chapter 3: managing healthcare: case studies of singapore and britain

Chapter 3:Chapter 3:Managing Healthcare:Managing Healthcare:

Case Studies of Case Studies of Singapore Singapore and Britainand Britain

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

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

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

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

Healthcare in Healthcare in SingaporeSingapore

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

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

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


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

Healthcare in SingaporeApproach to Managing Healthcare since

the 1980s Government’s concern = rising cost of

providing healthcare

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


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

You will payYou will pay

Your Boss will payYour Boss will pay


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

Healthcare in Singapore Medishield

National healthcare insurance scheme Pay with their Medisave Claim from Medishield to pay for large

medical bills not covered by MedisaveHelp 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


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

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

Healthcare in SingaporeMedifund

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

Healthcare in SingaporeRestructuring 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 HospitalSingapore General Hospital


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


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

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

WORKING WITH ORGANISATIONS

Have Singapore’s Healthcare Policies met the needs of the

People?To a large extentStill 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

Healthcare in BritainHealthcare in Britain

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


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


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


NHS Started in 1948 – very popularProvide 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


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

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:

Managing NHS1980s: 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

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

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

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

Managing NHSImpacts:

(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

Managing NHS

Providing Quality ServiceLate 1980s: People felt that NHS were of

poor standard1998: 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

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

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

Managing NHSE.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

Have British Healthcare Policies met the Needs of the

People?To a large extentThe intention of providing healthcare based on

need has remained unchanged since 1948Challenge: 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 NHSMany Britons are thankful for the NHS and feel

safe knowing that they can have medical services when they need them

Have British Healthcare Policies met the Needs of the

People?Doctors also feel that NHS has improved

over the yearsOthers felt that there has been no real

improvementFor the last 50 years, NHS has reformed to

meet the changing needs of the people in healthcare

chapter 3: managing healthcare: case studies of singapore and britain

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