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2 posts from May 2017

05/05/2017

Singapore: A More Conservative Healthcare Model

Singapore has a health system widely considered by many conservatives as vastly superior to that of America’s.  So what makes this healthcare system different than America’s, and how did the government of Singapore get this system to work?  These questions should become clear at the end of this post.

Singapore’s healthcare system is vastly different from our own.  The first major difference is that it is far more regulated than America’s current system.  To say that the government has some control over the market at all levels of healthcare is an understatement.  The Ministry of Health has the ability to set provider service fees, cost control, service planning and a list of other regulatory machinations to control the quality of services rendered at hospitals and other institutions.  The system focuses on utilizing a number of different stop gap measures to help the poor, sick and the elderly such as MediSave, MediShield and Medifund.  While many similar systems exist in the American healthcare system, the fact that the government can also control costs and financing has little to no equal in the American healthcare system.  U.S. Medicare and Medicaid do have measures that allow the federal government to set the maximum amount that they will spend on patients.  This owes itself to some cost control as all hospitals have to take these patients.  However, the existence of insurance companies throws off this rate control by giving more basic healthcare practices the ability to deny Medicaid and Medicare recipients and take patience with private insurance companies that pay more money.  In Singapore, most hospitals in Singapore are connected to the government via heavy subsidizing and have not choice but to conform to the rules of the government.

The 1993 White Paper generated by the government of Singapore gave a set of criteria upon which the government would aim to give Singaporeans excellent healthcare.  In it five major fundamentals were stated: promoting good health, personal responsibility over reliance on welfare or medical insurance, providing good and affordable basic medical services to all Singaporeans, reliance on free market competition to raise efficiency and finally intervention whenever necessary to keep healthcare costs down.  That brings us to the second question - why do some conservatives think the system better than America’s? 

Singapore’s system is intrinsically based on many more conservative views of healthcare.  Pushing concepts such as free-market driven decision making, Singapore’s healthcare system has a radically different view of how healthcare should work from the perspective of most single-payer enthusiasts.  For all of the control on healthcare, the main purpose of the government in Singapore’s model is aimed at addressing specific issues.  Controlling worst case possible actions in the market place and ensuring everyone can get treated for diseases.  From there, the people are allowed to make decisions about which general practitioner they see, the hospital they go to and the treatment they receive.  The ensuing freedom seems like a factor that would resonate greatly with the average American voter and the idea of a healthcare system based on personal responsibility is something that many American’s would find attractive.  The system also thusly prevents moral hazard from occurring via pushing health insurance as a last resort, not a primary form of payment.   In doing this, the system all but removes insurance companies as middlemen in the healthcare of patients.  Since patients are spending their own money, no one can force them to spend it on a medication they do not want or a treatment regimen they do not like.  The importance of government control is thus ensuring that no treatment system is, for lack of a better term, a scam.  So then how does the government know that the healthcare system is working properly?  For years, the American healthcare system has been based on the concept that insurance would pay for healthcare.   This notion was further entrenched by the Affordable Care Act’s measures pushing insurance companies to spend more to keep American’s healthy.  Many conservatives take pride in freedom   In order to change America’s healthcare to a more conservative   model, the Republican party would need to write how the new system would work.  In doing so, they would also need to create an entire framework of mechanisms to slowly transform healthcare from its current system to the entirely new one.  The problem right now

One thing that has become abundantly clear is that the free market economy, much like nature, does not care whether you live or die.  That being the case, it is in everyone’s best interest to ensure proper government regulation in the healthcare system.  Singapore has pushed a system that has a large amount of government regulation in it.  The tantalizing portions of this system, however, are that it pushes people to be more responsible, reduces third party interventions into an individual’s healthcare, and yields overall more efficient healthcare.  Personally, I feel that there are many aspects of Singapore’s healthcare system that could be imported into America.  There is a good case for changing the face of healthcare to be more similar to Singapore’s model.  The problem is that in changing America’s healthcare model a voluminous bill would have to be created in order to work stop-gap measures keeping individual from dying during the interim.

Kunle Adejare, PharmD, 19

Single Payer Healthcare

So what is single payer health care?  According to Merriam Webster’s dictionary single payer healthcare is defined as “of, relating to, or being a system in which healthcare-providers are paid for their services by the government rather than by private insurers”. Is this an accurate statement?  I will now explain what a single-payer is, the strengths that it creates, and the limitations towards fixing healthcare that come from it.

To begin with, is the definition of single payer healthcare, as given by Merriam Webster’s dictionary, correct?  The answer is complex, but best summarized as, not exactly.  Single-payer healthcare is generally simplified to having the government pay for everything.  For this reason, single payer healthcare can be said to be a subset or even a step towards socialized medicine wherein the government owns healthcare facilities and pays the medical personnel.   It is, however, possible to have a single-payer system that is run by the government.  The reason why anyone talking about healthcare system models needs to know this is that, many healthcare systems espoused by the left as perfect examples of nationalized single-payer healthcare are more accurately stated as universal government-guided healthcare systems (UGGHS).  The difference between these systems is that single payer healthcare has its strengths in reducing administrative costs and thus creating a more efficient system.  Universal government-guided healthcare, on the other hand, is any system where the government works to set prices for medical expenditures in a nation.  In this model, the government has far more control and thus can achieve more cost saving measures than simple administrative costs.  It should be noted that while UGGHS and single-payer can go together, they do not have to.

As stated previously, the greatest strength of single-payer healthcare is savings on administrative costs.  Right now, the U.S. healthcare system is a series of many different insurance companies that pay what they want and have their own set of paperwork associated with it.  This leads to tremendous problems as currently doctors are spending around half of their time on paperwork.  Considering that this time spent on paperwork excludes time spent examining patients, it is not too much of an exaggeration to say that paperwork is literally affecting patient’s health.  With this in mind, reducing administrative costs is a strength that single-payer healthcare can fix.  More importantly, it could even lead to overall better healthcare by giving medical doctors more time for individual patients and more time to take patients overall.  If such is the case, single-payer healthcare could revolutionize medicine for the better.

So then what are the limitations of this new system?  Firstly, the most important benefit of changing to a single-payer system, better healthcare overall, is not a guarantee but a hypothesis.  In reality, it is not uncommon for single-payer healthcare to begin leading to increased wait times in nations that have made their healthcare more socialistic in this manner.  Second, the biggest benefits of single-payer healthcare tend to run more in line with the UGGHS model stated earlier.  This means that even as healthcare costs would be changed, they would not be made cheaper since a single-payer healthcare system without an UGGHS will not necessarily control costs.  In the long-run, the worst case scenario is that healthcare becomes more expensive, and less capable of ensuring health benefits to people who most need them.

Ultimately the American healthcare system is a complex web of priorities, incentives and duties that ultimately lead to an individual receiving treatment.  Many different entities can play a part to helping an individual receive healthcare.  My opinion is that some sort of nationalized government-guided healthcare system is necessary in some way shape or form for cost control purposes.  This stems from the fact that countries like Germany and Finland use UGGHS, in addition to other factors, to help make healthcare simpler and more affordable.  At the same time, one cannot deny that having the federal government intrude too much in areas of healthcare has the potential for more harm than good.  So while I personally have been convinced that single-payer models have strengths that need to be examined more closely, I also think that the government’s role in healthcare needs to be better established.  Not for what it should do, but for what it should not.

Kunle Adejare, PharmD '19

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