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Lesson1: Financing for Singapore Healthcare (Singapore's Healthcare…
Lesson1: Financing for Singapore Healthcare
Schemes available in Singapore
Medisave
scheme which help individuals set aside part of monthly income into account (meet future personal or immediate family's medical expenses)
reformed structure of healthcare (managing costs through individual financing)
SG grapple with ageing population and increased demand for healthcare services: usage expanded (include more illnesses)
Medishield/Medishield Life
Medishield: low cost basic medical insurance scheme
purpose: help members meet large Class B2/C hospitalisation bills, which could not be sufficiently covered by Medisave balances
operated by CPF Board
new basic health insurance scheme was revamped at the end of 2015: Medishield Life
Medifund
set up as a safety net (patients with difficulty paying the subsidised bill charges, despite Medisave and Medishield Life coverage)
initial capital of $200 million, gov will inject capital into the fund when budget surpluses are available
Eldershield
offers disability insurance to all 40 year old Singaporeans with CPF accounts
it is to risk-pool against the financial risk of suffering a severe disability
provides monthly cash payout (help pay out-of-pocket expense for the care of a severely-disabled person)
Singapore's Healthcare Philosophy
ensure quality and affordable basic medical services for everyone
promote healthy living and preventive health programmes
maintains high standards of living, clean water and hygiene
current framework served us well (need prepare for future --> ageing population and smaller family size
need for greater collective responsibility (do not face life's uncertainties alone)
3 major shifts: increase government share of national healthcare expenditure; gradually expand Medisave use; enhance collective responsibility for healthcare
Financing Philosophy
Offers universal coverage to all citizens
Individual responsibility and affordable healthcare to all citizens (mixed financing system with multiple tiers of protection --> subsidies, medisave, medishield life, medifund)
Promoting competition and transparency
Challenges faced in the healthcare system?
ageing population (increase in the number of HD and ICU beds; higher occupancy rate; longer waiting time)
increasing incidence of chronic disease
increasing demand for more healthcare services
increasing demand for more affordable healthcare
Healthcare Landscape
1985-2000
Private Limited Label
Restructuring Singapore Public Healthcare Services started in early 1985
Restructuring Government Hospitals is not privatization
Autonomous government hospitals with financial discipline
Revenue Cap constrain the increase in operating costs directly
Cost Recovery or not for profit
Umbrella body known as HCS or Health Corporation Singapore
2000-2010
Centralisation
Group Purchasing Office (GPO):
allows for bulk buying of medical consumables and materials
consolidation of purchases (increases leverage of hospital to demand lower prices)
added advantage: standardisation of cost prices throughout cluster
Finance Shared Services (FSS):
outsourced accounts payable, accounts receivable and payroll service provider to various institutions under NHG or SHS group and other related companies
backend accounting functions are consolidated or shared to reduce the manpower and operating cost
Integrated Health Information System (IHIS):
conceived in 2008 by MOH (central employer for all public healthcare IT professionals)
Competition
Creates price variation
Reason: cost structure differs, and prices are marked up to cover costs of the institution/department (within same organisation will also differ --> cost and prices of inpatient and outpatient different)
How to reduce: consolidating common services for the institutions
Save resources (medical equipment and manpower): transfer stable patients from hospitals --> community hospitals, nursing homes or hospices
Post 2010
Regional group or clusters were created to enable integrated care
Hospitals, polyclinics, community hospital, education centre, and specialty centres under each group
Partner with general practitioners, polyclinics and other healthcare providers in the area
"build partnerships and seek synergies beyond the public sector"
3 clusters by 2018: West (NUHS), Central (NHG), East (SingHealth)
Health care, not sick care
Shift in mind-set from disease management to health management
Healthcare workers must move into people's homes to proactively identify patients who are at risk for future hospital admissions
Communication channels must be created for people not currently interacting with the health system
Deploying nurses for regular, open conversations at a nearby community club for the elderly
Create the foundation for proactive, rather than reactive, care models to prevent hospital admissions in the first place
Right-sitting of care to move patients to more suitable providers in the community is a major on-going initiative for the public sector Specialist Outpatient Clinic (SOC)
Non-professional care team
Professional medical resources already capacity-strained
Required to explore around new care delivery models, and also hints at care delivery workforces emerging from unexpected areas
Provide caregiver education guides and brainstorm workshops (help elderly innovate in their own homes for safer independent living)
Non-professional care team members provide low cost solution to monitor and aid the elderly
Community is the hospital
Locate aged care and support facilities within the community - seniors can age gracefully and close to their loved ones
Make every neighbourhood a senior-friendly one
Develop range of aged care services in every neighbourhood and void decks to meet seniors' social and healthcare needs, to make care accessible to seniors needing care and to support caregivers
However, current payment structures and care delivery infrastructures are more often set up to reward fixing what went wrong, rather than support preventing it in the first place
Fast vs Slow medicine
FAST
residents requiring emergency or inpatient care (acute hospital)
medical conditions managed will be complex
healthcare services would be of very fast pace and high intensity
cannot be scheduled and can be difficult to organise
care provided is costly and number of patients leaving curative care at any one time might be small
must constantly push patients to community hospitals or step-down care facilities
SLOW
community hospital: provide stimulating environment for preparing the patient for home (for older persons)
average stay: 3 weeks (patient would be assessed during this period of time)
good potential for recovery: provided with high quality physical rehabilitation and sub-acute medical care
if quality of life is poor: more conservative approach would be taken
helps to minimise the length of hospitalisation wherever possible
focus on promoting in-home care
function as a "ILTC hub" (partnerships and service links with ILTC providers can be fostered)
Ways to ensure affordable basic medical services for EVERYONE??
medical cost is affordable for patient (cost burden)
have different levels of subsidy, availability of subsidy for various healthcare services and settings
inform patients the choice of ward class (need financial counselling), choices of treatment options (by doctors counselling), for patients to select the most affordable options provided
design an insurance scheme that is affordable and comprehensive in coverage
refine medifund criteria to prevent them to be too strict
promoting healthy lifestyle reduces need for medical services, thus reducing healthcare costs for seeking treatments
healthcare institutions to keep the cost of providing medical services low
emphasis on preventive and primary care
consolidation of common services across institutions in the healthcare clusters, allows individual institutions to reduce manpower cost on staff performing similar duties
careful evaluation of new medical technologies for adoption to ensure cost-effectiveness
intermediate and long-term care (ILTC) institutions. Instead of spending cost in creating more beds in the hospitals, healthcare organisations can transfer the more stable patients to community care hospitals
ILTC serves to prevent patients from unexpected and avoidable re-admission to emergency department or hospital inpatient care