Download - HFS Phua
![Page 1: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/1.jpg)
Dr Phua Kai Hong, AB cum laude SM (Harvard), PhD (LSE) Lee Kuan Yew School of Public Policy National University of Singapore
Health Systems Financing in Asia
![Page 2: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/2.jpg)
Current Trends and Issues in Health Care Financing in Asia
• Predominantly out-of-pocket expenditure in WHO SEARO and WPRO (Asia-Pacific)
• Growth in social insurance and less taxation in WPRO region (eg Korea, China, Vietnam)
• Increasing catastrophic expenditure and impoverishment due to healthcare spending (China and transitional economies)
• High expenditures for drugs and diagnostics (50-60 % of total health budget in China)
• Strong fundamentals and driving forces for increasing demand and consumption
![Page 3: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/3.jpg)
Comparative Health and Expenditure in Selected Asian Countries (WHO Report 2000)
$/capita (Int $) Public/Total %GNP %Pop>60 DALE
Japan 2373 (1759) 80.2 7.1 22.6 74.5 Korea 700 (862) 37.8 6.7 10.2 65.0 China 20 (74) 24.9 2.7 10.0 62.3 India 23 (84) 13.0 5.2 7.5 53.2
Singapore 843 (750) 35.8 3.1 10.3 69.3 Brunei - (857) 40.6 5.4 5.0 64.4 Malaysia 110 (202) 57.6 2.4 6.5 61.4 Thailand 133 (327) 33.0 5.7 8.5 60.2 Philippines 40 (100) 48.5 3.4 5.6 58.9 Indonesia 18 (56) 36.8 1.7 7.3 59.7 Vietnam 17 (65) 20.0 4.8 7.5 58.2 Myanmar 100 (78) 12.6 2.6 7.4 51.6 Cambodia 21 (73) 9.4 7.2 4.8 45.7 Laos 13 (53) 62.7 3.6 5.2 46.1
![Page 4: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/4.jpg)
Health Expenditure % GDP Per capita 1. France 9.8% $2,369 2. Italy 9.3% $1,855 3. San Marino 7.5% $2,257 4. Andorra 7.5% $1,368 5. Malta 6.3% $551 6. Singapore 3.1% $876 7. Spain 8.0% $1,071 8. Oman 3.9% $370 9. Austria 9.0% $2,277 10. Japan 7.1% $2,373
Health Systems Performance WHO Rankings 2000
![Page 5: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/5.jpg)
WHO Health Systems Performance Assessment
• Health Attainment (Effectiveness) • Responsiveness (Efficiency) - basic amenities, social support, respect, confidentiality, autonomy, choice, communications • Fairness in Financing (Equity) - distribution of risks, social protection
![Page 6: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/6.jpg)
Effects of Health Care Financing and Payment Systems
• EQUITY Who pays? Who benefits? - Distribution - Access • EFFICIENCY Supply & Demand - Allocation - Production • EFFECTIVENESS Outcomes - Quality of Care - Health Status
![Page 7: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/7.jpg)
Comparative Health Expenditure in Selected Developed Countries
U.S.
Germany Canada Japan U.K.
Singapore
Year
![Page 8: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/8.jpg)
Some Reasons for Singapore’s High Ranking and Low Expenditure
• Relatively high GNP growth in denominator • Lower consumption due to age structure
(age-adjusted projection up to 6-8% of GNP) • Strong budgetary controls on public spending • Absence of comprehensive health insurance • Government subsidies for public health and
differential pricing for personal consumption • ? Cost-sharing and co-payment system
![Page 9: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/9.jpg)
Health Expenditures as % of GDP in East Asian Economies (2000)
• National Health Insurance Systems Japan 7.1 Korea 6.7 Taiwan 5.0 • National Health Service Systems Hong Kong 4.7 Malaysia 2.4 Singapore 3.1
![Page 10: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/10.jpg)
Healthcare Expenditure in East Asia
Japan 7.1 80 : 20 Taiwan 5.0 66 : 34 Malaysia 2.4 58 : 43 Hong Kong 4.7 54 : 46 Korea 6.7 38 : 62 Singapore 3.1 36 : 64
% GNP Public:Private
![Page 11: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/11.jpg)
![Page 12: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/12.jpg)
Asian Health Care Financing Systems With Universal Coverage • Social Health Insurance - Japan, Republic of Korea, Taiwan, Thailand • National Health Service
- Singapore, Hong Kong, Malaysia, Sri Lanka Without Universal Coverage • Social Health Insurance
- China, Vietnam and transitional economies
• National Health Service - India, Indonesia and other developing countries
![Page 13: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/13.jpg)
Selected Health Care Financing - Social Health Insurance Models
• JAPAN Universal health insurance (1922/1939) NHI Law amended (1984/1990) Trial DRG/PPS in 10 Hospitals (1/11/1998) Long term care insurance (1997/2000) • KOREA Universal health insurance (1976/1989) Health Care Reform Committee (1994/1997) K-RDRG Pilot Program (1997-1998) • TAIWAN Universal health insurance (1995) Partial DRG system (from 1998) Cost-containment measures (from 2000)
![Page 14: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/14.jpg)
Selected Health Care Financing – National Health Service Models
• SINGAPORE National Health Plan (1983) Medisave/Medishield/Medifund (1984/1990/1993) Review Committee on National Health Policies (1992) White Paper on Affordable Health Care (1993) Casemix Funding (1999) Eldercare Fund/Eldershield (2000/2002) Enhanced Medishield/Private Insurance (2005) • HONG KONG Scott Report (1985) Consultation Paper - Towards Better Health (1993) Harvard Consultant’s Report (1999) Consultative Paper - Lifelong Investments in Health Care(2000) Proposal for Supplementary Private Insurance (2010)
![Page 15: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/15.jpg)
Changing Features of the Singapore Health Care System
Mixed Public-Private Health Care Market • Choice of private and public systems • Competition and integration between public,
private and voluntary sectors • Appropriate mix of financing methods • Co-payment at the point of consumption • Selective insurance to avoid moral hazard • Targeted public subsidies to address inequity • Government benchmarks for prices & quality
![Page 16: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/16.jpg)
Public-Private Health Expenditure in Singapore (1965-2000)
![Page 17: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/17.jpg)
Singapore Health Statistics – Past and Present
1980 2005 • Life expectancy 70 years 80 years • Infant mortality 12/’000 2.5/’000 • Aged/total population 5 % 9 % • Public hospital mix 85 % 80 % • Health expenditure/GDP 3 % 4 % • Health expenditure/ 6 % 7 %
government budget • User fees recovered / 3 % 60%
public expenditure
![Page 18: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/18.jpg)
Singapore’s Hybrid Health Care Financing
Seeks to avoid either extremes - Welfare State Tax-funded/ Social insurance - ‘Free’ services - Low quality - Inefficiency
Free Market Fee for service Private insurance - Moral hazard - Adverse selection - Inequity
![Page 19: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/19.jpg)
Healthcare Financing Strategies
Instill personal and family responsibility (Cost-sharing)
+ Ensure future sustainability with ageing and avoid inter-generational problems
(Savings) +
Enhance risk-pooling and social protection (Insurance)
+ Target subsidy and equitable distribution
(Taxation)
![Page 20: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/20.jpg)
Medisave
Medishield
Medifund
PRIMARY CARE
ACUTE CARE
CATASTROPHIC (LONG TERM CARE)
Financing Method
Private Payment
Compulsory Savings
Social/Private Insurance
PUBLIC SUBSIDIES Source: Dr. Phua Kai Hong
Taxes PUBLIC HEALTH SERVICES
(Eldershield)
(Eldercare fund)
Health Care Financing in Singapore
![Page 21: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/21.jpg)
Public Hospitals: Bed Distribution
![Page 22: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/22.jpg)
Health Care Financing Reforms - The Unfinished Agenda
1983 Blue Paper – National Health Plan 1984 Medisave 1990 Medishield 1993 Medifund 1993 White Paper - Affordable Health Care 2000 Eldercare Fund 2008 Eldershield 2005 Enhanced Medishield/Private Insurance 2017 Means Test (Targeted Public Subsidies) 2018 ?
![Page 23: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/23.jpg)
The Singapore Health Care Model • Singapore’s health system ranked extremely high • Reputation for high quality, choice and efficiency • Equity risks covered by subsidies and safety nets • Fully funded medical savings with social insurance
to finance increasing needs of ageing population • Balance between health care supply and demand
with pricing and subsidy, while containing costs • Goals of efficiency, equity, quality and sustainability
to be maintained by appropriate public-private mix in provision, financing, regulation and education
![Page 24: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/24.jpg)
Similar Approaches to Old Age Security and Health Care Financing
World Bank’s 3 Pillars for Old Age Security • Redistribution (Taxation) • Savings • Insurance Singapore’s 3M for Health Care Financing • Medisave (avoids inter-generational transfers) • Medishield (pools risks for catastrophic care) • Medifund (subsidizes the poor and indigent)
![Page 25: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/25.jpg)
4 8 12 16 20 24 28
0
2
4
6
8
10
12
14
France Switzerland
Russia Germany
Italy
Finland
Norway Sweden
Belgium
United Kingdom
Denmark
Spain Portugal
Greece
Japan
Ireland
New Zealand
Australia
Canada
United States
Hong Kong
Taiwan
Korea
Malaysia Singapore
Hea
lth E
xpen
ditu
re a
s %
of G
DP
Aged Dependency Ratio (>65/Aged 15-64)
Health Expenditures and Ageing
![Page 26: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/26.jpg)
Population Ageing: Impact on Health Expenditure
• Health expenditure will increase with growing proportion of the aged
• Health expenditure will increase with longer survival of the aged population
• Health expenditure will increase with widening periods of morbidity and disability before death
![Page 27: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/27.jpg)
Population Ageing Trends by 2030
![Page 28: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/28.jpg)
Health and Long Term Care Financing in Japan
• Universal health insurance 1922-1939 • National Health Insurance (1961) • Health Service Law for the Aged (1982/1986) • National Health Insurance amendments 1984-1990 • The Golden Plan / New Golden Plan (1990) - 10 -Year Gold Plan for the Development of Health
and Welfare Services for the Elderly • Public Long Term Care Insurance Act (1997) -
implemented in 2000 - 50% insurance (40 years and above) - 50% general taxation
![Page 29: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/29.jpg)
Health and Long Term Care Financing in Singapore
FINANCING METHOD • Personal savings • Compulsory savings • Catastrophic
insurance • Disability insurance • Endowment • Taxation
3-M SYSTEM + 2E
• MEDISAVE (1984) • MEDISHIELD (1990) • + ELDERSHIELD(2002) • MEDIFUND (1992) • + ELDERCARE FUND
(2000)
![Page 30: HFS Phua](https://reader033.vdocument.in/reader033/viewer/2022051311/5445fe79afaf9fef2a8b471e/html5/thumbnails/30.jpg)
Special Conditions in Asia
• Fastest pace of economic transition • Highest rates of population ageing and
population growth • Great propensity for savings • Strong traditional family support systems
Old age security and health care financing must contend with such considerations