Healthcare competition 2: Singapore

Singapore's total health spending is relatively small, only 4.1 percent of GDP in 2009, compared to 5 percent and up in many rich countries. Well, there are two reasons for this. One, the numerator, health expenditures, may not be so big as people live healthy lifestyle and get sick less frequently. And two, the denominator, GDP, is so big that the ratio becomes smaller.

Majority of Singaporeans are covered by their government's healthcare financing schemes, known as the 3Ms: Medisave, Medishield and Medifund. The EIU Healthcare Report February 2009, as reprinted in Asia Healthspace blog, defined those 3 Ms:

Medisave is a simple national savings scheme designed to enable patients to save income for future healthcare expenses. At end-2008 there were 2.9m Medisave accounts, the average balance of which stood at S$14,900 (around US$10,600). Medishield is a low-cost insurance scheme, premiums for which can be paid out of Medisave accounts, and is aimed at providing patients with cover in the event that balances in Medisave accounts are insufficient to meet healthcare expenses. At the end of 2008, 84% of the population were Medishield members, with the ratio for the working-age population standing at 93%. Medifund is an endowment fund that is financed by the government to provide a safety net for those who cannot afford their part of subsidised healthcare expenses. The Private Medical Insurance Scheme, which allows private insurers to offer medical insurance to members of the Central Provident Fund (a compulsory savings scheme to finance pension payments) and is similar to that offered under Medishield, has around 500,000 members.

While there is a big public sector healthcare like government hospitals, there is a dynamic private sector healthcare that compete with each other. While government hospitals admit the bulk of confined patients, private hospitals and clinics attend to 75 percent of all primary healthcare services.

Singapore is a developed economy and its public hospitals are way advanced and more modern compared to public hospitals in the Philippines and other developing countries. But government clinics do not provide free healthcare, the government subsidizes only 50 percent of treatment cost in all public clinics. Thus, patients still have to fork out cash, either via their health insurance or out of pocket spending. This system should somehow implant into the minds of the citizens that "health is not exactly a right", there is a big portion of healthcare being personal, parental, and company responsibility.

It is this kind of competition among public and private healthcare hospitals and institutions, and not 100 percent healthcare subsidy by the government, that helps Singaporeans be in good health. Alcohol and tobacco taxes there are very high. Not many people therefore, can afford to become drunkards or chain smokers. Compare that in the Philippines where alcohol and tobacco taxes are low, and many people can be habitual drunkards and chain smokers. Which increases demand for public healthcare when people from poorer income groups would run to government hospitals and clinics for lifestyle-related diseases like lung cancer and liver cancer.