Managing Healthcare: Case Studies of Singapore and Britain

Managing Healthcare:
Case Studies of
Singapore and Britain
Requirements
To what extent is healthcare the
responsibility of the
government?
What makes a healthcare system
effective?
2. Managing Healthcare
2.1 Challenges faced by
Governments when managing
healthcare:
Need to provide healthcare for the
sick even if they are unable to pay
Provide healthcare, a public good,
with limited resources and
competing needs
healthcare:
Providing Quality Healthcare
Expectations of better healthcare
from people in developed countries
Success of a government can
sometimes depend on how well they
meet peoples demands for
healthcare
4
healthcare:
Increasing Expenditure on
Healthcare
Increase in the cost of healthcare due
to research and development,
training, etc
2.2 How is healthcare paid for?
See next slide
Providing Basic Health Care in

the 1960s (concerns during early
independence)
More hospitals and clinics started
to be built
Island-wide Inoculation
/vaccination Programme
Tuberculosis, smallpox common
Routine Examination of children in
schools
Clean-up of Singapore streets

Environmental pollution, indiscriminate
littering & improper disposal of rubbish
Deterrents Fines
Public Campaigns
Improving Health Care Services in the

1970s with improvement in economy and better
std of living
Specialisation of Medical Services

Plastic & Reconstruction Department at the
Singapore General Hospital (1972)
Polyclinics replaced outpatient

dispensaries
One-stop Health Centres
Outpatient Medical Care, Maternal & Child
Health Care
Conveniently located all over Singapore
Improvement in hospital facilities &

quality of healthcare
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3. Healthcare in Singapore
3.2 How has the approach to
manage healthcare changed since
the 1980s?
Rising cost
Finite resources
Healthcare cost should not put a strain
on government spending
Healthcare should encourage individual
responsibility and community support
BUT government should also make
healthcare affordable
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3. Healthcare in Singapore
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How is healthcare managed in

Singapore? Three Factors
Individual (1)
Encouraging Self-Reliance
Singaporeans use Medisave to pay for part of
their hospital bills and medical treatment.
Singaporeans can also opt to buy Medishield
to pay for larger medical bills which
Medisave does not cover.
Encouraging self-reliance thus allows
Singaporeans to share healthcare costs with
the government, allowing the government to
lighten its burden and allow it to devote
more resources to more pressing issues.
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Individual (1)
Maintains Good Health / Healthy
Lifestyle
The individual maintains good health
and adopts a healthy lifestyle, so that
he or she will not have to spend
money on medical treatment and
save on medical expenses
This releases the government from
being burdened to provide additional
resources for healthcare
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Government (2)
Keeps healthcare affordable
The government gives direct subsidies to
government hospitals, polyclinics and some nursing
homes.
In order to ensure that healthcare remains
affordable for the lower-income group, more
subsidies are given to the Class C wards in
hospitals.
To help needy Singaporeans who still cannot afford
to pay their healthcare bills despite Medisave and
Medishield, the government has Medifund which is
given to public hospitals to provide help for needy
patients. Patients who need help in paying for their
healthcare can apply for the fund.
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Singapore Hospitals
Ward Classes
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Class of
Ward
Number Subsidy
to a
Room
AirConditio
-ning
A
B1
B2+
B2
1
4
5
6
0%
20%
50%
up to
60%*
Yes
Yes
Yes
No
up to
80%*
No
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Government (2)
Keeps healthcare affordable
The government has also considered means-testing
which distributes medical resources and subsidies
according to income levels.
This ensures that those who would benefit more
from subsidies get the most help.
The government has also considered restructuring
to allow hospitals to reorganise themselves to
better meet their patients needs.
This would allow the government to reduce the
amount of subsidies to hospitals and reduce its
burden to provide resources to meet rising
healthcare costs.
35

Government (2)
Promotes a healthy lifestyle
By promoting healthy lifestyle programmes in
school and the workplace, and encouraging
Singaporeans to do physical exercise and
follow a healthy diet, the government can
help Singaporeans to be healthy, avoid
medical treatment and save on medical
expenses thus reducing the governments
burden to provide resources to meet rising
healthcare costs.
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Community (3)
Provides some healthcare services
Provides support services
Private and non-government bodies provide
healthcare services in addition to those provided by
the government.
These healthcare and support services range from
long-term post-hospital care or care for specific
illnesses.
These services cater to the poor or those with
specific illnesses who are unable to get any support.
This helps to lighten the burden of the government
in providing healthcare and allows it to divert
resources to other needs.
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How successful has Singapore been in meeting

the healthcare needs of the people?
Successful:
The government has put in place
policies like Medisave, Medishield,
and Eldershield so that people can
be self-reliant and afford to pay
for their healthcare needs
Medifund to help those who cannot
pay for healthcare have access to
it
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Successful:
policies like Medisave, Medishield,
and Eldershield so that people can
be self-reliant and afford to pay
for their healthcare needs
Medifund to help those who cannot
pay for healthcare have access to
it
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Successful:
subsidies in hospitals so that
healthcare will be more affordable
for lower income Singaporeans
The government has also provided
support to certain community
organisations to provide specific
healthcare support services to
Singaporeans
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Unsuccessful:
The elderly who did not have the
opportunity to save for healthcare
when they were working
They are dependent on their
family, the community and the
government for their healthcare
needs
It is a problem because of an
increasing aging population
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Unsuccessful:
The unemployed also have
problems paying for healthcare as
they do not earn any money, thus
they cannot contribute to their
Medisave accounts
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Conclusion:
Yes. Singapore has been successful to a
large extent because the government
has put in place several measures to
make healthcare accessible and
affordable to Singaporeans.
No. Singapore has been unsuccessful to
a small extent as some of the elderly
and unemployed Singaporeans have
problems getting access to healthcare.
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William Beveridge
Creator
of the
welfare
state
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NHS Live (Videos)
1940s
1950s
1960s
1970s
1980s
1990s
Key Question:
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Origins of the
Welfare State
High Unemployment in Britain after
World War Two
Poverty, Shortage of food and fuel
Beveridges report
Governments duty to end poverty, disease,
unemployment
Decision to create a welfare state

Aimed at ending poverty and sickness
To look after the citizens from birth to death
Every citizen was guaranteed a minimum
standard of living
Job, home and medical care
Means of Achieving the

Welfare State
Nationalisation of Utilities and Industries
These industries to be operated for the benefit
of the citizens and not making profits
To create employment and keep these services
affordable
Provision of Social Welfare

Welfare Benefits
Provision of Health and Medical Care

National Health Service (1948)
Free basic medical service for all citizens
Problems of Welfare
State
Low Efficiency
Reliance on government funds to survive
Long waiting queues at hospitals and clinics
Increase in Government Spending

Costs of welfare benefits unchecked
The Why Work Attitude

Little motivation to work
Loss of businesses
More money to be generated from taxes to pay
for welfare services
Reduction in profits discouraged investments
Margaret Thatcher
Wanted
to
improve
the NHS
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How has the British government

managed the NHS over the years?
Key Criteria:
Ensuring that healthcare spending
is put to good use by:
Managing Government Spending
Increasing Efficiency
Providing Quality Service
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Balance government and the
increasing of taxes
1980s Dental and optical
treatment was no longer free
except to students under 19,
expectant mothers and mothers
with children under the age of 1
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Increase in contributions to the
National Insurance Tax in 2003 to
finance healthcare
The government justified the
increase in national insurance tax
and at the same time manage to
balance its spending to provide
healthcare services to the public
especially to the needy
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In order to continue to provide
quality healthcare despite the rise of
demand for NHS services and the
insufficiency of medical personnel,
Margaret Thatcher introduced
privatisation for non-medical
services (e.g. cleaning, laundry,
meals preparation) so that hospital
staff could concentrate on providing
healthcare services
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By using private companies, whose
aim is to make a profit, the nonmedical services were more
efficient and cost-effective.
Hospitals would improve their
services to meet the need of the
people and patients would have
more choices in healthcare.
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Providing Quality Service

NHS Plan (2000) to improve poor
service standards such as long
queues and waiting times
Allowing NHS patients to use private
hospital care without them paying for
it
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NHS Improvement Plan (2004)
Choose from 4 different healthcare
providers
Access medical records via the internet
NHS Direct Medical advice offered
over the phone
This will help reduce the queues at

the NHS and ease the strain on
resources and medical staff so that
they can attend to more urgent
cases.
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Which is the most effective factor:
Improving efficiency is more effective
because when efficiency is improved, it
will lead to an improvement in quality
services as people will not have to wait
so long for treatment and medical staff
can focus on urgent medical services.
This will help the government manage
its spending people would be more
willing to pay for better service and not
rely on the government to provide them
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Managing Healthcare:

Providing Basic Health Care in

Clean-up of Singapore streets

Improving Health Care Services in the

Specialisation of Medical Services

Polyclinics replaced outpatient

Conveniently located all over Singapore

Improvement in hospital facilities &

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copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

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copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

How is healthcare managed in

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How is healthcare managed in

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copyright (your organization) 2003

How is healthcare managed in

copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

copyright (your organization) 2003

How is healthcare managed in

How is healthcare managed in

copyright (your organization) 2003

How is healthcare managed in

How successful has Singapore been in meeting

How successful has Singapore been in meeting

How successful has Singapore been in meeting

How successful has Singapore been in meeting

How successful has Singapore been in meeting

How successful has Singapore been in meeting

copyright (your organization) 2003

NHS Live (Videos)

Decision to create a welfare state

Means of Achieving the

Provision of Social Welfare

Provision of Health and Medical Care

Increase in Government Spending

The Why Work Attitude

How has the British government

How has the British government

Managing Government Spending

How has the British government

Managing Government Spending

How has the British government

How has the British government

How has the British government

Providing Quality Service