Chapt 3: Managing Healthcare by 4pHbs4

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									Chapt 3: Managing Healthcare

     Case Study of Singapore
     Learning Points
   Identify the challenges governments
    face in managing healthcare

   Identify some ways that healthcare is
    paid for in a country
   Challenges that Governments
   Face…
1. Healthcare is considered as a public good
- The citizens expect the government to provide
   basic healthcare for them
- Limited resources



2. The need to provide quality healthcare
- Longer lifespan of people

- People in more developed countries expect more

   & better healthcare services
  Challenges that Governments
  Face…

3. Increasing expenditure on healthcare
-  People demand for the better
   treatments, more effective medicines
   and better-qualified medical staff
How is healthcare paid for?
         Government
            taxes



                       Personal
  Self    Healthcare
                       Insurance



          Employer-
             paid
          insurance
Healthcare in Singapore
         Learning Points

1.   Identify how the government managed
     healthcare expenses before the 1980s

2.   Identify how the government manages
     healthcare expenses after the 1980s
Life in Singapore
1960s and 1970s
What are the effects of poor housing
   conditions on people’s health?
       Singapore Healthcare In the
       1950s and 1960s
   Polyclinics were known as health centers.
   They are mostly located in rural areas.
   Medical staff brought help to the people living away
    from town areas in mobile health centers (vans).
   To improve healthcare, government trained a huge
    no. of nurses and doctors in hospitals.
   The government also educate people on how to
    prevent illness through health programs.
   To keep people healthy, students were introduced
    to physical education.
       Video – Singapore Healthcare
       After the 1960s

   Improved healthcare services like having
    more clinics and medical staff.

   Health programs like being healthy at work
    and going for medical checkups are
    implemented.
       How does the Government managed
       Healthcare Expenses?

   Healthcare expenses comes from   What is govt
    the government budget            budget?


   Government budget is             The amount of
    spent on needs of the people     money that the
                                     govt plans to
    E.g. healthcare, education,      spend on
    transportation, housing …        meeting the
                                     needs of the
                                     people
Singapore’s Healthcare Expenditure
            (2008)
                           Healthcare – 4%




            Others – 96%
       How does the Government
       managed Healthcare Expenses
       after the 1980s
Problems in the early 1980s:
rising cost of healthcare → strain on govt spending due
                                  to limited resources

Solution:
1. Individuals must have self-reliance & to maintain
   good health
2. Government will keep healthcare affordable and will
   promote healthy living
3. Community will provide some healthcare services
   and other support services
Do you know the cost of
healthcare in Singapore?
        Charges of Hospital Wards
                    Class of Ward / Charges per day (SGD)

                    A (1&2)     B (1&1+)      B2        C

Restructured
  Hospitals
AH / CGH / KK /
  NUH / SGH /       196 – 295   113 - 177   50 - 57   25 – 29
  TTSH


Private Hospitals
ESH / GH / MAH /
  MEH / TMC         200 – 460   135 – 200    110
        • Assume a person is hospitalized due to inflammation of
          the appendix and underwent an appendicitis operation.
        • Staying a total of 7 days in a private hospital with 2
          days in ICU, his total hospital bill came up to S$8,950.
        Breakdown of Hospital Bill         Amount Payable (S$)
Room & Board                                         750
(5 days)
Hospital Miscellaneous Expenses
• Prescription drugs
                                                    2,950
• Diagnostic Procedures
• Operating Theatre Fees
Anaesthetist Charge                                  500
Surgeon’s fee                                       1,700
ICU (2 days)                                        2,250
Post-Hospitalisation Treatment                       800
Total                                               8,950
      • Assume a person is hospitalized due to Heart Disease
        and underwent a Coronary Artery Bypass Graft surgery.
      • Staying a total of 9 days in a private hospital, his total
        hospital bill came up to S$18,900.


  Breakdown of Hospital Bill            Amount Payable (S$)
Room & Board (7 days)                             5,870
ICU Charges (2 days)                              1,630
Surgical Procedure                                9,000
Surgical Implants / Approved                      2,400
Medical Consumables
Total                                             18,900
       Role of an Individual

   To have self-reliance         What is self-
                                  reliance?

   How?
                                  Citizens to be
    1. Medisave (what is it?)     responsible for
    2. Medishield (what is it?)   themselves and
                                  take care of
                                  themselves
Central Provident Fund (CPF)
      Medisave
   Comes from the individual’s CPF
   Can be used to pay for hospital bills and
    medical treatment
      MediShield
   National healthcare insurance scheme
   Individuals pay for this through Medisave


Why is it required? Isn’t Medisave sufficient?
- For people who needs long-term treatment who
  cannot afford their treatment fees or
  hospitalization fees and Medisave cannot cover
  the fees.
        Advantages of Singaporeans
        being self-reliant
     Singaporeans share the cost of healthcare with the
      government by paying for their own healthcare
     Help lighten the government’s load
      -> Government does not need to increase taxes


Problem: Does every Singaporean have CPF?
     So how are they going to pay for their healthcare
     costs?
       Role of the Government
                                   A total budget of
                                   $3,705 million
                                   has been allocated
                                   to MOH for FY2009
1. To keep healthcare affordable   to promote good
                                   health and keep
                                   healthcare
   How?                           affordable

    1. Government subsidies (to who?)
    2. Medifund (what is it?)
    3. Restructuring of hospitals
    4. Means-testing
      Government Subsidies
   Direct subsidies given to govt hospitals,
    polyclinics and some nursing homes for
    elderly.

   Lower income group receive the most
    subsidies.
   Govt gives different rates of subsidies to
    the different classes of wards in hospitals.
    Class C receive the most in subsidies.
      Medifund
   A sum of money set aside by the govt
   Started in 1993 with a fund of $200 million

   For people who cannot pay for their medical fees
    despite Medisave, Medishield and govt subsidies
   E.g. low-income workers, self-employed people
    who do not make any CPF contributions
   People who need help apply for the fund at the
    hospital where they are being treated
    Restructuring of Hospitals

   Hospital have the freedom to reorganise
    to meet the needs of the people

   Hospital becomes financially
    independent from the govt where they
    have their own board of directors
    therefore govt able to reduce the
    amount of subsidies to hospitals
                                  Checking the financial
                                  background of a person to
         Means-testing            see if they are able to
                                  afford healthcare


   Govt belief: Subsidies should benefit patients who
    need them the most
   Govt gives heavy subsidies to polyclinics and
    government hospitals especially to class B2 and C
    wards.

   Means-testing implemented in Jan 2009 where
    lower-income group will receive a higher amount of
    subsidies than the higher-income group
   Means testing takes into consideration the patient's
    monthly income and ownership of private property.
  Role of the Government
  2. Promote a healthy lifestyle

                   Will not need
                                    Save medical
Good health          medical
                                      expenses
                    treatment


     How?
      - By having health programmes in schools
         and workplaces
       Role of the Community
    Community needs to provide healthcare support
     services as it is not possible for the govt to run all
     of them

1.   Voluntary welfare organizations
2.   Private organizations

    They are given grants to run community hospitals,
     nursing homes, day rehabilitation centres
      Role of the Community
Voluntary welfare organizations

E.g. Ren Ci, St. Andrew’s Community Hospital

Private organizations

E.g. NKF
    (cater to the needs of specific groups of people
    such as the poor or those with a particular illness)
      How successful is the healthcare
      policies in Singapore?
Effective                      Ineffective

 Provided Singaporeans with    There are still groups of
  the money to pay for           people who are still not able
  healthcare                     to pay for their own medical
                                 expenses:
                                 1. Elderly
                                 2. People who are unable to
                                    work

                               How are they going to pay for
                               their own healthcare then?
                      Singapore:
           Shared Responsibility in Healthcare

   Individual         Government            Community


                   1. Keeps               Voluntary
1. Self-reliance      healthcare          welfare and
• Medisave            affordable          private
• MediShield       • Govt subsidies       organisations
                   • Medifund             provide
2. Maintains       • Restructuring        healthcare
   good health       of hospitals         and support
                   • Means-testing        services

                   2. Promoting a
                      healthy lifestyle
   http://worldfocus.org/blog/2009/01/27/
    the-fundamentals-of-singapores-health-
    care-system/3795/
   http://www.geraldtan.com/medaffairs/
    meanstest.html

								
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