Singapore Healthcare: Importance of a Shared vision

Room for Optimism

I am optimistic about future of Singapore’s Healthcare at least for the next decade for several reasons:

Over the last decade, I have regularly escorted my parents, who fortunately enjoy civil service benefits to public hospitals and polyclinics, and have been tremendously impressed by the continuous improvements and developments which I feel more than justifies the cost increases over the period.

I am further encouraged as I see:
1. Significant room for improvement in public hospitals. Productivity may be still be increased by at least 30% even based on casual observations as productivity consultant.
2. The quality of the “B” and “C” class treatment is exemplary relative to any country in Asia, and I daresay most countries in the world. A 10-20% expense cutback care” may probably affect the level of comfort but not quality of treatment provided.

Combined, I would venture that in a crunch, cost of operating B and C class wards may be further lowered by at least 40%, providing ample opportunities for cost reduction to the public.

Perusing a number of verbose whitepapers, I firmly believe that our health care authorities do have a clear, creative, comprehensive and practicable vision which unfortunately the politicians do not yet have to confidence to publicly debate and transform this into a shared national vision. The reality is stark and would seem cruel both to some segments of the citizenry and to the politicians themselves.

Stark realities

1. HealthCare in Singapore, as in most developed countries today, is a lifestyle issue. It reflects the general lifestyle of the population. All around the world, even in the most “socialist” countries the wealth gap is today widening the difference between living in a one room HDB and at the luxurious Ardmore Park is stark, so is the cost of living. This gap will increase even more as we envisioned the latest luxurious developments that are already in the plan. The gap between being in a “A” class ward and a “C” class ward must similarly reflect this gap; otherwise there will be distortions in supply and demand. Health Minister Khaw recently spoke frankly about this in the recent interview. He mentioned that if the condition of the “B” and “C’ class wards are further improved, then those that can afford the “A” class would choose the “B” and those “B’, “C”.

Whether it is healthcare, housing or general lifestyle, given the current trends in globalization, governments will need to bite the bullet to let the people understand this stark reality that the government will have to give more emphasis to promoting meritocracy and excellence than to ameliorating the income, wealth and lifestyle gap. Grass root leaders must be deployed to bring home this message aggressively to the people. Wishy-washiness about this issue, for reason of vote popularity, will only balloon the issue to cause great dissent for the future

2. Insurance is not the Answer. The Weekend Today article referred to the thousands of Americans (out of some 47 million uninsured) who are caught, face problems with no medical insurance and are “squeezed by financial companies that have taken over their debt from the medical provider”. I am actually heartened to hear that banks have rose to the occasion to provide such financing and marvel at how every society and community can find solutions to meet desperate needs…..and why should someone not impose tough conditions when offering a loan under such conditions? We might also mention that tens of millions of American’s are dissatisfied with their medical insurance coverage and half of all US families pay a quarter of their income on health insurance. Medical insurance can only be part of the solution. Nor will there ever be a panacea as a person’s lifestyle is very much his own choice.

In a free society citizens choose the lifestyle they want and then plan and work towards it. Just as people must actively plan for their retirement and not leave it to CPF, the government or an employer, they must do the same for their medical care. The greatest sin politicians, employer or person in authority can commit is to beguile people to believe that they will be taken care of. Leaders must help people to recognize the realities of the new globalized economy and not coddle them in an unreal world.

Most US citizens whilst unhappy accept this reality. This is why healthcare seemingly a “crisis issue” is not a vote swinger. Most US citizens realize that it is problem they have to live with. Singaporeans must learn to realize this too.


3. More subsidies or less? If we examined the positions taken by the current US presidential candidates, one thing they agree on is that citizens will have to care for themselves through insurance or other means. The state will act as a facilitator, though different candidates differ on the type of facilitation. In Singapore the issue may be more sensitive. Can we fully expect Singaporeans to accept more responsibilities for their own and families healthcare, likewise education, housing and retirement living within “Singapore Inc” ? If they perceive, rightly or wrongly that a big part of their personal savings go or have gone through CPF, taxes, COEs to the state to fund Singapore Inc’s monolithic government related businesses and investment companies, would they not expect the state provides them a desired level of welfare? After all it was the state that taught them that there is no free lunch and you cannot have the cake and eat it!

This is certainly not a vibrant national mentality and may become a threat to Singapore’s future…but then Singapore Inc is already a reality that demands to be fed, or the whole system may collapse.

There are a number of reasons other than public sentiment that renders it unlikely that the government will reduced health subsidies in the immediate future. For one, the government certainly feels it is earning enough from its citizen funds to keep subsidies going. There is also the need to make Singapore businesses more competitive internationally. In view of the limited ways for the government to channel subsidies to businesses without causing an outcry from trading partners, it is unforeseeable that they will withdraw or reduce the quantum of healthcare subsidies which is already in place.

With these observations, I do not believe Means Testing is introduced to limit subsidies, probably more to justify them. Means testing is just a technique of deciding who gets a free lunch or at least a subsidized one. . So far the government has given assurance that it will not discriminate against anyone, and that it will compensate those who may unjustly lose privileges. Rather than assurances, it is probably more important that citizens clearly understand the underlying thoughts, criteria and learn to manage their healthcare situation within in.

Methods and procedures are important, but it should not cloud the understanding of the criteria as it often does in the implementation of public projects. The methodology should be one that does not cause confusion, excessive paperwork, inconvenience and it certainly should not add any further cost to administering the health care system.

4. Creating a shared vision. Roles and responsibilities in National Healthcare needs clear definition and be part of a shared national vision. If we accept the principle that an individual is fully responsible, a set of appropriate policies must emanate from this decision. It is then up to an individual to ensure he negotiates the terms of employment, or put enough reserves as a business owner, to ensure that he obtains the healthcare he desires over the period of his lifetime. If employed he could weigh between a better coverage during the years he is employed; higher employers contribution to long term care; or higher salaries in lieu.

Employers and the government will under this principle will be less responsible for the direct provision of benefits. Their role is to ensure that an optimized infrastructure exist for this principle to operate efficiently. Many issues will still remain, should employers or government provide a minimum amount of insurance coverage? How commercially organized medical insurance schemes should be publicly managed for the common good?

Thorny issues remain but it would be far worse if there is no common consensus on whether the burden of healthcare should be on the individual, employer of the state.

The high cost of administrating the healthcare system in the United States (probably the highest in the world), has been identified often by analysts as a contributing factor to the overall high cost of care. This cost is largely due to the complexity of the system which has gone through tears, fragmentation and patches as politician battle to gain public favor.

The Singapore Healthcare System is already far more complex than a decade ago ironically not because of political competition but probably the lack of it resulting in many unanswered questions.

What is the state’s role vis-a-vis employers and individuals? Would we risk unraveling Singapore Inc by pushing more burden to the individual? How would we integrate state and minimum benefits into corporately provided benefits?

As I mentioned earlier, it is unlikely that Singapore’s Healthcare system would hit a crisis within the next 10 years. It is hence tempting for politician to engage in patch working to gain popularity and votes rather than discuss critical and tough issues. Whilst this is acceptable in a democracy, I would agree with the Weekend Today article that we should not in this respect, emulate the American Way.

The current Singapore government has been bold in initiating the discussion on the legalizing casinos and integrated resorts. Perhaps it should be brave enough to debate and create a truly shared vision for national healthcare. Without a shared frame of reference discussions on national healthcare will be meaningless and murky.