The privatised-public service hospitals in Singapore has been a failure

Straits Times ran an article on 24th Mar 2019 entitled “Hard choices need to be made for sustainable healthcare: PM”

The words from PM Lee sounds like an early warning that something different must be done to contain or cope with the rising healthcare costs. He said: “Singapore’s healthcare receipts exceed $9 billion and rising faster than GDP growth, with a certainty that they will go up even further. Eventually, this will become unsustainable”.

The worst is yet to come: “In the medium term, Singapore will have to find new ways to fund healthcare spending.” As it is, Singapore healthcare spending by the government is one of the lowest among all developed countries but the government is proud of it.

“PM Lee noted that Singapore spends less on healthcare than most other developed countries, yet has better outcomes.” True, Singapore has been ranked highly in her healthcare systems and even above the USA.

But please take a closer look: the government is claiming credit for our healthcare outcome by spending far less of government’s budget than other developed countries. Who pays for the bulk of the cost? The truth is, a high proportion of healthcare cost is borne by the people themselves.

The government’s primary duty is to ensure that the healthcare cost remains affordable by offering a range of subsidies and tapping extensively into the people’s MediSave accounts to pay direct costs and insurance premiums.

According to MOH government expenditure and healthcare data (last updated on 15 Jan 18), government health expenditure as a percentage of GDP was only 1.6% in FY13, 1.8% in FY14 and 2.1% in FY15. In FY 2017, it was about 2.5% of GDP. This spending as a percentage of a Singapore’s GDP were even lower than Malaysia, Taiwan and S. Korea.

Making Hard Choices simply means getting the people to pay more and more of their healthcare costs. Making Hard Choices also means it is alright to spend $22.7 billion on defence and security (about 30% of total 2019 Budget) as against $9 to 10 billion on healthcare for the people.

In fact, in the 1990s, the government made the Hard Choice to privatise all public hospitals and turned them into “Private Limited Companies.” This Hard Choice of the government led to the creation of a new model of healthcare service: the privatised-public service hospitals in Singapore.

As a private limited company, the public hospital has to be profit-driven to show good performance, not service with a heart. Obviously, the private-sector hospitals will follow the pricing of the privatised-public service hospitals and their medical fees can’t be lower.

Let me give you an example. A short 10-minute Nasal Endoscopy (putting a tube into the nose to examine the inner linings of the throat) performed by an ENT consultant costs $265 (before subsidy) and $98 after subsidy, to be paid via Medisave or out-of pocket. This amounts to 37% of the bill.

In addition, there is a consultant’s fee of $76 and scope accessories $46. Out of a total of $122, the patient pays $30.50 from Medisave or out-of-pocket which is 25% of the consultant’s bill. These bills may be deceptive as the sums look small and deductible from Medisave provided the patient has enough balance for the year.

My wife (a PG) has to undergo an MRI of her head due to a persistent pain in her throat. The cost is $1600 and after subsidy, she has to pay $700 or 44% of the bill. This is a sizeable sum for someone with no income.

The high cost of medications is yet another cause for concern. Take the example of Lyrica (Pfizer), a pain-killer for nerve pain. A 50mg tablet in a UK pharmacy costs $0.49 while in a local hospital, a 75mg tablet costs $1.60. In a private-sector hospital, a 25mg tablet costs $1.80.

It seems like the ‘privatised-public service hospitals’ practise ‘inflationary pricing’ by adding 50-70% of cost to the consumer price and then gives a subsidy.

So it is not surprising that Singapore was ranked No. 4 for out of 11 Asian countries surveyed medical inflation, according to the Asia Healthcare Trends Report by Aon.

The Singapore National Eye Centre took the lead to cut fees for 20 treatments by 15 to 32 percent after a ST report on a patient who received $4.50 from MediShield Life for a fully subsidised bill of $4477. No medical institutions could afford to cut the fees by such hefty margins if they aren’t inflated.

The Singapore healthcare sector is in a dilemma – there is an invincible hand that pushes up medical costs in order to make more profits and there is a government bent on spending less on healthcare and yet promises to make healthcare costs affordable.

If only the government can make a Hard Choice to make healthcare costs really affordable for the people, there is a simple solution.

Kok Meng Cheng

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19 Responses to “The privatised-public service hospitals in Singapore has been a failure”

  • LIONS:

    Mwdical costs is a Major CONtributor to INFLATION INDEX here,perhaps,higher than housing?

    Going forward,it will get wor$e.

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  • Bobo:

    “If only the government can make a Hard Choice to make healthcare costs really affordable for the people, there is a simple solution.”
    70% would not allow medical charges to slide. That’s the strong reason they voted for PAP. They gave the mandate for ownself check ownself, for all the nonsense policies, support more and more Foreign workers to take the job from local borned Singaporeans etc.etc.

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  • F U:

    WTF, Malaysians, major surgery ZERO$.
    If you can’t manage, Get the F out!.
    What you say? need to buy 1.4$ Trillion Dollars on F35? F U.
    This lot treat sinkies as stupid.

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  • patriot of TUMASIK:

    From Birth to Grave with Sickness in between you Pay & Pay…

    From single room rented in shop-house and house & with Night soil carriers @ Pasir Panjang to HOMES all over the Best district 9-10-11 and with Gurkhas to watch over your SHIT…

    HOW??? Join the PAP and be Paid & Paid

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  • first expand T2 changi now...:

    gov will be expanding the RSW/ Gardens by the bay at a cost of $billions. a new tower to house a 1000rm luxury hotel for the super rich and adding new theme additions for visitors n tourists.
    and to soften the blow to sgs the report says this will provide 5000 jobs..but didnt say for locals or foreigners!
    your guess is as good as any.
    gov spends but citizens will ultimately pay the price.
    wait for it-the new cpf goal post will be shifted until where oso dunno; price increases of everything under our sg sky.

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  • TL Tan:

    People need to face reality that you get what you pay for. In a welfare state like the UK, healthcare is heavily subsidized but their tax burden is exorbitant. In Switzerland, although taxes are relatively lower, there is no public health care and everyone must have their own private insurance, which is very expensive. Here in Singapore, we are actually having the best of all worlds – We have very high quality public healthcare yet extremely low taxes. Hardly any other country can achieve this feat, and we could only achieve it because of very targeted healthcare spending by our government, and long-term planning.

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  • oxygen:

    WHEN PAPpypolitic and PAPpynomics SPEAK OF SUBSIDY, their minds are very clear of these -it is just a matter of painless move of their mouths and lips, their banking revenue accounts JUST PILES UP.

    STUPID AH SENGs THOUGHT HE GOT A FANTASTIC “DISCOUNT” INSTEAD.

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  • somemore got problems ?:

    //Singapore’s healthcare receipts exceed $9 billion and rising faster than GDP growth,//

    how come ? exceeding $9billion becos of open-leg (more people ?) but faster than gdp (low quality growth per capita ?). or rent-seeking much by those a lot of non-producers ?

    //noted that Singapore spends less on healthcare than most other developed countries,//

    less on healthcare ? somemore got problems ? must squeeze even further ?

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  • Sg:

    Haha
    Talk about privatising a hospital? Pls`
    The country is already privatised. The voters has given the mandate to make Temasek Holdings a private company which is a legal entity with citizens monies.
    This means that the Directors can do whatever they like and can pay themselves billions in bonuses year by year .
    DAFT SINGAPOREANS. 40% of your hard earned money go to pay these bonuses. Happy?

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  • I'm Halimah also jiak liao bee:

    Loony- is it any surprise to you that you and your Cronies imported hundreds of thousands Fts into here, and you expect everything to stay the same ???
    So who is going to foot the bill for all these new arrivals ??? they having paid no taxes before their arrival, and bring their whole village to come with them, especially those Ah nehs and Ah Tiongs.

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  • Singapore Fooled Again n Again:

    The choice is on our hand. We can vote for a change to put people with a heart to run the country and not to a group of privileged decision makers with profits and power as priority (was voted in by us 3 to 4 years ago)

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  • opposition dude:

    Goondu Loong pulls a nice big figure of $9 billion without a breakdown of how exactly it’s spent. Typical PAP talk, just like $8 heart bypass who CLAIMED that HDB lost a billion and then $2 billion without any breakdown. Just the mouth say only.

    Halthcare is bloody expensive and we all know that. Sure some pay a low cost but every single one of us knows a pioneer or two who say that they paid too much for their dental/medical/operation and it wasn’t subsidised under the PGP.

    So, it seems like the dafts just love getting screwed every election with their, ahem, never say die attitude with their simpleton brains forever thinking that Singapore will go bye bye if the PAP aren’t in charge. How their brains got to this conculsion without any proof of any sort is something I will never ever understand.

    Man up you kiasees! You want change to come then make damn bloody sure PAP doesn’t have so many donkeys in parliament after this year’s election!

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  • no volt:

    Why these ministers treat themselves so good, major surgery cheap cheap, salary & allowances in millions$, with pension etc… and treat the citizens so bad, especially when the country belongs to the People? Simple 4 rooms HDB now over $300K, pay until I die also cannot finish paying.

    You mean after erection they treat everything as belong to them? Erection new laws to guarantee win forever?

    Cannot lah!, I sure no volt them again. Volt Malaysia better.

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  • Singapore Fooled Again n Again:

    The ironic and sad thing is that we native Singaporeans have to foot more money! WHY?

    Due to the massive importation of new citizens, PRs and foreigners, the infrastructures, hospitals, MRT lines and trains, roads, schools, water and electricity infrastructures all needed billions and billions to support these new entries.

    I'm Halimah also jiak liao bee:
    Loony- is it any surprise to you that you and your Cronies imported hundreds of thousands Fts into here, and you expect everything to stay the same ???
    So who is going to foot the bill for all these new arrivals ??? they having paid no taxes before their arrival, and bring their whole village to come with them, especially those Ah nehs and Ah Tiongs.

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  • Oxygen Turban:

    Oxygen better wear a Turban lah!

    Comment steady, don’t own self pook own self backside.

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  • Changi Hospital Eye Specialist:

    Changi Hospital Eye Specialist Clinic is the BEST example .. just slightly over 12 months into its new place, its space(waiting area), rooms, staff .. again hit its capacity .. Its waiting area is FULL, patients come in with wheelchair find no where to park .. Bells non-stop ringing .. nurses call aloud patients’ name .. Patients fall asleep … like market place .. Gosh

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  • HarderTruths:

    What he is saying is the healthcare cash cow is running below expectations and his bonus is suffering – so there must be another way found to make us pay more for nothing substantial and keep believing this is for our own good.

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  • quality of care consciousness:

    //just slightly over 12 months into its new place, its space(waiting area), rooms, staff .. again hit its capacity ..//

    say population increased by 2 folds. hospitals increased by two folds ??

    not private hospitals (for medical tourism and the more well to do), but the types of public hospitals (subsidized for average daft sinkies) catering to the higher number of average people from population increase (well open-leg policy right as sinkie land belongs to everyone) ?

    how about the quality of care consciousness (not just the number for showing / boasting the bland statistics) ?

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  • IB Tan:

    No problem, increase tax only for those earning $1million/yr and above. No burden for these people. Tell them this is doing NS to SG.

    TL Tan:
    People need to face reality that you get what you pay for. In a welfare state like the UK, healthcare is heavily subsidized but their tax burden is exorbitant.

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