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Singapore health minister Ong Ye Kung said the republic’s health financing system avoids the pitfalls of systems elsewhere that are either entirely free or fully private. (Ministry of Health, Singapore pic)
SINGAPORE: Nine in 10 Singaporeans pay nothing for treatment at public hospitals, because healthcare is financed by a system of government subsidies, national health insurance from birth and compulsory medical savings.
This was revealed to Malaysian journalists by Singapore health minister Ong Ye Kung in a recent discussion.
He said Singaporeans enjoy various subsidy levels, sometimes up to 80%, depending on the treatment received. The remainder of the bill is paid out of the MediShield Life insurance scheme and the MediSave savings programme.
“What is out of your pocket? Zero. For nine out of 10 subsidised patients, it becomes zero,” he said when explaining how the system works.
“Every month, part of your salary goes into MediSave, which you can use to pay for healthcare. With every hospital bill comes a reminder (after subsidy and insurance) that you can use your MediSave to co-pay the bill,” he said.
In the MediSave scheme, working Singaporeans have an account each into which contributions of between 8% and 10.5% of monthly salary (depending on age) is paid; the money is then used to pay for hospitalisation, surgery and certain outpatient treatments.
Ong said the co-payment model avoids the pitfalls of systems elsewhere that are either entirely free or fully private.
“The UK system is very affordable for the patient, but not accessible because queues are long. The US system is very accessible with insurance, but not affordable because many people can’t afford the premiums.
“No matter how you design your financing system, whether you call it free or whatever, there is no such thing as free healthcare,” he said. Populations pay for their healthcare in the end, one way or another.
“You can make it RM1, but somebody is paying the taxes to pay for that RM1 healthcare,” he said, referring to Malaysia’s heavily subsidised national health service, in which citizens pay a nominal fee of RM1 or RM5 for treatment at government clinics and hospitals.
Ong said there is a final safety net called MediFund for those who still cannot afford their bills.
“This is money we park with each hospital for Singaporeans who cannot afford the bills. Then they apply for MediFund, which can finally pay for all this,” he said.
Ong said healthcare financing must strike a middle ground, as there is no such thing as absolute accessibility or absolute affordability.
“Never go for a 100% solution (in one aspect), because you pay a huge price somewhere else. We always say that in healthcare, there is a trilemma of quality, accessibility and affordability. You cannot achieve 100 % for each,” he said.
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