Chapter 3: Managing Healthcare: Case Studies of Singapore and Britain

1. Chapter 3:Managing Healthcare:Case Studies of Singapore and Britain

2. Learning Outcome • A comparative study of public health care polices in Singapore and Britain • how policies work in different countries • impact of policies on society and nation • evaluate the effectiveness of the policies in meeting health care needs of the people and nation

4. Challenges Governments Face in Managing Healthcare • Healthcare = Public good which governments have to provide for the people, given the limited resources and competing needs of the country • Providing Quality Healthcare • Improvements in science and healthcare have enabled people to live longer • Today, people expect more and better healthcare services

5. Challenges Governments Face in Managing Healthcare • Increasing Expenditure on Healthcare • Funds have been invested in research for bettertreatments, more effective medicines and training for better-qualified medical staff • Individuals and governments want to have the best possible healthcare they can afford for themselves and their citizens respectively

6. How is Healthcare Paid For? • The government is responsible to make the best use of limited resources to meet the healthcare needs of its people

8. Healthcare in Singapore

9. Healthcare in Singapore • Managing Healthcare in the 1960s and 1970s • 1960s: Healthcare was part of Singapore’s overall plans for improvement and development • E.g. Squatters and overcrowded areas were cleared and people moved to Housing and Development Board (HDB) flats

10. Healthcare in Singapore • Built hospitals, clinics and outpatient dispensaries to provide healthcare for a growing population • People had to go for vaccination against diseases • Medical officers and nurses were sent to schools to provide healthcare for students

11. Healthcare in Singapore • 1970s: Improvement in Singapore’s economy + Better standard of living • People wanted better healthcare services • Polyclinics provided wider range of healthcare such as medical check-ups for babies • Conveniently located in town centres • Improvement in facilities in government hospitals and the quality of healthcare

12. Healthcare in Singapore • Government budget is used in to pay for the building of polyclinics, government hospitals and providing of healthcare services • 5.9% of government expenditure on healthcare

13. Healthcare in Singapore • Approach to Managing Healthcare since the 1980s • Government’s concern = rising cost of providing healthcare

14. Healthcare in Singapore • 1983: National Health Plan • Suggested that healthcare policies should not put a strain on government spending • Should encourage self responsibility and community support • Government should maintain policies to keep healthcare affordable

17. Healthcare in Singapore • Encouraging Self-Reliance • Medisave • Introduced in 1984 • A certain amount (6-8%) from the workers’ Central Provident Fund (CPF) is channelled into their Medisave accounts • Can be used to pay hospital bills and certain medical treatment when needed

18. Your Boss will pay You will pay

19. Healthcare in Singapore • Impacts: (1) Encourages Singapore to be responsible for their own health(2) Better able to pay for healthcare(3) Lighten government’s burden of paying for healthcare services – need not depend on raising taxes to pay for rising healthcare costs

20. Healthcare in Singapore • Medishield • National healthcare insurance scheme • Pay with their Medisave • Claim from Medishield to pay for large medical bills not covered by Medisave • Help people pay for their long-term treatment of more serious illnesses • Expanded its uses • paying premiums for Eldershield – pay for healthcare in case of disability of those above 40 years old

22. Healthcare in Singapore • Keeping Healthcare Affordable • Shared responsibility = individuals are self-reliant + the government ensures healthcare remains affordable • Government subsidies • Direct subsidies given to government hospitals, polyclinics and some nursing home for the elderly • Impact: Ensure basic healthcare services are available for all Singaporeans

23. Healthcare in Singapore • Different subsidies given to different classes of wards in hospitals • Class C wards receive the most subsidies • Impact: Ensure healthcare remain affordable to the middle-income group

24. Healthcare in Singapore • Medifund • Set up in 1993 • Provide help to those who are not able to pay for healthcare • Government started with $200 m fund and the interest earned from the fund is used to help needy patients • Needy patients apply for the fund at the hospital where they are being treated

25. Healthcare in Singapore • Restructuring of hospitals • Started in 1990s • Hospitals have more freedom to reorganise to meet the needs of Singaporeans • Government is able to reduce the amount of subsidies to hospitals • Impact: Many people felt that restructuring = higher hospital bills Singapore General Hospital

26. Healthcare in Singapore • Means-testing • Defn: The way to check whether the patients are able to pay for healthcare • Needy patients should get most of the subsidy while the richer ones should get the least. • Not implemented in government hospitals yet • Impact: Affordability of a patient is dictated by the government

27. Healthcare in Singapore • Promoting a Healthy Lifestyle • Helps to cope rising cost of healthcare for both the government and individuals • Schools and workplaces have programmes to emphasise the need to maintain good health • E.g. Regular physical exercises • Impact: Will not need medical treatment and save on medical expenses

28. Healthcare in Singapore • Working with Organisations • The community also provides some healthcare support services to meet peoples’ needs • Not possible for government to run all healthcare services • Voluntary welfare organisations and some private organisations are given grants (money given by the government) to run community hospitals, nursing homes and day rehabilitation centres • Government gives support to cater to the needs of the poor or with particular illness

29. WORKING WITH ORGANISATIONS

30. WORKING WITH ORGANISATIONS

31. Have Singapore’s Healthcare Policies met the needs of the People? • To a large extent • Still some people who cannot pay for the healthcare services that they need • The elderly • Did not have the opportunity to save for healthcare when they were earning an income • Have to depend on the family, community or the government to look after their needs • Those unable to work • Have to depend on the government for their healthcare needs

32. Healthcare in Britain

33. Origin of National Health Service (NHS) • 1940s: The British government felt that it was their responsibility to look after the citizens • 1942: ‘The Beveridge Report’ • Recommended that the government put an end to poverty, disease and unemployment • Aim: To help rebuild people’s lives after WWII • Government thus created a welfare system for the people of Britain

34. Origin of National Health Service (NHS) • Welfare State • The government looks after the citizens from ‘cradle to grave’ • E.g. (1) Maternity grant and allowance, (2) Child benefits, (3) Supplementary benefits for the sick, injured and unemployed, (4) Retirement pension and (5) Death grant

36. Origin of National Health Service (NHS) • Ensure that every citizen has a minimum standard of welfare for a decent life • Job + Home + Healthcare • People of the country contribute to a national fund to help the needy people in their country

37. Origin of National Health Service (NHS) • NHS • Started in 1948 – very popular • Provide free healthcare for its people • People do not have to pay for the medical treatments that they receive when they are attended to by doctors at clinics and hospitals • E.g. All medical services, dental and optical treatments were free of charge

39. Origin of National Health Service (NHS) • Impacts:(1) Too many people wanted to use the free medical care(2) Doctors used or recommended medical treatment freely without much consideration for cost • 1951: Medical treatment was no longer free • E.g. NHS charge a small fee for medicine given to patients • E.g. Charge for dental treatment

40. Managing NHS • Managing Government Spending • The money to pay for healthcare came from the people • If healthcare costs increase, the government has to collect more taxes to pay for healthcare and other expenditure • Government’s challenge: To control spending on healthcare • 1980s:

41. Managing NHS • 1980s: Government under Margaret Thatcher • Cut back on government spending on welfare benefits such as healthcare • Wanted a system that would make the individual more responsible for his own healthcare and welfare • Because the government was spending too much on welfare benefits • Impossible to remove free healthcare for the British • The NHS was the most important public good provided by the government

42. Managing NHS • 2000: Prime Minister Tony Blair promised the people that the government would increased public spending on healthcare and improve NHS • Resulted in increase in the National insurance contribution in 2003

43. Managing NHS • Increasing Efficiency • 1980s: Growing demand for healthcare for the elderly • Slower population growth caused reduction in taxes over time • People also expect more and better treatments • NHS had grown very large but insufficient resources to cope with demand • E.g. Insufficient doctors, nurses and facilities in hospitals for surgeries

44. Managing NHS • Privatisation of NHS • Aims: (1) To reduce government subsidies(2) Save costs(3) Make NHS more efficient • E.g. Contract out non-medical services • Impact: Allow hospitals to concentrate on providing medical services

45. Managing NHS • Impacts:(1) Private companies had to more efficient to make profits(2) Patients would have more choices (3) Hospitals would improve their services to meet the people’s needs(4) Brtish citizens encouraged to take responsibility for their own health(5) Medicine, dental treatment and services provided by opticians no longer free except for students under 19 years old, expectant mothers and mothers with children under 1 year old

46. Managing NHS • Providing Quality Service • Late 1980s: People felt that NHS were of poor standard • 1998: NHS focus on providing quality service for patients • Impacts: (1) Patients were given information to help them decide on their own treatment and care(2) Wait a long time to receive medical treatment

47. Managing NHS • 2 plans were introduced to deliver quality service by putting the needs of the patients as top priority • NHS Plan (2000) • Made changes based on feedback from staff, patients and all those involved in healthcare • Provided for increase in the amount of government spending till 2004 • To work towards offering patients faster and more convenient services • Allow NHS to use facilities in private hospitals without having the patient pay for it

48. Managing NHS • NHS Improvement Plan (2004) • Patients have the right to choose from 4 different healthcare providers • NHS pay for the treatment • Every patient have access to their own personal HealthSpace on the Internet where they can view their care records

49. Managing NHS • E.g. NHS Direct • A service to provide medical advice over the phone to patients with minor illnesses • Impacts: (1) Save a visit to the doctor(2) Not strain the resources of the NHS with doctors having to attend to too many patients

50. Have British Healthcare Policies met the Needs of the People? • To a large extent • The intention of providing healthcare based on need has remained unchanged since 1948 • Challenge: NHS has to ensure that resources are best used to meet the needs of the people • Involves the provision of funds and the management of the NHS • Many Britons are thankful for the NHS and feel safe knowing that they can have medical services when they need them