Individuals paying more for top grade health care?

19 Mar 2005, The Straits Times

Question

Name of the Person: Leong Sze Hian 

Individuals paying more for top grade health care?

According to the 2004 report of the World Health Organisation (WHO), Singapore's per capita government expenditure on health at average exchange rates has been falling gradually, from US$365 in 1997 to US$274 in 2001. 

Government expenditure on health also fell from 39 per cent in 1997 to 33.5 per cent in 2001.It is in a way somewhat puzzling that on the one hand rising health-care costs necessitated various measures, such as the need to increase MediShield premiums from July 1, on the other hand the WHO report seems to indicate that the burden of rising health-care costs has gradually been shifting from the public sector to individual Singaporeans. 

Since the WHO has ranked Singapore sixth out of 119 countries and the top in Asia for overall health-system performance, how do we reconcile and explain Singapore's relatively low 101st out of 191 ranking for 'fairness of financing' in health care? 

The ElderShield opt-out rate for the recent cohorts has declined to less than 20 per cent. Does 'recent cohorts' refer to those who became eligible when they reached the initial entry age for ElderShield? 

When ElderShield was first launched, about a third opted out, and the last time the ElderShield opt-out rate was reported in the media, it was more than 40 per cent. I would like to ask what is the opt-out rate for all eligible Singaporeans since the scheme started. 

If the opt-out rate has been reduced to 'less than 20 per cent', then I would like to suggest that we learn from the successful experience of ElderShield to try and get the 440,000 Singaporeans who do not have any form of medical insurance to opt back into MediShield.

Reply

Reply from MOH 

Healthcare subsidies have increased over the years 

1. In yyyIndividuals paying more for top grade health care?yyy (ST, March 19), Mr Leong Sze Hian wrongly inferred from the World Health Organisation (WHO) report that the yyyburden of rising healthcare costs has gradually been shifting from the public sector to individual Singaporeansyyy. 

2. The WHO defines government healthcare expenditure broadly to include capital spending on environmental health projects. The lumpiness of such capital projects (e.g. incinerator plants) results in volatile spending patterns that distort the underlying trends in the data. In this case, it skewed the WHO figures downward due to the completion of projects at the end of the reporting period. 

3. A more accurate measure of the Governmentyyys share of medical cost is what we provide in healthcare subsidies. This has been increasing steadily from $560 million in Fiscal Year (FY) 1997, to $850 million in FY2000, and further to $1.3 billion in FY2004. 

4. Over the same period, Government healthcare subsidies increased from 13% of total health expenditure to around 20%. 

5. Mr Leong also commented on Singaporeyyys 101st (out of 191) ranking for "fairness of financing" in healthcare, as reported by the WHO. 

6. Not surprisingly, Singapore was ranked lower than countries with extensive welfare systems, which promise cheap or free healthcare to all citizens. For example, the top ranked country in terms of yyyfairness of financingyyy is Colombia, where healthcare fees range from US$1 to US$8 per year. But is this sustainable? Besides, at such low fees, what standards of medical care can patients expect to receive? 

7. Finally, Mr Leong thought that ElderShieldyyys opt-out rate was lower than that of MediShield. But this is not so. On an overall basis, the opt-out rate of ElderShield is about one-third for all eligible Singaporeans. For MediShield, it is only 10%.