continue :
With people living longer and mothers producing fewer babies,
uncontrollable healthcare costs can potentially wreck our finances,
not to mention create major political problems.
Is this the reason for the higher
cost so as to cover the lesser usage from a smaller population
?
Is this not a Classic Case of the State planning hospital capacity
based on some pre-determinded economies of scale, and the planned
services not being consumed; hence, resulting in the increases to
billing rates for all medical and hospital services so as to
achieve breakeven ?
Singapore is fortunate that our founding fathers were successful in
developing the economy. With clean water, clean air and good
sanitation, the health of our people has improved over the years.
We now enjoy high life expectancy and very low infant mortality
rates.
Singapore is fortunate to have the
British as our Colonial Rulers, as they had set up a strong and
efficient administrative foundation and visionary infrastructure
for Singapore's future.
This had certainly allowed our founding fathers to concentrate on
the Economy in a lassier
fare environment that allowed a free economy to thrive and
grow unhindered - guided by true market forces.
Our [health-care] system today is not perfect but it is not bad.
WHO has rated our system as among the top 10 most cost-effective in
the world.
Today, we spend only 4 per cent of our GDP on health. The average
public hospital bill size for the unsubsidised Class A ward is
about one month of the average salary. In the heavily subsidised
Class C ward, the average bill ($786) is less than a week of
salary.
A heavily subsidised bill for
Class C ward at $786 ?
Will the amount of $786 be less than a week of salary ?
The Minister of Health must be referring to his own weekly salary,
and not that of a Singaporean from the Lower Income Group that form
the bulk of Singaporeans in the Class C ward.
For the high standard of medical care that hospitals provide, we
think this is very good value for money.
Whose 'value standard' is used to determine
a sense of 'good value for money' - the 'value standard' of the MILLION DOLLAR
salary of the Minister, or based on the typical Lower Income - {or
Lower and Upper Middle Income } - Singaporean wage earner
?
Five aspects of managing a health-care system
First, we work on the basis that health-care cost will continue to
rise. While we do our best to manage medical inflation, we know
that the trend is rising. The reason is simple. Doctors and nurses
will continue to command high salaries and advances in medical
science will continue to churn out new drugs and new equipment
which are more expensive than their replacements.
The key to managing health-care cost is therefore to ensure that
there is a constant and expanding flow of money going into the
health-care sector to pay for new services. There is no short cut
to this problem.
We are more likely to succeed if we share the financial burden
widely. If we load the burden on one payer - whether the government
as in the British system, or the employers like the American system
- we will cause very severe strains. In Singapore, we involve both
the Government as well as employers, and in addition, we rope in
patients and their families as well. Our health-care system is
supported by all the major stakeholders: Government, employers,
patients, family members, insurers and charities.
Is it any fairer when the sharing
of the financial burden is based on an opaque cost accounting
system which Singaporeans have no access to ?
When will the bubble burst if costs continue to rise ?
Will the day come when costs will reach the levels that currency
has to be dealt with in six-digits ?
Second, we believe that the health-care market can work better
under competition. Market competition is the best way to allocate
resources efficiently. Compared to other economic sectors, the
health-care sector is notoriously unproductive. But there is no
fundamental reason why the health-care market must fail. It fails
only because we allow it to fail.
For markets to function, there must be timely information so
consumers and producers can make rational decisions. When we want
to buy a mobile phone, we shop around for the best prices for the
functions that we desire. But how many patients shop around before
they go for their cataract eye operation or knee cap replacement?
And how can they shop around when information on how much patients
pay for such operations is not easily available?
In Singapore, we are trying to push out timely and relevant
information. We gather data from our hospitals and publish them
regularly.
Unfortunately, in Singapore, while
lip service is given to the term 'market competition' - such
equilibrium of market forces is always thwarted when it does not
meet with Government goals.
