Singapore: The bellwether of Global health system?

With the longest life expectancy at 84.8 years in 2019, Singapore has proved the world that its economy is wealthy because its people are healthy. Females have a life expectancy at an average of 87.6 years with 75.8 years in good health. It ranks at 2nd position out of 166 countries for its healthcare results. It was also ranked the fourth healthiest country in the world and the first in Asia by Bloomberg Global Health Index. It spends only 4% of its GDP on healthcare but sets-up world-class medical institutions spending 70 % less than Canada and 50% less than the United States. Innovative cost-saving features and health savings have conveyed the small island’s motto of good governance. The Asia-Pacific region contributes half to cancer deaths in the world whereas Singapore has the highest survival rate.

But what is the secret behind the achievement of such an effective health care system?

The Economic Secret

Singapore makes people pay more out of their pockets for healthcare but keeps the cost down by combining public and private medical funding. It subsidizes most of its healthcare cost to ensure the greatest care for the poor section of the society.

Singapore imbibes three main cost-saving features:

Þ Encourages competition: It asks the hospitals to post prices of their services on the internet and the patients get a variety of options to choose from. The track record of the hospitals is also posted online for a consistent quality consciousness amongst the hospitals. The government can intervene in the healthcare system when the markets fail in keeping the healthcare costs low. It conducts “Patient Satisfaction Surveys” to estimate the patient’s satisfaction in obtaining healthcare. It is an effective measure for improvisation of the system and making it accountable.

Þ Saving for future health expenditure: It stands on the philosophy that people who are well off can take their responsibility instead of relying on the government. It uses the Central Provident Fund’s medical savings component, called Medisave. It makes it pragmatic for the residents to pay for their health care as it is a compulsory savings account. A contribution rate (percentage of wages) is set by the government for the workers and the employers. Hence, as salaries increased, their percentage contribution to the CPF surged. There is no tax on this saving during the time of the deposit and withdrawal.

Þ High out-of-pocket costs for consumers: When insurance policies pay the price for medical procedures, the consumers tend to overconsume it. This also drives up the prices of these procedures. Hence, out of pocket spending avoids overconsumption. It represents 92% of private healthcare spending as compared to 11% in the United States. The government makes sure that the patients contribute to their cost of healthcare. If a certain section of people doesn’t want to stay with the subsidized program, then they can always pay beyond at their willingness.

Categorization of Public Hospitals

It is generally perceived that public hospitals are not maintained, or the available facilities are not adequate. It might lack technological advancement or the low ratio of doctors to patients. A consumer with a high purchasing power will generally prefer private hospitals over the public ones.

Albeit this is a general perception, countries like Singapore have left no stone unturned to prove this perception wrong. The public hospitals of Singapore are an embodiment of how the system should work. Amenities and level of government subsidy classify the wards. They have five wards: A, B1, B2+, B2 and C. ‘A’ costs the most and C the least. ‘A’ class patient has a private room with bathroom and can avail air conditioning facilities and choose doctors of his/her choice. ‘C’ class patient shares the room with eight or nine other patients and doesn’t have access to air conditioners. The doctors are assigned to them. ‘A’ class patient cannot avail any subsidy. A ‘C’ class patient gets a subsidy of up to 80% of inpatient ward charges, medicines and medical treatments. Amenities and choices decline as the subsidies increase from ward A to C.

The government regulates the number of medical colleges and its students and the foreign medical schools’ degree recognized in Singapore. All this is done to control the availability of physicians in the country. Their main idea is to have to more doctors which in turn will induce demand from patients to assess their healthcare needs.

Tech-savvy Leadership

 
With the goal of ‘one patient, one record’, Singapore pursues cost-saving technologies for healthcare. It invests on this goal by employing the National electronic- healthcare system. An electronic medical record system stores the records of patients’ healthcare. The system stores all the records of medical conditions of the patients including the lists of medication taken for treatment and doctors consulted. It updates whenever the patient gets medical tests done or consults a doctor. Any public and a private hospital can update or access the records. The patients can also access their records via computer or mobile phone.

The Ministry also publishes hospital bills on its website of the patients. It discloses even the minutest details such charges of the ward, cost of the doctor, prescribed medicines’ details, laboratory tests and more. It also updates the average cost of the top 70 medical conditions. Such publishes ensure transparency in the system and empowers patients to choose the most effective treatment with accurate information. This encourages competition between healthcare institutions and pushes them to drive down the cost.

    “There’s always one more thing to learn”

For any country to prosper, it all begins with a small step of political commitment towards the safety and prosperity of its citizens. India as one of the fastest growing economies of the world can learn a lot from Singapore specially when it comes to public decision making.

Even though India is one of the fastest-growing economies of the world, it spends less than 2% of its GDP on health. According to Economic Survey 2018-19, healthcare is still inaccessible in rural India. The tertiary healthcare in India has improved but the primary healthcare remains a huge concern. 60% of the latter has only one doctor while 5% have none. The Survey states that this indicates higher rural Infant Mortality Rate and Maternal Mortality Ratio. The level of participation in providing healthcare facilities is quite low owing to inadequate infrastructure facilities, lack of supplies or poor monitoring of staff. The Survey also identified the cost of medicines as one of the major factors in an increased Out of pocket expenditure. It is one of the highest in the world. The government acknowledges a majority of consumers forced to pay even though there are provisions of providing free medicines to the beneficiaries.

AYUSHMANN BHARAT scheme aims to bring down the Out of Pocket Expenditure of the government.

As the second-largest populous country in the world with huge diversity, it will not able to meet the demands of the entire population with a single solution. The government and policymakers can categorize the population and devise schemes suiting their needs. We can explore the feasibility of a medical savings account in the economy. Sharing of best practices and regulating the number of medical colleges and students to increase the ratio of doctors to patients can be a successful step. Since the demand for healthcare is at its surge, the scare supply of hospitals and doctors needs to meet this teeming demand. Encouraging IT sector to come up with new cost-effective technology for improvisation of the healthcare system is pivotal. The National Health Policy 2017 aims to increase government expenditure on health to 2.5% by 2025. But for this, we need to increase the Health Allocation in the budget and strengthen the public healthcare system, especially at the primary level. Proper mobility of resources for nutrition, safe drinking water and sanitation also needs attention.

To achieve a comprehensive and universal health provision, we need to start strengthening our existing efforts towards a progressive direction. A dynamic involvement of the government can certainly win the trust of the people in the system. Visionary leadership can always make the system progress by leaps and bounds.