Last month the Singapore lawmakers passed a universal health insurance scheme (Medishield Life) with almost USD3 billion in subsidies that would make Singapore a “more caring and progressive society”, to help the elderly and lower-income group with better social safety nets. This is the latest in a series of reforms to better protect all Singaporeans for life against large hospital bills.
This eases very much addresses the concerns of Singaporeans on the rising healthcare costs. An Asian Development Bank (ADB) study in 2012 showed that in many developing countries, households spent 4% to 7% of their budgets on health. And this percentage is increasing annually.
Dr Margaret Chan, the Director General of World Health Organisation (WHO) in a keynote address last week in Singapore specifically mentioned that the Singapore’s version of universal health coverage balances the advantages of competitiveness and other market forces with the need for state intervention to steer these forces in the right direction. She says that it balances freedom to choose providers, services, and facilities with an obligatory health savings account, the MediSave plan, with its emphasis on individual responsibility.
Excerpts of her speech …..
“Another innovation, MediShield Life, embodies the principle of collective responsibility through risk pooling. This is the safety net. It protects households from falling into financial ruin when medical bills are especially high. Studies conducted by WHO show that catastrophic medical bills force 100 to 150 million people below the poverty line every year.”
As Singapore’s Minister of Health observed earlier this year, the scheme tells people that they “need not face life’s uncertainties alone, especially those who meet unexpected shocks in their life journeys.”
To work well, it must be home grown in line with each country’s culture, domestic political institutions, the legacy of the existing health system, and the expectations of citizens.
Our world is in turmoil from multiple causes. The climate is changing, antibiotics are failing, and health care costs are soaring. Inequalities, in income levels, opportunities, and access to social services, both within and between countries, have reached the highest levels seen in nearly a century.
Countries are losing their middle classes, the backbone of democracy. Last month’s Oxfam report on wealth distribution contains a startling statistic: just 80 rich and powerful people own more of the world’s total wealth than 3.5 billion people at the other end of the scale.
Universal health coverage is one of the most powerful social equalizers among all policy options. It is the ultimate expression of fairness. If public health has something that can help our troubled, out-of-balance world, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity, and stability. They hold societies together and help reduce social tensions.
The rise of NCDs adds considerably to the costs of health care. The costs of cancer care, for example, are becoming unaffordable for even the wealthiest countries in the world. In 2012, the US Food and Drug Administration approved 12 drugs for various cancer indications. Of these 12, 11 were priced above $100,000 per patient per year. How many countries can afford this cost?
Prevention is by far the better option, but this, too, is more problematic than for infectious diseases, many of which can be prevented by vaccines or cured by medicines, all delivered by the health sector.
The Singapore experience and all of the other experiences we have heard about give us one compelling message. Any country that really wants to move towards universal health coverage can do so. There are no excuses.
Health is likely one of the most precious commodities in life. But it is highly political and it requires investment. You need political leadership. You need commitment. And you need a conversation with the public, as has been done here in Singapore. I thank you for the opportunity to participate in this discussion.”