Master of Science Health Services Management

1. Master of ScienceHealth Services Management Current Issues in Health Services Management Question 1 What are the existing major problems and challenges confronting the country?

2. Singapore Health Care System

3. Background Information (1) Singapore

4. Background Information (2) • Land Area: 699.0sq km • Total Population: 43514000 • Race: Chinese 76.0% Malay 13.8% Indian 8.4% Others 1.8% Source: Ministy of Health (2005)

5. Background Information (3) Source: Ministy of Health (2005)

6. Background Information (4) Source: Singapore Department of Statistics (2006)

7. Political Status of Singapore • The People’s Action Party (PAP) holds +90% votes in parliament • Semi-autocratic • Paternalistic • Interventionist • Strong Government trusted by most Singaporean

8. Health Care Reform in Singapore (1) • 1819: Founded as a British trading colony • 1963: Joined the Malaysian Federation • 1965: Became independent

9. Health Care Reform in Singapore (2) 1984 Implemented the Singapore National Health Plan 1983 Initiated the Singapore National Health Plan

10. Singapore Health Care Delivery System (1) • Primary Medical Care • Secondary / Hospital Services • Tertiary & Specialized Services • Elderly, Long Term and Rehabilitation Care Services

11. Singapore Health Care Delivery System (2) - In the year 2003 • 24 hospitals with a total of 10,500 beds • 3.5 beds per thousand population • 5 acute hospitals for inpatient, specialist and A&E services • Tertiary & Specialized Services delivered in Singapore General Hospital and National University Hospital

12. Singapore Health Care Delivery System (3) - In the year 2003

13. Problems Before Health Care Reform in Singapore • Historical Problems • Demographic & Social Problems • Financing Problems

14. Historical Problems (1) • Since 1965, inherited from the British colonial government a largely tax-based publicly provided health care system with expenditure increasing year by year. • Publicly funded approximate 40- 50% of total health care expenditure.

15. Historical Problems (2) • Embedded traditional British style “Entitlement Culture” & its political status. • This is a common phenomenon in most former British colonies that people used to rely on the government to provide free or heavily subsidized basic health care service.

16. Historical Problems (3) • Singapore’s public health expenditure rose 5 times from +$50 million in 1971 to +250 million in 1981. • Public health expenditure rose in an alarming rate.

17. Historical Problems (4) • Singapore faced a dilemma: Whether continue to put larger proportion of public expenditure in free or heavily subsidized health care. • Singapore being a small new born country with no natural resources would be extremely difficult to cope with such a crisis.

18. Historical Problems (5) Health Care Expenditure per Capita from 1960 to 1988 Source: Department of Statistics (1988)

19. Historical Problems (6) Health Care Expenditure per Capita from 1960 to 1988 Total Health Expenditure from 1960 to 1988 Source: Department of Statistics (1988)

20. Historical Problems (7) 5 Times Source: Department of Statistics (1988)

21. Demographic & Social Problems • Increasing population • Aging population • Changing diseases pattern • Demand for higher quality services • Technological development in health care • Manpower problem

22. Increasing Population (1) Increasing Population Source: Singapore Department of Statistics (2005)

23. Increasing Population (2) Source: Singapore Department of Statistics (2006)

24. Increasing Population (3) Singapore Demographic Projection Aging Population Source: D R Phillips & A C M Chan, Ageing and Long-term Care: National Policies in the Asia-Pacific (2002)

25. Aging Population (1) Source: Singapore Department of Statistics (2006)

26. Aging Population (2) 81.6 79.7 77.9 Source: Singapore Department of Statistics (2006)

27. Aging Population (3) 2.1 Source: Singapore Department of Statistics (2006)

28. Aging Population (4) Source: Singapore Department of Statistics (2006)

29. Aging Population (5) Source: Singapore Department of Statistics (2006)

30. Aging Population (6) Source: Singapore Department of Statistics (2006)

31. Aging Population (7)

32. Changing Diseases Pattern (1) Leading Causes of Death in Singapore • 2005 • Cancer • Heart Disease • Cerebrovascular Disease Accidents • 1950 • Tuberculosis • Pneumonia • Diarrhea • Infections of newborn

33. Changing Diseases Pattern (2) Source: Ministy of Health (2005)

34. Changing Diseases Pattern (3) • Chronic degenerative diseases, e.g. cancer and heart disease, replaced infectious diseases as the major causes of death.

35. Changing Diseases Pattern (4) • Chronic illness required long-term treatments and also more likely to require expensive medications. • Hi-tech equipments, e.g. CT, MRI, laser, micro-surgery, may be used to cure these diseases. Ultimately pushed up health care expenditure.

36. Demand for Higher Quality Services (1) • As people became more educated and they demanded for higher quality of health care services. Higher Quality Services Always Equal To Higher Costs $$$$$$

37. Technology Development (1) • Advanced technology saves more lives Increase Health Care Costs Source: Ministry of Health (2005)

38. Manpower Problem (1) • Training of health care professionals is expensive. • Prevention of over-supply is needed because experience shows that over supply of doctors & specialists will cause inflated health care expenditure.

39. Financing of Singapore Health Care Services

40. Financing Problems (1) Increasing public &total health expenditure in Singapore (1960 – 1995) Source: E LIU & S Y YUE, Health Care Expenditure and Financing in Singapore (1999)

41. Financing Problems (2) Source: Ministy of Health (2005)

42. Financing Problems (3) • Due to the historical, demographic and social problems, health care expenditure increased rapidly.

43. Major Challenges Confronting Singapore (1) • How can Singapore provide its people with a quality health care service which will be sustainable, affordable and accessible to all without pumping more and more public funds to support it?

44. Major Challenges Confronting Singapore (2) • Can Singapore change its people's perception to believe that health care is not a "take for granted" service?

45. Major Challenges Confronting Singapore (3) • Can Singapore also change its people's perception to accept that accessible to all only means emergency and secondary care that are within reasonable reach of the community?

46. Challenges After Health Care Reform in Singapore • Hospital Structure Challenges • Efficiency & Services Quality • Financing Challenges • Catastrophic illness • Poor or disadvantage group care • Elderly care

47. Hospital Structure Challenge (1) Enhancement of Efficiency & Services Quality: • Centralized (MOH) or decentralized (HCS) • Autonomy in strategic direction, recruitment and remuneration required?

48. Hospital Structure Challenge (2) Enhancement of Efficiency & Services Quality: • Flexibility in business and financing discipline • Competition between public hospitals

49. Financing Challenge (1) Catastrophic Illness: • Limitations of Medisave • Lack of coverage of major or chronic illnesses • Prolong treatment is too costly and expensive • Medisave did not provide any protection for people with catastrophic illness

50. Financing Challenge (2) Poor or Disadvantage Group Care: • Limitations of Medisave • Lack of coverage of primary care • Poor or disadvantage group people were not able to make financial contribution towards their Medisave account. • Poor or disadvantage group sought health care services from the public sector.