With changing demographics and disease patterns, Singapore has made four shifts to its approach to delivering good healthcare, Prime Minister Lee Hsien Loong said at the Universal Health Coverage Ministerial Meeting on Tuesday (Feb 10).
"In Singapore, we face the same challenges and difficulties as other societies in delivering good healthcare, because these trade-offs are intrinsic to healthcare delivery. Given these difficulties, we have developed our own approach, and it works reasonably well for us," he told the audience, which included World Health Organization (WHO) Director-General Dr Margaret Chan and Singapore Health Minister Gan Kim Yong.
The Republic's three-pronged approach consists of, first, a focus on public health, such as investing in basic sanitation, compulsory inoculation and mass education; second, a system that "marries the best of a privatised healthcare system with the best aspects of a single-payer model", with Government hospitals restructured to become autonomous, non-profit accounting entities; and third, a balance in healthcare financing between individuals, insurance and Government, with official subsidies supplemented by compulsory savings in the form of Medisave, MediShield and Medifund.
"Insurance premiums will be higher because MediShield Life is a more encompassing scheme, so the government is subsidising the premiums to keep them affordable, especially for the lower-income group," said Mr Lee.
"But because the premiums are going to be higher than before, it is necessary to make MediShield Life compulsory, because with higher premiums there will be more temptation for people to opt out and come back into the healthcare system. And the healthcare system cannot refuse to treat them."
But maintaining good healthcare is an "continuing challenge", said Mr Lee, due to progressions in medical science, an ageing population meaning an increase in the demand for healthcare, and an increase of diseases of affluence rather than poverty, such as more instances of diabetes and obesity.
As a consequence, he said, Singapore has made four shifts to its approach to healthcare:
Providing more comprehensive support for outpatient treatment, in the form of the Community Health Assist Scheme to subsidise treatment for lower or middle-class Singaporeans at private GPs
Replacing MediShield with the universal, compulsory MediShield Life insurance scheme, which will "give better protection from growing bill sizes"
"Right-siting" services to give people better, more affordable care in their communities, such as by building community hospitals and improving access to GPs and polyclinics
Encouraging Singaporeans to take better care of their health. This is achieved through campaigns promoting healthier food choices, Active Ageing, and providing more "healthy lifestyle" amenities such as cycling connectors and exercise corners
"HEALTHCARE IS AN EMOTIVE AND POLITICAL ISSUE"
The Prime Minister said that though the Government is "very mindful" of the risk of excessive healthcare spending, costs were "bound to grow", even over the next five years - a necessary consequence of ensuring affordable healthcare for all.
"We know there will be political pressure to defer necessary fee increases and to manage the services. And it's easy to leave bills to the next generation and focus on the short-term political gain," he said. "If we succumb to this temptation, we will end up with system which becomes non-viable, and will hurt Singaporeans not just financially, but even purely in health terms."
He added that Singapore's healthcare efforts depend on "a supportive political environment", with people willing to take personal responsibility to save for their own healthcare and participate in a universal medical insurance scheme, healthcare providers ensuring that they deliver cost-effective care, and the Government adopting a people-centred approach while staying hard-headed about costs.
"(The Government must) be a trustworthy steward, presenting the trade-offs as they are to the citizens and not sacrifice tomorrow for today’s political gain," said Mr Lee.
"Healthcare is always an emotional and political issue – it's tempting to make promises and say we will do more, we will do better and it will cost less."
He added that every dollar that the Government spends on healthcare is a dollar taken from taxpayers : "This requires an honest conversation among ourselves, and hard choices made, so that we can move ahead together, with clarity on what our society wants and stands for."
The WHO's Director-General Dr Margaret Chan also commented that Singapore's universal health coverage is fair and inclusive, and that it balances the advantages of competition with the need for state intervention.
No comments:
Post a Comment