Universal Healthcare Coverage In Singapore
Abstract
This essay shows an overview on the key concept of Universal health coverage (UHC). Universal health coverage means all individuals and communities have access to the healthcare services they need, while being protected from financial burden. It covers a full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitative to palliative care (World Health Organization 2018). Its aim is to provide a continuum of health delivery that is affordable and accessible for all, and addressing risk factors and targeted disease. To manage this, it is crucial to look into the various concepts of policies in the health system. By the end of this essay, it will give an insight on how universal health coverage works together with different the policies provided in the Singapore health care system.
Healthcare Policies in Singapore
Singapore is well-known for its broad coverage of healthcare system. For instance, Singapore provides primary healthcare services with clinicians accounting for a large majority of personal health care needs. There are also public and private hospitals with 24-hour emergency departments for secondary and tertiary level patients, along with supporting services for patients requiring long-term care. Policies and regulation related to health system are critical to the provision of healthcare service and has a profound effect on health status. The philosophy of Singapore’s healthcare system is based on three approaches. First, it is a need to focus on building a healthy population with preventive healthcare and mass education to encourage healthy living. Secondly, is the emphasis on individual responsibility towards healthy living through Singapore innovative “3M” system (Medisave, Medishield Life, Medifund). Thirdly, it is within the government’s responsibility to ensure cost containment on domestic front, which can be achieved by redistributing national income via subsidies that can improve the power of citizens. These policies and its regulatory system will be further discussed in the following essay.
Foundation for a Strong Public Health System
Health system accounts for the maintenance and improvement of population health. In Singapore, primary health care is provided by government polyclinics and private general practitioner clinics. These health care professionals are the first point of contact with patients. Primary care involved a complete range of medical care for both acute and chronic illnesses provided by the clinicians, with proper medical facilities and healthcare services including outpatient treatment, health screening, mass education, vaccinations, x-ray and laboratory services, rounding up as a one-stop health center for the community.
According to the Health Statistic Singapore 2015, Singapore population is slowly increasing over the years, from 5,535,263 in 2015 to the current 5,813,896 in 2018. Statistic also shows an increment especially in the elderly aged group 65 years old and above between 2015 and 2017, 11. 8% to 13% respectively. With people living longer, communicable diseases are inevitable and also require more vigilance. This rise in population, coupled with an ageing population proved to be a constant challenge for Singapore as it calls for urgent demand for health care in the future as the elderly require more attention for medical care. Singapore has rise to its calling through continuously promoting high standard of medical care. For example, MOH has developed national standards of healthcare, with public sector hospitals to ensure that provisions of healthcare are appropriate to needs of population. In safeguarding public health through evolvement in development of healthcare setting and new medical knowledge, Ministry Of Health (MOH) and Health Science Authority (HAS) is also continually investing in developing capabilities in regulation and enforcement. Another aspect Singapore has achieved is in the management of patients holistically through integrated healthcare services by strengthening primary care, intermediate and rehabilitative care and palliative care. To illustrate this initiative, the Agency for Integrated Care (AIC) was established as a separate entity in August 2009 to foster integration between healthcare providers and to improve the quality and standards of care in the among these sectors.
Healthcare Financing Model
Singapore adopts a mixed health financing system with the aim to provide basic health care for all people through the framework of Government subsidies alongside 3M system (Medisave, MediShield Life and Medifund). (Ministry of Health Singapore: Medisave. ) This financing framework ensures that hospital bills remain affordable for Singaporeans. Medisave is a compulsory medical savings scheme that every working individual and employers have to contribute to a personal account,with a percentage depending on their wages, ranging from 6% to 8% (Central Provident Fund Board, 2016). Funds in the account are used under strict guidelines to pay for hospitalization expenses and outpatient fees, day surgery and health insurance for the account holder, as well as for family members. MediShield Life is a complementary health insurance scheme that enables individual to handle part of the expenses in circumstances in cases where their Medisave balance is insufficient for coverage. MediShield Life operates on a copayment and deductible system which is payable through Medisave. Singaporeans are automatically enrolled in the program. Permanent residents are covered by MediShield Life, whereas undocumented immigrants and visitors are not. Medifund is the government endowment fund set up to help citizens and PRs who have difficulties affording their medical expenses despite government subsidies, Medisave, and MediShield Life coverage. The application for Medifund is subject to the approval of Medifund-approved institutions (MFI). Apart from constantly reviewing the subsidy framework, it is necessary to redefine the 3Ms financing framework regularly and update the Medisave daily inpatient withdrawal limits to keep healthcare affordable. As extracted from the Singapore Health Budget 2011, in FY2011, “the Medifund budget allocation will be increased from $80 to $85 million to help more subsidised patients, with Medication Assistance Fund doubling to $20 million and extend it to cover 6 more drugs, to help needy patients with high cost drugs.
Principles of Effective Healthcare Systems
The following nine principles highlight the basic factors that ensure the happiness, harmonious relations and security of all people. (Constitution of the WHO Oct, 2006) Principle one emphasize that health is a complete physical, mental, and social well-being and not merely the absence of disease or infirmity, Indeed, Singapore’s philosophy is to ensure that everyone has access to different levels of healthcare by providing accessible healthcare services and facilities, with regulations implemented for both public and private sectors for quality and innovative good healthcare standard. Principle two highlights the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic and social condition. To reiterate, Singapore governance believes that if tension between races and social groups can be avoided, the country should benefit from all successes. Third principle states that the health of all people is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and states. In fact, the government has appointed the Health Promotion Board to implement workplace programmes to combat obesity, and prevention and management of chronic disease, mental health and tobacco cessation, to help individual maintain a healthy lifestyle. Principles four, the achievement of any states in the population and protection of health is of value to all. For instance, Singapore has been educating its population in the events of emergencies, such as that seen in the case of H1N1 virus, by providing proper medic and right treatment so that the nation will be well-prepared and responsive when outbreak strikes. Principle five, unequal development in different countries in the promotion of health and control of diseases, especially communicable diseases is a common danger.
In attaining fairness and equality in the provision of health, the most fundamental level of healthcare of having safe water supply and clean sanitation, housing, and appropriate medical care have to be met. Principle six, healthy development of a child is of basic importance the ability to live harmoniously in a changing total environment is essential to such development. In order for a citizen to grow up healthy and contribute economically, vaccination has been put in place and children has the right to timely access to appropriate health services through the establishment of a system to protect their health. Principle seven, extension to all people of the benefits of medical, psychological, and related knowledge is essential to the fullest attainment of health. This is done through constant training of skillful people in a specific expertise, ensuring accessible healthcare services for all without discrimination, and spending wisely with coverage for everyone. Principle eight, informed opinion and active cooperation on the part of the public are the utmost importance in the improvement of health of the people. This is done on part of collective responsibility and involvement from all citizens, taking on active roles, including organization and implementation of heath care service. Principle nine, government has a responsibility for the heath of their people which can be fulfilled only by the provision of adequate and social measures. This is achieved through a cohesive health system, by providing integrated and coordinated care for the people.
Governance and its Roles
Government’s role is to formulate and implement sound policies, and manage resources to provide service efficiently, allowing citizens to select, hold accountable and monitor actions taken by government. It continues to develop and maintain the nation’s public health care system by regulating both public and private health insurance in the country. The health care system is administered by Singapore’s Ministry of Health (MOH), who covers overall responsibility for healthcare, setting direction for policies and managing the public healthcare system, while ensuring quality of care and responsiveness health services. These include accessing and planning, system governance and financing, cost control, and health information technology. It regulates the health care system through legislation and enforcement, among those are implementation of best practices, to provide safety treatment for patients to ensure equality of health, setting standard of procedures to deliver quality of care. It is a way of communication and guidelines for everyone to follow, to ensure maintenance in delivering quality service. Auditing is done through observation and guidance to see if there are any gaps for improvement. Also, having a complaint system, so as to learn from the complaint and improve from that area, and to share experiences for further improvement.
On top of that, it is also necessary to conduct annual management review, whereby governance staff will do a review and gauge patient satisfaction levels and expectations regarding public health care and other health service attributes. Professional bodies include the Singapore Medical Council, Singapore Dental Council, Singapore Nursing Board, and Singapore Pharmacy Council, Traditional Medicinal Practitioner Board, Optometrists Opticians Board, Allied Health Professions Council, and Health Science Authority, regulates professionals through practice guidelines and codes of ethics and conduct. The ministry engages with these bodies to explain policy rationale and strategize initiatives. The Health Sciences Authority (HSA) regulates the manufacturing, importing and supplying, presentation, and advertising of health products for clinical trials. Its mission is to ensure that medical resources are internationally benchmarked standards of safety, quality, and efficacy.
The insurance industry is regulated by the Monetary Authority of Singapore (MAS) as part of its financial regulatory role. It supervises and oversees all financial institutions in Singapore, setting directions and coherent investment for regulating insurance activities. The government will consult relevant stakeholders, including patients, before enacting policies to ensure that concerns and feedback of public are taken into consideration and that public understands and support the idea to facilitate implementation. Besides that, there is also Central Provident Fund (CPF). It is a comprehensive social security saving plan that enables working Singapore Citizens and Permanent Residents to set aside funds for retirement to support them in the old age. It provides an expanse of coverage from addressing healthcare and home ownership, to family protection and asset enhancement. Every working adults and employers are required to make monthly contributions to the employees’ CPF into three accounts, ordinary account, special account and the Medisave account.
Conclusion
To summarize, this essay emphasizes the concept of universal health care and the different kinds of policies provided in the Singapore health care system. It has identified the gaps, challenges and target reforms of health systems over the past years. This is a critical issue considering the developments of its population. On a praiseworthy note, Singapore has attained one of the most successful systems in terms of delivery of excellent healthcare services that are of efficiency and effectiveness. It is done possible through joint responsibilities among government, individuals and employers. Furthermore, the case of Singapore shows that policy tools are more effective when used simultaneously. Good governance also comes from performing active role in regulating the resources and cost of healthcare service. With this, we can better understand the procedures of health system working together and therefore be well-prepared and responsive to future challenges.
