend that much on medical treatment. This will change in the next 30 odd years, so we had better get prepared.
Wait a minute….expenditure of healthcare as % of GDP is 3.4% in the case of Singapore, compared to much higher percentages in the 3 other countries. Doesnt it mean that our government is spending must less on its people than other country’s government in this respect ?
“running faster, working harder: repairing the care” is a 15 min video explaining health care underfunding in Canada, British Columbia. In the video, Dr Pollock mentioned education, employment, welfare, healthcare and housing are interdependent political decisions for the solvable problems of ignorance, idleness, wants (poverty), disease and squalor.
Sadly, Singapore has gone further down the privatisation (profit-driven) road than UK. E.g. Free education for FTs but driving out Singaporeans, cheap foreign labour competing for jobs at all levels, no welfare, KPI-driven restructured hospitals, “market-subsidy” HDBs. For healthcare in Singapore, the “sustained under-investment” to orchestrate a “crisis” did happened. The show is now repeated for the Minister of Health’s solution for elderly care.
So sad that the film above describes exactly how things are in Singapore. I have seen healthcare from the insides of both restructured and private hospitals. Patient care is compromised based on the standards set by local nursing training. Most common reason is that nurses in Singapore are overloaded (e.g. 1 RN : 12 or more patients in Singapore compared with 1 RN : 4 patients in Australia).
Due to corporate policies, we cannot let our patients know the truth. Instead, it takes a concerned patient’s kin to raise issues. “Are Hospitals Safe?-What killed my dad?”. It is a shame.
Yes, it means that the Singapore Govt is spending less (in % terms) than US, UK or France. But from the other indicators, Singaporeans live longer than US and UK (shorter than France), and the numbers of child deaths is lowest compared to the other countries.
This shows that even though we spent less, we gained more. Well done to the efficiency of the Singaporean govt-funded part of the healthcare system.
BUT, there is a catch. Singaporeans, compared to the other countries, pay for a greater percentage on their medical bills. Meaning that part of the “benefit” of a higher lifespan and a lower infant mortality rate comes from our own pockets.
So what does this mean for Singaporean Healthcare Policy? It shows that the MOH has done an excellent job in creating an efficient and effective healthcare system for Singapore, where you get the most out of every dollar spent. BUT more could be done in terms of “welfare” (ie. paying more for the citizens). Of course, the biggest question now is, HOW MUCH should MOH be paying for citizens, and CAN WE AFFORD IT?
Regarding life expectancy, how to compare with western countries when our racial makeup is different? Seems like many east asians live a longer life with many living past 100 years in Japan and China.
Life expectancy is really nothing to boast about. Our elderly work till their 70s for a miserly $600 a month. Those who don’t work get public assistance of $300+ a month, enough for only 1 or 2 meals a day consisting of plain porridge. Maybe being active working and eating plain food is why we can live till so old?
Those statistics are important – they tell us that Singaporeans are spending a great deal on out of pocket expenses to keep themselves healthy.
The other important question is whether standard definitions are used for infant mortality. Check out the issue with maternal mortality in Singapore: See: http://www.annals.edu.sg/pdfMay02/glau.pdf
Infant mortality affects the calculation of life expectancy. If the infant mortality figure is not accurate, then life expectancy is correspondingly affected
I do not know the answer but Prof Wong HB used to say that infant mortality in Singapore was very low because of the wide hips of Singaporean women!!!
The metrics presented are all related to healthcare, but its difficult to draw conclusions cross-metrics. Besides seeing that we have
1) higher life expectancy (asian trend?)
2) lower infant mortality (proximity to hospitals due to urbanization?)
the only other thing is that we achieved this in spite of low government expenditure
How can you draw the conclusion that the government money is spent efficiently? It appears more that the difference is topped up by individuals to achieve seeing that out of pocket expenditure is 93%
The outpocket stats are startling. I think the healthcare system is fine, but its not just about the provision- which means the facilitates, the staff etc- but also about the funding.
Okay, if the richer middle class and upper classes can afford to pay more, either through the present system, or through private or public health insurance, that’s fine- but if the poorer people cannot get access or can only get cheap access and cheap facilitates, then that’s a worry.
And I think we need more preventative health care, because our obesity rates are going up, as with the stats concerning cancer and other diseases. It will be a bigger expensive problem in the future, and so has to be addressed now. If we just treat people when they are sick, and make it expensive for them, it doesn’t help the economy and the future generations.
So health care to me, is a right, not a privilege. And so people need to have not just sufficient doctors and nurses of high qualifications, but also have enough money to pay for them. if not its not gonna work very well in the long run.
How come TOC did not show us all the statistical charts supplied by WHO and
OECD.,in order for us to have a better picture on how Singapore is placed amongst
the developed nations.I am sure you can do a better job than the mainline media.
If I am correct,Singapore is placed in the best 15 nations that have the best health
care for thier citizens.Thanks. In Singapore, average waiting time for a selective
surgery is about one month.As for serious one,it is about a week. Compare with
country like CANADA,selective surgery or medical procedure like MRI ,colonscopy
the waiting time is btw. 5mth and 8mths.
Infant mortality is counted based on live births. In Singapore, it is common for a pregnant woman to go for ante-natal screening while the foetus is still developing. If any abnormality is detected, the woman would often be advised by her gynaecologist to consider terminating the pregnancy. If carried to term, the survival rates of such pregnancies are not good, and thus would worsen the infant mortality rates. The woman would often follow her gynae’s advice, and thus contributing to Singapore’s better number. Afterall, it costs the parents too much to maintain a newborn through long-term intensive care in Singapore. Thus, many would rather avoid any abnormalities.
Another factor to consider is the number of homeless, drug junkies, teens, etc, who become parents in countries like US, UK and France. Some even view having children as a way to get more welfare. Such pregnancies often carry higher risks of complications after birth. Thus infant mortality rate rises.
“In Singapore, average waiting time for a selective
surgery is about one month.As for serious one,it is about a week. Compare with
country like CANADA,selective surgery or medical procedure like MRI ,colonscopy
the waiting time is btw. 5mth and 8mths.”
I know of a case where an endoscopy takes 7 months in Singapore. I will be writing about it soon.
You have to be careful with some of these numbers. In larger countries because of they have people living in rural sparsely populated areas, infant mortality is higher because they need to fly the emergency cases over long distance to regional hospitals.
I’ve covered healthcare issues on my blog a number of times:
We are probably neither the best or the worst. We are in the okay category – if we can freeze our system today, and fix the gaps perhaps we have our cake and eat it…however this is not the case. In many of the new policy initiatives such as means testing, the goal is to keep shifting healthcare costs from govt to the people. That would have been alright if not for the growing income inequality – the main impact is on the lower middle and poorer people(completely poor have medifund). The gaps I’ve mentioned in blog is the large number of uninsure people because we only started medishield in the 80s and we left out many people, new borns with congenital defects and the more seriously ill who bust the low limits of insurance. Shifting the expediture of healthcare to the people exacerbates the effect of income inequality because the rich & not rich have roughly equally odds of being sick and different abilities shoulder this burden – so a single payer system or other healthcare schemes where the burden is shifted from the sick rather than to the sick will lead help to counter the inequality.
What is worrying is the direction which we are headed. Already our govt shoulders the lowest % healthcare expediture and our sick shoulder the largest expediture in the developed world yet the PAP govt implements policies to keep shifting the burden and this is typically done by higher forced savings (Medisave)and higher insurance premiums. The goal is to cut taxes for the high income earners and corporations ….these taxes are already so low and the income inequality in our society is already so high. The other dangerous trend is the attempts to turn SIngapore into a medical hub to growth healthcare profits – this will lead to privatising a large part of our healthcare system and escalating costs.
We should watch this carefully because the PAP govt is unlikely to take care of the interests of the ordinary Singaporeans in the area of healthcare – profits and growth being their primary goals.
For healthcare, all I want them to do is plug the gaps, stop shifting the expenditure from govt to the people, and keep costs under control by limiting the pace of privatisation and containing our ambitions to be a medical hub.
The kind of comments made by NotSoLucky kind of mirrors some of the louder debates going on the US. Basically, we you have is people who want to defend the status quo, use this red herring phrase “socialism” to dismiss what is a perfectly well-thought out explanation.
Anyway, here is an interesting point, the UK, NHS, is probably the only system that is completely tax funded and free at the point of use to virtually every person in the UK and even short term tourist (i.e. more than 55 million). For that it covers virtually all known illness. Putting as-aside the argument about abuse, does it not seemed strange that it only consumed just 8% of GDP? On a per capita basis it seemed to be only over 2x that of Singapore when you consider that in both cases, our per capita income is about roughly the same?
In the Singapore case, for a population of no more than 6 million, and medical insurance coverage that exclude quite a large number of condition, and if you account for spending on Singaporean (i.e. qualified for subsidy) only, and covering only a land mass much smaller than the UK. Yet, still consuming 3.4% of a much smaller GDP?
On a per capita cost basis of US$1,228. True the UK and Singapore may have roughly the same per capita income but if you express that cost as a percentage of low-income Singaporean real wages, that is a lot of money for that group. In the UK low-income people still earn more than Singapore’ low income so yes, the Brits may be paying more — i.e. US$2,992 but since thay are pay more it seemed to me the proportion is not too unreasonable for a “socialist” system.
Privatisation leads to profit-driven CEOs, who strive to pull up medical bills. The government is not helping any; what with the anti-welfare sentiments.
Of course this would stabilize costs – since only the rich can afford to pay for their bills, a smaller market which results naturally entails stability.
Notsolucky’s view is errnoeous as he probably thinks everyone is rich.
Why do people pay for their food/clothes/gadgets/house/cars and not for their healthcare?
The medishield/Private insurance plus government subsidies has already paid for a big percentage of the medical bills, the rest has to be paid by the people itself.
The price tag of the medical bill has to be of a certain level enough to scare away people who trying to see a doctor for small/non-life threatening illness, so that the scarce sources (doctors/nurses/hospital beds etc…) can be used in more important role to save lives who really needs it. Hospital has already used high price tag for ICU and ambulance so that people will not misuse it.
I think most importantly, the government has to send letters/email etc… to those hundreds thousands of housewives that are unisured to have at least a medishield, so big medical bills will not drain their savings (if any) away.
Ah yes, as illustrated by ny’s comment, here is another one of those red herring, scare mongering argument phrases that served only to cloud the issue. The “preventing abuse argument”.
Let the turn the question to those “preventing abuse argument” case. How does one know if one only has minor aliment if one does not see a doctor.
Say, I have a kind of deadly flu, which I don’t know about, but the symptoms are not different from a normal flu, and I get put off going to see doctor because of the high price tag. And because I didn’t see the doctor and then spread it to the wider population and cause and epidemic. Now is preventing a potential abuse or misuse of the system more worth than it cost?
The problem with using the “abuse” and “misuse” argument is that it can swing both ways.
By the way, thiis show that we better take good care of our health than to fall sick. At this present time, you just cannot afford to go to the hospital. As what my insurance agent said : You can die but cannot fall sick. You will go broke once you are in. Whatever CPF money still not enough to pay because now the cost is too high. Is is just what happen in US.
Don’t talk rot lah. Medishield and private insurance doesn’t cover pre-existing illnesses. A fair healthcare system should cover everyone, not just those who happen to be born healthy.
Resources are scare because Singapore hospital prefer wooing non-subsidized and wealthy medical tourists. Look at how much much blood was sold to those medical tourists in the jakarta blasts. Take blood from Singaporeans for free but sell it to medical tourists.
And what do you mean by misusing ambulances? You mean that if your father got a sharp pain in his heart, you prefer not to call ambulance but rub medicated oil on his chest ah? Only until he start foaming and collapse then you call ah?
Huh! Cover pre-existing illness, then that is not call insurance, that one call charity. If I know this type of medical insurance exist, I will not buy any insurance, I will wait I got a big hospital bill then I buy an insurance because it will pay for everything….
The wealthy medical tourist can afford to pay for top services, if he is turn away from SG, he will go to else where who willing to accept his money. You want the hospital to treat every patient equal, that’s a bit naive and superficial fairness.
As for ambulances, I mean those really misuse case such as difficult walking/ backpain etc…. Like those that can take taxi instead of ambulance case, heart attack of course call ambulance…..
For a deadly flu that you don’t know, and yet you know is high cost? However not all flu is high cost, so naturally you will see a doctor first. Let’s say you are so poor that you can not even afford a polyclinic consultation, you should still see a doctor first. If it is really a deadly flu, you will be treated no matter whether you have the money. The bill have to be paid somehow, but lifes is more important. Anyone should not treat money more important than health/life.
As for the abuse, I am talking more about known cases, not those first-time cases. The abuse will be obvious if the healthcare cost is “free”.
I think you are failing to look at the big picture and focusing too much on the specific. The point is whether you have a “free” and not “free” system there will be abuse. For example, in the Singapore system, you have a situation where people who can afford to B class decide to take advantage of C class. Where C class is meant for poorer people.
One thing you have to realise that when you have a health care system that is focus on eliminating abuse you could end up with a system that could cost more. That is because you could have system that spend more money, resources (time, opportunity cost) or effort detecting abuse than tackling the problem itself.
Yes if you bring out one HYPOTHETICAL example at a time. Yes it may seemed obvious. But when you are dealing a general policy level things don’t seemed so obvious.
On your point about free being obvious at detecting abuse, the question is how come in the UK, which is FREE AT POINT OF USE (it is not a free system because you pay by tax), only consumed 8% of GDP than compared to France (you have to pay for GPs and medicine) or the US (you have to pay for everything). So clearly, your theory does not hold. You would have expected the UK to top the list won’t you?
In the US now, you are facing a situation, where medical insurance company are now trying, using the excuse of controlling abuse, to change terms. At one time they were even rewarding their staff to look for excuse not to payout.
In Singapore health care policy under the PAP seemed more concern with ideological argument (i.e. preventing “abuse”, self -sufficiency, etc) than optimal us of resources for the benefit of as many people as possible.
Ok now I bet you are going to throw the “socialist” label at me now because I seemed to be arguing for “free” medicine. Well let me pre-empt by saying that I believe spending all the energy whether we should have “free” or not “free” healthcare is a waste of time. Also trying to compare heathcare system and then rank them is also a waste of time.
What is important is to find a system that can cover as many people as possible for the resources you got and not too focus on preventing abuse. Lucky Tan certainly got the issue nailed!
Kiddo, the more you talk, the more rot come from your mouth. You are saying that those who are born with illnesses should be allowed to die since they can’t be covered by insurance and the government already spent a lot.
And second, you are saying we should up the price of medical care so that only those we can pay should be allowed medical care. And it is better to earn profits from medical tourists than care for own citizens.
I hope you give birth to a kid without an asshole, fcuking traitor.
No one wants to be sick because it is an unpleasant feeling. I do not know where you come up with claims such as abusing the free health-care system. Is this something you learn in social studies class in school in Singapore?
I think in your own world, help should only come from the government and insurance company………..when did I suggest a human should die because of sickness???
If the medical tourist have the same subsidies as of Singaporean, I will be more agitated than you.
Buying Leopold MBT, Apache helicopters, stealth frigates and F-15 fighter-bombers are more important than providing “social welfarism” for Singaporeans where even CPF LIfe is “not guaranteed”.
“Only about half of all taxpayers actually pay taxes. Iras … issued returns to 1.5 million taxpayers but only 850,000 – 57 per cent – had to pay any taxes last year. The rest – 43 per cent – had enough reliefs to fall beneath the $22,000 annual income threshold to pay taxes”.
Came across this article from Telegraph.co.uk, which is interesting in view of yesterday National Day Rally Speech on Singapore healthcare. Interesting to see how, Daniel Hanna recommended Singapore ’s model of healthcare as an example to follow. Looks like we are doing fine for our healthcare in Singapore and even been singled out as a good model to consider :D
Below is the excerpt of the article, can click on the url above to see the full story.
=============================================================
The NHS row: my final word
Daniel Hannan
“If you want to go in for shorthand categorisation by country, the model I’ve been pushing for is one of personal healthcare accounts, a system most closely approximated in Singapore , whose people enjoy a higher level of healthcare than Britons do while paying considerably less for it. Nor can it be repeated often enough that Singapore – like every developed country – pays for the healthcare of those citizens who can’t afford it. No one I know wants a system where the poor go untended. Nor will you find such a system outside the Third World : it really isn’t a British peculiarity. After ten years in the European Parliament, I have found that the only foreign admirers of the NHS are those on the serious Left. Mainstream social democrats on the Continent do not, as a rule, argue for a heathcare system funded wholly out of general taxation.”
Wow I know Singapore ranks pretty well, but I never knew Singapore was that good. I think while we can be thankful for our healthcare system, it is nevertheless just a work in progress. We should never be complacent, and I am grateful to all the doctors, nurses and administrators out there who have put in their part to continuously improve our system. :)
41) A Tan
///////Only about half of all taxpayers actually pay taxes//////////
I believe that was the intent when GST was introduced. To tax via consumption rather than via income. This was supposed to be more equitable as the lower income will have less disposable income to spent and thus pay less GST, while the richer one still pay income tax and more GST for the expensive purchases they made.
We’re doing pretty well!
is this good news of bad news?
I believe that the US has a lot of explaining to do about their healthcare policies…
I need to do more research on this one
http://edition.cnn.com/2009/POLITICS/08/14/obama.health.care/index.html
From the way I see it, you can tax the people, or you can get bonds from other countries such as China. But, i think the customers’ confidence from China’s investors are dropping
These indicators fail to inform us whether the healthcare service is relevant to the population’s need. The missing information here includes the leading causes of death, the significance of lifestyle diseases on public healthcare, etc differentiated on the basis of income groups.
We do very well on this count. Health care appears to be an industry where a high level of government provision + government financing actually works better than leaving it to the market. Singapore has focused mostly on government provision. The UK and France have focused on government financing. The US does government financing for aged 65+ only, and does rather little government provision.
We have also benefited from being a relatively young population that doesn’t need to spend that much on medical treatment. This will change in the next 30 odd years, so we had better get prepared.
Wait a minute….expenditure of healthcare as % of GDP is 3.4% in the case of Singapore, compared to much higher percentages in the 3 other countries. Doesnt it mean that our government is spending must less on its people than other country’s government in this respect ?
Copied from a comment in LuckySingaporean’s blog entry
http://singaporemind.blogspot.com/2009/08/issues-singaporeans-want-pm-to-address.html
by Anonymous, at 13/8/09 20:49:
“running faster, working harder: repairing the care” is a 15 min video explaining health care underfunding in Canada, British Columbia. In the video, Dr Pollock mentioned education, employment, welfare, healthcare and housing are interdependent political decisions for the solvable problems of ignorance, idleness, wants (poverty), disease and squalor.
Quicktime link:
http://www.workingtv.com/bcnu2009/rtc2/rfwh.mov
Windows Media link:
http://www.workingtv.com/bcnu2009/rtc2/rfwh.wmv
Sadly, Singapore has gone further down the privatisation (profit-driven) road than UK. E.g. Free education for FTs but driving out Singaporeans, cheap foreign labour competing for jobs at all levels, no welfare, KPI-driven restructured hospitals, “market-subsidy” HDBs. For healthcare in Singapore, the “sustained under-investment” to orchestrate a “crisis” did happened. The show is now repeated for the Minister of Health’s solution for elderly care.
So sad that the film above describes exactly how things are in Singapore. I have seen healthcare from the insides of both restructured and private hospitals. Patient care is compromised based on the standards set by local nursing training. Most common reason is that nurses in Singapore are overloaded (e.g. 1 RN : 12 or more patients in Singapore compared with 1 RN : 4 patients in Australia).
Due to corporate policies, we cannot let our patients know the truth. Instead, it takes a concerned patient’s kin to raise issues. “Are Hospitals Safe?-What killed my dad?”. It is a shame.
http://www.cancerstory.com/
7) Gigi on August 15th, 2009 12.28 pm
Yes, it means that the Singapore Govt is spending less (in % terms) than US, UK or France. But from the other indicators, Singaporeans live longer than US and UK (shorter than France), and the numbers of child deaths is lowest compared to the other countries.
This shows that even though we spent less, we gained more. Well done to the efficiency of the Singaporean govt-funded part of the healthcare system.
BUT, there is a catch. Singaporeans, compared to the other countries, pay for a greater percentage on their medical bills. Meaning that part of the “benefit” of a higher lifespan and a lower infant mortality rate comes from our own pockets.
So what does this mean for Singaporean Healthcare Policy? It shows that the MOH has done an excellent job in creating an efficient and effective healthcare system for Singapore, where you get the most out of every dollar spent. BUT more could be done in terms of “welfare” (ie. paying more for the citizens). Of course, the biggest question now is, HOW MUCH should MOH be paying for citizens, and CAN WE AFFORD IT?
The enfant mortality is lower because there aren’t many enfants to begin with.
The longevity could be long but the existence is miserable.
This comparison is superficial as well because the environment we live in is different.
It is warmer.
We should compare ourselves with Malaysians, Taiwanese and Indonesians on the mortality count.
The other side of things is we are spending by proportion a lot more than the listed countries above for an improvement of 2 years max of longevity.
IS this worthwhile?
The govt contribution is so much lesser for us.
The mid path is the one taken by France.
I am not surprised at the initial response to this survey because the govt probably targetted all these measures before him and made it look good.
The truth is we are paying a disproportion of our medical expense out of our pocket for an improved mortality of 2 years.
The infant mortality count is skewed since we have fewer children and therefore take care of everyone of them more carefully.
However, we are now have the problem of not enough children.
statistics only show part of the picture.
Regarding life expectancy, how to compare with western countries when our racial makeup is different? Seems like many east asians live a longer life with many living past 100 years in Japan and China.
Life expectancy is really nothing to boast about. Our elderly work till their 70s for a miserly $600 a month. Those who don’t work get public assistance of $300+ a month, enough for only 1 or 2 meals a day consisting of plain porridge. Maybe being active working and eating plain food is why we can live till so old?
Those statistics are important – they tell us that Singaporeans are spending a great deal on out of pocket expenses to keep themselves healthy.
The other important question is whether standard definitions are used for infant mortality. Check out the issue with maternal mortality in Singapore: See: http://www.annals.edu.sg/pdfMay02/glau.pdf
Infant mortality affects the calculation of life expectancy. If the infant mortality figure is not accurate, then life expectancy is correspondingly affected
I do not know the answer but Prof Wong HB used to say that infant mortality in Singapore was very low because of the wide hips of Singaporean women!!!
The metrics presented are all related to healthcare, but its difficult to draw conclusions cross-metrics. Besides seeing that we have
1) higher life expectancy (asian trend?)
2) lower infant mortality (proximity to hospitals due to urbanization?)
the only other thing is that we achieved this in spite of low government expenditure
How can you draw the conclusion that the government money is spent efficiently? It appears more that the difference is topped up by individuals to achieve seeing that out of pocket expenditure is 93%
The outpocket stats are startling. I think the healthcare system is fine, but its not just about the provision- which means the facilitates, the staff etc- but also about the funding.
Okay, if the richer middle class and upper classes can afford to pay more, either through the present system, or through private or public health insurance, that’s fine- but if the poorer people cannot get access or can only get cheap access and cheap facilitates, then that’s a worry.
And I think we need more preventative health care, because our obesity rates are going up, as with the stats concerning cancer and other diseases. It will be a bigger expensive problem in the future, and so has to be addressed now. If we just treat people when they are sick, and make it expensive for them, it doesn’t help the economy and the future generations.
So health care to me, is a right, not a privilege. And so people need to have not just sufficient doctors and nurses of high qualifications, but also have enough money to pay for them. if not its not gonna work very well in the long run.
How come TOC did not show us all the statistical charts supplied by WHO and
OECD.,in order for us to have a better picture on how Singapore is placed amongst
the developed nations.I am sure you can do a better job than the mainline media.
If I am correct,Singapore is placed in the best 15 nations that have the best health
care for thier citizens.Thanks. In Singapore, average waiting time for a selective
surgery is about one month.As for serious one,it is about a week. Compare with
country like CANADA,selective surgery or medical procedure like MRI ,colonscopy
the waiting time is btw. 5mth and 8mths.
Infant mortality is counted based on live births. In Singapore, it is common for a pregnant woman to go for ante-natal screening while the foetus is still developing. If any abnormality is detected, the woman would often be advised by her gynaecologist to consider terminating the pregnancy. If carried to term, the survival rates of such pregnancies are not good, and thus would worsen the infant mortality rates. The woman would often follow her gynae’s advice, and thus contributing to Singapore’s better number. Afterall, it costs the parents too much to maintain a newborn through long-term intensive care in Singapore. Thus, many would rather avoid any abnormalities.
Another factor to consider is the number of homeless, drug junkies, teens, etc, who become parents in countries like US, UK and France. Some even view having children as a way to get more welfare. Such pregnancies often carry higher risks of complications after birth. Thus infant mortality rate rises.
There was a BBC program last night (14.08.09) talking about healthcare systems. Invited guests include a Doctor in a SG government hospital.
http://worldhaveyoursay.wordpress.com/2009/08/14/does-your-country-have-the-best-healthcare-system/
preston loon,
“In Singapore, average waiting time for a selective
surgery is about one month.As for serious one,it is about a week. Compare with
country like CANADA,selective surgery or medical procedure like MRI ,colonscopy
the waiting time is btw. 5mth and 8mths.”
I know of a case where an endoscopy takes 7 months in Singapore. I will be writing about it soon.
You have to be careful with some of these numbers. In larger countries because of they have people living in rural sparsely populated areas, infant mortality is higher because they need to fly the emergency cases over long distance to regional hospitals.
I’ve covered healthcare issues on my blog a number of times:
http://singaporemind.blogspot.com/2009/07/truth-about-healthcare.html
We are probably neither the best or the worst. We are in the okay category – if we can freeze our system today, and fix the gaps perhaps we have our cake and eat it…however this is not the case. In many of the new policy initiatives such as means testing, the goal is to keep shifting healthcare costs from govt to the people. That would have been alright if not for the growing income inequality – the main impact is on the lower middle and poorer people(completely poor have medifund). The gaps I’ve mentioned in blog is the large number of uninsure people because we only started medishield in the 80s and we left out many people, new borns with congenital defects and the more seriously ill who bust the low limits of insurance. Shifting the expediture of healthcare to the people exacerbates the effect of income inequality because the rich & not rich have roughly equally odds of being sick and different abilities shoulder this burden – so a single payer system or other healthcare schemes where the burden is shifted from the sick rather than to the sick will lead help to counter the inequality.
What is worrying is the direction which we are headed. Already our govt shoulders the lowest % healthcare expediture and our sick shoulder the largest expediture in the developed world yet the PAP govt implements policies to keep shifting the burden and this is typically done by higher forced savings (Medisave)and higher insurance premiums. The goal is to cut taxes for the high income earners and corporations ….these taxes are already so low and the income inequality in our society is already so high. The other dangerous trend is the attempts to turn SIngapore into a medical hub to growth healthcare profits – this will lead to privatising a large part of our healthcare system and escalating costs.
We should watch this carefully because the PAP govt is unlikely to take care of the interests of the ordinary Singaporeans in the area of healthcare – profits and growth being their primary goals.
what certifies these figures?
the figures come from who or where or what?
are my questions valid?
So lucky tan, what do you suggest our government should do? Revert to socialism and in the process, may lose many jobs?
notsolucky,
For healthcare, all I want them to do is plug the gaps, stop shifting the expenditure from govt to the people, and keep costs under control by limiting the pace of privatisation and containing our ambitions to be a medical hub.
“For healthcare, all I want them to do is plug the gaps, stop shifting the expenditure from govt to the people,”
Free health care then?
” and keep costs under control by limiting the pace of privatisation and containing our ambitions to be a medical hub.”
You are speculating that privatisation will raise costs. Could it not stabilize costs in the interests of the people in the long run?
23) NotSoLucky on August 16th, 2009 10.08 am
You are speculating that privatisation will raise costs. Could it not stabilize costs in the interests of the people in the long run?
Stabilise at a higher price? LOL
Well, you do believe in competition, don’t you? :P
We should aim to be like Cuba…..biggest bang for the buck healthcare system in the world.
The kind of comments made by NotSoLucky kind of mirrors some of the louder debates going on the US. Basically, we you have is people who want to defend the status quo, use this red herring phrase “socialism” to dismiss what is a perfectly well-thought out explanation.
Anyway, here is an interesting point, the UK, NHS, is probably the only system that is completely tax funded and free at the point of use to virtually every person in the UK and even short term tourist (i.e. more than 55 million). For that it covers virtually all known illness. Putting as-aside the argument about abuse, does it not seemed strange that it only consumed just 8% of GDP? On a per capita basis it seemed to be only over 2x that of Singapore when you consider that in both cases, our per capita income is about roughly the same?
In the Singapore case, for a population of no more than 6 million, and medical insurance coverage that exclude quite a large number of condition, and if you account for spending on Singaporean (i.e. qualified for subsidy) only, and covering only a land mass much smaller than the UK. Yet, still consuming 3.4% of a much smaller GDP?
On a per capita cost basis of US$1,228. True the UK and Singapore may have roughly the same per capita income but if you express that cost as a percentage of low-income Singaporean real wages, that is a lot of money for that group. In the UK low-income people still earn more than Singapore’ low income so yes, the Brits may be paying more — i.e. US$2,992 but since thay are pay more it seemed to me the proportion is not too unreasonable for a “socialist” system.
Privatisation leads to profit-driven CEOs, who strive to pull up medical bills. The government is not helping any; what with the anti-welfare sentiments.
Of course this would stabilize costs – since only the rich can afford to pay for their bills, a smaller market which results naturally entails stability.
Notsolucky’s view is errnoeous as he probably thinks everyone is rich.
Why do people pay for their food/clothes/gadgets/house/cars and not for their healthcare?
The medishield/Private insurance plus government subsidies has already paid for a big percentage of the medical bills, the rest has to be paid by the people itself.
The price tag of the medical bill has to be of a certain level enough to scare away people who trying to see a doctor for small/non-life threatening illness, so that the scarce sources (doctors/nurses/hospital beds etc…) can be used in more important role to save lives who really needs it. Hospital has already used high price tag for ICU and ambulance so that people will not misuse it.
I think most importantly, the government has to send letters/email etc… to those hundreds thousands of housewives that are unisured to have at least a medishield, so big medical bills will not drain their savings (if any) away.
Ah yes, as illustrated by ny’s comment, here is another one of those red herring, scare mongering argument phrases that served only to cloud the issue. The “preventing abuse argument”.
Let the turn the question to those “preventing abuse argument” case. How does one know if one only has minor aliment if one does not see a doctor.
Say, I have a kind of deadly flu, which I don’t know about, but the symptoms are not different from a normal flu, and I get put off going to see doctor because of the high price tag. And because I didn’t see the doctor and then spread it to the wider population and cause and epidemic. Now is preventing a potential abuse or misuse of the system more worth than it cost?
The problem with using the “abuse” and “misuse” argument is that it can swing both ways.
By the way, thiis show that we better take good care of our health than to fall sick. At this present time, you just cannot afford to go to the hospital. As what my insurance agent said : You can die but cannot fall sick. You will go broke once you are in. Whatever CPF money still not enough to pay because now the cost is too high. Is is just what happen in US.
29) ny on August 16th, 2009 10.35 am
Don’t talk rot lah. Medishield and private insurance doesn’t cover pre-existing illnesses. A fair healthcare system should cover everyone, not just those who happen to be born healthy.
Resources are scare because Singapore hospital prefer wooing non-subsidized and wealthy medical tourists. Look at how much much blood was sold to those medical tourists in the jakarta blasts. Take blood from Singaporeans for free but sell it to medical tourists.
And what do you mean by misusing ambulances? You mean that if your father got a sharp pain in his heart, you prefer not to call ambulance but rub medicated oil on his chest ah? Only until he start foaming and collapse then you call ah?
32) Terence Goh on August 16th, 2009 4.10 pm
Huh! Cover pre-existing illness, then that is not call insurance, that one call charity. If I know this type of medical insurance exist, I will not buy any insurance, I will wait I got a big hospital bill then I buy an insurance because it will pay for everything….
The wealthy medical tourist can afford to pay for top services, if he is turn away from SG, he will go to else where who willing to accept his money. You want the hospital to treat every patient equal, that’s a bit naive and superficial fairness.
As for ambulances, I mean those really misuse case such as difficult walking/ backpain etc…. Like those that can take taxi instead of ambulance case, heart attack of course call ambulance…..
30) Tan Ah Kow on August 16th, 2009 10.49 am
For a deadly flu that you don’t know, and yet you know is high cost? However not all flu is high cost, so naturally you will see a doctor first. Let’s say you are so poor that you can not even afford a polyclinic consultation, you should still see a doctor first. If it is really a deadly flu, you will be treated no matter whether you have the money. The bill have to be paid somehow, but lifes is more important. Anyone should not treat money more important than health/life.
As for the abuse, I am talking more about known cases, not those first-time cases. The abuse will be obvious if the healthcare cost is “free”.
Ny,
I think you are failing to look at the big picture and focusing too much on the specific. The point is whether you have a “free” and not “free” system there will be abuse. For example, in the Singapore system, you have a situation where people who can afford to B class decide to take advantage of C class. Where C class is meant for poorer people.
One thing you have to realise that when you have a health care system that is focus on eliminating abuse you could end up with a system that could cost more. That is because you could have system that spend more money, resources (time, opportunity cost) or effort detecting abuse than tackling the problem itself.
Yes if you bring out one HYPOTHETICAL example at a time. Yes it may seemed obvious. But when you are dealing a general policy level things don’t seemed so obvious.
On your point about free being obvious at detecting abuse, the question is how come in the UK, which is FREE AT POINT OF USE (it is not a free system because you pay by tax), only consumed 8% of GDP than compared to France (you have to pay for GPs and medicine) or the US (you have to pay for everything). So clearly, your theory does not hold. You would have expected the UK to top the list won’t you?
In the US now, you are facing a situation, where medical insurance company are now trying, using the excuse of controlling abuse, to change terms. At one time they were even rewarding their staff to look for excuse not to payout.
In Singapore health care policy under the PAP seemed more concern with ideological argument (i.e. preventing “abuse”, self -sufficiency, etc) than optimal us of resources for the benefit of as many people as possible.
Ok now I bet you are going to throw the “socialist” label at me now because I seemed to be arguing for “free” medicine. Well let me pre-empt by saying that I believe spending all the energy whether we should have “free” or not “free” healthcare is a waste of time. Also trying to compare heathcare system and then rank them is also a waste of time.
What is important is to find a system that can cover as many people as possible for the resources you got and not too focus on preventing abuse. Lucky Tan certainly got the issue nailed!
33) ny on August 16th, 2009 5.14 pm
Kiddo, the more you talk, the more rot come from your mouth. You are saying that those who are born with illnesses should be allowed to die since they can’t be covered by insurance and the government already spent a lot.
And second, you are saying we should up the price of medical care so that only those we can pay should be allowed medical care. And it is better to earn profits from medical tourists than care for own citizens.
I hope you give birth to a kid without an asshole, fcuking traitor.
Ny,
Do you want to be sick?
No one wants to be sick because it is an unpleasant feeling. I do not know where you come up with claims such as abusing the free health-care system. Is this something you learn in social studies class in school in Singapore?
In the not so distant future, the poor, sick, aged singaporean have 1 option :(
http://www.comedycentral.com/videos/index.jhtml?title=suicide-booth&videoId=136575
36) Terence Goh on August 16th, 2009 11.30 pm
I think in your own world, help should only come from the government and insurance company………..when did I suggest a human should die because of sickness???
If the medical tourist have the same subsidies as of Singaporean, I will be more agitated than you.
FY2009 MOH BUdget – about S$3-bilion?
FY2009 MINDEF Budget – about S$11.5-billion?
FY2008 GST COllection – S$6.57-billion
FY2009 GST Collection (estimated) – S$6.56-billion
Buying Leopold MBT, Apache helicopters, stealth frigates and F-15 fighter-bombers are more important than providing “social welfarism” for Singaporeans where even CPF LIfe is “not guaranteed”.
“Only about half of all taxpayers actually pay taxes. Iras … issued returns to 1.5 million taxpayers but only 850,000 – 57 per cent – had to pay any taxes last year. The rest – 43 per cent – had enough reliefs to fall beneath the $22,000 annual income threshold to pay taxes”.
Came across this article from Telegraph.co.uk, which is interesting in view of yesterday National Day Rally Speech on Singapore healthcare. Interesting to see how, Daniel Hanna recommended Singapore ’s model of healthcare as an example to follow. Looks like we are doing fine for our healthcare in Singapore and even been singled out as a good model to consider :D
http://blogs.telegraph.co.uk/news/danielhannan/100006578/the-nhs-row-my-final-word/
Below is the excerpt of the article, can click on the url above to see the full story.
=============================================================
The NHS row: my final word
Daniel Hannan
“If you want to go in for shorthand categorisation by country, the model I’ve been pushing for is one of personal healthcare accounts, a system most closely approximated in Singapore , whose people enjoy a higher level of healthcare than Britons do while paying considerably less for it. Nor can it be repeated often enough that Singapore – like every developed country – pays for the healthcare of those citizens who can’t afford it. No one I know wants a system where the poor go untended. Nor will you find such a system outside the Third World : it really isn’t a British peculiarity. After ten years in the European Parliament, I have found that the only foreign admirers of the NHS are those on the serious Left. Mainstream social democrats on the Continent do not, as a rule, argue for a heathcare system funded wholly out of general taxation.”
Wow I know Singapore ranks pretty well, but I never knew Singapore was that good. I think while we can be thankful for our healthcare system, it is nevertheless just a work in progress. We should never be complacent, and I am grateful to all the doctors, nurses and administrators out there who have put in their part to continuously improve our system. :)
41) A Tan
///////Only about half of all taxpayers actually pay taxes//////////
I believe that was the intent when GST was introduced. To tax via consumption rather than via income. This was supposed to be more equitable as the lower income will have less disposable income to spent and thus pay less GST, while the richer one still pay income tax and more GST for the expensive purchases they made.
Anyone can share why SG is not moving towards drug prescription by pharmacists and not by doctors?
kopitiamapek some doctors do that only if they dont have the medication in their office
http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model
:D