I refer to the article “Want to ditch ObamaCare? Let’s copy Singapore’s health care miracle” (Fox news, Nov 29).
S’pore has built the world’s greatest healthcare system?
It states that “Give how badly we’ve managed to botch up health care here in the United States, you’d probably be surprised to find out that another country—Singapore—has used forgotten American ideas to build the world’s greatest healthcare system.
As the political debate over health care reform heats up again, it is important to understand both what Singapore has built as well as the fact that everything that it has accomplished has been shown to work just as well here in the United States, too.
Singapore is the only country in the world that can boast of being in the top five in infant mortality, life expectancy, and maternal mortality. Better yet, when Business Week compared countries on 21 different healthcare metrics, Singapore stood out as the world’s healthiest country.
By contrast, the U.S. health care system delivers mediocre results while spending more than any other nation on health care. The United States ranks 41st in life expectancy, 55th in infant mortality, and 49th in maternal mortality while spending nearly 18 percent of GDP on health care.
By contrast, other developed nations deliver much better results while spending between 9 and 12 percent of GDP. So getting our 18 percent of GDP down to the typical 9 to 12 percent would be a major accomplishment.
S’pore only spends 4.7% of GDP on healthcare?
But the fact remains that Singapore is managing to deliver the world’s very best health outcomes for just 4.7 percent of GDP—or less than half of what Canada, Japan, and the United Kingdom are spending.
How does Singapore do it? By empowering consumers and fostering competition.
Everyone in S’pore “has money to pay for access to the same doctors and the same facilities”?
The most fundamental way to empower consumers is by providing real health security. So Singapore provides true universal access as well as coverage for preexisting conditions. Singapore then builds on that by making sure that everyone—rich and poor, young and old—has money to pay for access to the same doctors and the same facilities.
This is done by ensuring plentiful contributions into health savings accounts and by providing a high-deductible health insurance plan that people can actually afford—not only the premiums, but the deductibles and copays, too.
Providing people with adequate health savings balances and universal high-deductible health insurance transforms people into empowered consumers. The government then provides them with price-comparison data as well as provider-performance data so people can comparison shop both on price and quality. The result is the world’s most competitive healthcare market—one in which providers have to deliver on both quality and price if they are going to survive.
The results are startling. Major surgeries cost 62 to 92 percent less in Singapore. As just one example, a heart-bypass surgery that would cost $130,000 in the United States costs just $18,000 in Singapore. Overall, Singapore spends 72 percent less per person on health care than the United States and between 46 and 57 percent less than Canada, Japan, France, and the United Kingdom.
If we could cut our health care spending down to Singapore’s level, we would have annual savings of about 12.2 percent of GDP, or about $2.1 trillion per year.”
Can’t pay your medical bills?
What happens when you can’t pay for your medical bills in Singapore?
Apply for Medifund?
Well, if you are a Singaporean and is under public Class C or B2 treatment – you can apply for Medifund, provided you meet the criteria.
1,096,628 Medifund applications approved
In this connection, a whopping 1,096,628 Singaporeans’ applications for Medifund assistance was approved in FY2015.
Medifund criteria?
As the criteria is not fully public information – we understand that some of the criteria may be along the lines of
… 100 per cent funding for Class A
… 50 per cent funding for Class B
… cannot have a 5-room HDB flat or bigger property
… All the immediate family members’ Medisave must have been exhausted (subject to Medisave eligibility and withdrawal limits)
… cannot have more than $4,000 in the bank
… insufficient income to support an installment plan
Why don’t everyone choose subsidised treatment?
Looking at the above – why would people still choose Class B1 , A or private hospitals, other than for reasons of greater comfort or one’s availability of higher medical insurance coverage than MediShield Life, etc?
Well, a common reason may be that one has to wait much longer for subsidised treatment or the unavailability of the lower class wards.
How many can’t pay?
So, how many people can’t pay for their medical bills and may end up in the typical debt collection process?
I believe nobody knows. But here are some clues.
Hospitals owed $110m, wrote-off $90m?
I understand that the last available statistics given in a Parliamentary reply was that public hospitals were then owed about $110 million, after writing off about $90 million in FY 2008, FY 2009 and FY 2010.
21% in debt due to healthcare?
I understand that the last available statistic on credit counseling was that about 21 per cent of Singaporeans who sought help from Credit Counseling Singapore cited healthcare costs as one of the reasons for getting into debt.
Greatest fear of S’poreans?
According to the article “Lack of money for medical bills tops Singaporeans’ retirement fears: Nielsen survey” (Straits Times, Feb 25, 2014) – “Singaporeans’ biggest fear when it comes to ageing is not having enough money to pay for medical bills during their retirement, a survey has found.”
Also, why is it that a survey in 2013/14 found that some patients chose to die without treatment due to concerns about healthcare costs?
Very high % of income contribution to Medisave?
As Singaporeans contribute as much as 10.5 per cent of their income to their Medisave accounts – we may from a cashflow perspective – arguably be paying the highest “implicit healthcare premium” (as a percentage of income) in the world.
Still not spending a single cent on healthcare?
Do the total contributions and interest credited to Medisave account balances annually, still exceed annual total public healthcare expenditure and total withdrawals from Medisave accounts to pay for medical expenses and insurance premiums?
If so, then from a cashflow perspective, we may still continue to be the only country in the world that is arguably, not spending a single cent on healthcare?
Leong Sze Hian
