Healthcare

Healthcare is a basic right enshrined in the Universal Declaration of Human Rights and other similar covenants. It is not a commodity, and we assert that market forces have no part to play in the financing or delivery of basic healthcare to Singaporeans. This was historically the case in Singapore. The availability of low-cost, affordable, quality healthcare in the 1950s, ’60s and ’70s was one reason for Singapore’s rapid progress into the ranks of developed nations. When the Singapore government conducted its first major healthcare financing review with the Blue Paper produced in 1981, Singapore had infant mortality statistics better than the USA and comparable to the UK despite having a completely nationalised healthcare system with a small private component. Restructuring of hospitals only occurred in the mid-1980s without major gains in health outcomes despite major disruption including increased user fees. This is because of the already high quality care provided by “socialised medicine” in the preceding decades. 

No one should risk bankruptcy while seeking life-saving medical treatment. If healthcare is a basic right, then a good system must ensure that even the poorest can afford essential healthcare.

Many individuals and families have experienced how easily their Medisave accounts can be depleted with just one major episode of illness or a complicated surgery. This led to the creation of Medishield however this was found inadequate and after the GE 2011, Medishield Life was started. Finally the safety net program of Medifund was set up when all the resources of an individual have been depleted.

In SDP’s healthcare plan of 2012, we proposed that a much higher percentage of government revenue be channelled into healthcare for our citizens. This was to  ensure universality and affordability of healthcare. Healthcare expenditures from the government have gone up but a significant proportion of that increase has gone into infrastructure building and redevelopment with a much smaller proportion going into actual patient care. This is partly a result of the hospital centricity of most healthcare funding in Singapore. Major insurance companies often require hospitalisation to pay claims. There is also limited subsidized funding for most outpatient care beyond primary healthcare in polyclinics.

1. We proposed that Maternal and Pediatric services –should be largely free and funded by the government from the taxes as these are health promoting and have a vital role in the future of our nation. This would reduce the cost of producing and bringing up children and potentially address the problem of our falling birth rates. 
2. We called for  Primary healthcare services – for chronic illnesses, to be paid through a risk pooling system so that the cost of running these services will be shared by all in the community. Healthier SG is an attempt to focus on preventative care but does not provide enough support for primary care physicians who are going to end up subsidizing a large proportion of the costs of care. This is because the current system of low consultation charges in primary care is augmented by high medication charges which are discouraged under Healthier SG. 
3. We argued that the running costs of the hospitals must be paid from taxes. This is the only way to bring down the cost of services at the point of use. The creation of two then five and now three clusters has resulted in a significant amount of wastage and duplication as there are now multiple CEOs, CFOs and other administrators when the whole system was highly efficiently run out of the MOH in the past. The clusters need to be abandoned and we need to return to a single unified public healthcare sector which can result in major economies of scale and better outcomes for patients and healthcare workers.
4. Hospice care – caring for the dying. No one can abuse such services and such services should not be dependent on charity. Funding for such services should be from our taxes as well as from donations from appreciative family members of the care receivers as well as other donors. 
5. Home care for the non-ambulant chronic sick – these services should also be funded in the same way as hospice care. Again, no one is going to deliberately choose to be home-bound and non-ambulant just to “abuse” these services.

There must also be greater expansion of the use of other healthcare workers for the delivery of healthcare especially in chronic illnesses and home care. Void decks should be made available for voluntary and community organisations to bring healthcare closer to these patients. Nurse run void deck medical centers potentially in partnership with allied health professionals will make primary care even more accessible as well as chronic disease care and health maintenance.

Finally, the core of the SDP Healthcare proposal is a single-payer universal healthcare system in which the government manages a central healthcare fund. This fund will be run along the lines of a government-subsidised public insurance scheme to finance compulsory basic health, accident and pregnancy (for women) coverage for all citizens and permanent residents (PR) residing here for more than 6 months a year.

This would cover co-payments for all services funded primarily by the government such as hospital services, hospice and other complex services. The premiums would be kept affordable as administrative costs are minimized and there are caps on payments by individuals. Reinsurance will be deployed to cover extremely expensive drugs for rare conditions and those who cannot afford their premiums will have the government cover them. There will also be evidence based guidelines developed independent of industry input to determine which services should be funded and covered by the national health insurance system. It would be a hybrid system in that while digital services are used for the majority, those who are elderly or not comfortable with digital healthcare will have the option for alterative approaches.

Ultimately, the fundamental principle is that healthcare is a basic human rights just like the right to safety. As such, we will commit our resources as a nation not only to protecting our nation’s borders and security but also our health and our families’ instead of viewing healthcare as an industry driven by profit.

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