A Description of Singapore’s Healthcare System

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A Description of Singapore’s Healthcare System

This paper aims to employ the health systems model provided by the World Health Organization (WHO) to describe Singapore’s health system and assess the performance of Singapore’s health system in the last 25 year, with the inclusion of recent attempts or polices in the country’s heath system reform. The paper accomplishes this goal by providing a brief history of Singapore’s health care system and describing Singaporean government’s role in health system efficiency, delivery, and organisation. The paper also illustrates the role of non-governmental organizations in health system organization, delivery, and efficiency, and evaluates the performance of Singaporean health system. In addition, the paper analyses and critiques Singaporean health system initiatives and policies focusing on primary institutional, cultural, social, political, and economic influencing factors. The paper then concludes by analysing the future and past health system reforms in Singapore in relation to the emerging matters identified in the region.

History of Singapore’s Health Care System

Singapore, an Island nation with a population of approximately 5.2 million people, is famous for its widely covered and efficient healthcare system (Lee & Satku, 2016). The early Singapore’s primary healthcare after the attainment of independence in 1965 commenced with a mass-inoculation intervention against adverse tropical epidemic illnesses (Lee & Satku, 2016). The Singaporean administration then proceeded to the extension of the hospitalisation network including child and maternal health clinics, satellite out-patient dispensaries, and general hospitals, with the aim of providing convenience to attendances associated with outpatient. As a result, Singaporean administration ranked the country’s health care the fifth preference for public funds. In 1983, the Singaporean government focused on the promotion of a National Health Plan in order to foresee and evade the future problems. This plan detailed the design of infrastructure for the subsequent 20 years along with the notion of Medisave (Hwee et al., 2014). In the year 1985, the government embarked on the restructuring of hospitals within the public sector leading to the merging of the financial and business fields into healthcare services. This undertaking was aimed at ensuring the provision of efficient financing and higher quality services. These developments led to the maintenance of Singapore’s national health care expenditure at a level which was 3% of the country’s Gross Domestic Product (GDP) via the period between 1980s and 1990s (Hwee et al., 2014). Moreover, the terms of dollar witnessed an annual, steady increase during this period from the year 1967 up to the year 1995 (Yap & Nurjoni, 2015). In 2002, the Singaporean administration ensured the promulgation of the ElderShield plan with the aim of assisting the elders as well as the adversely disabled persons. Since then, Singapore’s system of health care has been experiencing tremendous improvements. Currently, Singapore’s health care system is considered among the world’s leading health care systems (Lee & Satku, 2016). 

Government’s role in Health System Efficiency, Delivery, and Organisation

The government plays a significant role in health system’s efficiency, delivery, and organisation. Nambiar & Mander (2017) assert that some of the essential roles of the government in health care are purchase of health care, provision of health care, ensuring access of vulnerable populations to quality care, support acquisition of novel knowledge, regulation of health care markets, development and evaluation of health practices and technologies, monitoring quality of health care, informing health care decision-makers, establishment of health care task force, and convening of stakeholders across the system of healthcare.

According to Low (2015), the government has a duty to purchase based on the aspect of value, as opposed to cost only. Thus, the government often focuses on value-based purchasing. Apart from being a purchases, the government’s obligation in healthcare is to ensure the provision of direct care to citizens such as active-duty army employees along with their beneficiaries (Low, 2015). The federal administration is in charge of operating nursing homes and hospitals, employing health care professionals, and developing framework intervention for the provision of high-quality care. In relation to the vulnerable populations, the government focuses on supporting interventions like community health centers which offer care to these vulnerable groups. While focusing on meeting this obligation, the federal administration is neither a care provider not primary purchaser, but plays the role of maintaining standards as requirements for its financial assistance to health care programmes. According to Nambiar & Mander (2017), these standards are aimed at ensuring the provision of quality care to beneficiaries.

Low (2015) asserts that the government’s role in healthcare is to support research with the aim of enhancing the acquisition of novel knowledge. Besides, the government plays the role of regulating health care markets by governing issues such as exit and entry and regulating issues associated with quality. The government also has the role of developing and evaluating health practices as well as technologies. Nambiar & Mander (2017) argue that this goal is accomplished via the establishment of innovations or via the assessment of technology established by others. The government also plays a significant role in the measurement and monitoring of the care quality and establishing the tools employed in monitoring quality of care. In relation to the provision of dependable leading economic indicators aimed at informing and guiding economic policymakers and the business community, the government offers health care quality information which is key to the attainment of the duty of policymakers (Low, 2015). In addition, the government is in charge of monitoring the care quality within organisations receiving federal funding.

 According to Nambiar & Mander (2017), the internet provides the government with a suitable platform on which it can offer reliable information to parties in charge of making decisions in health care such as policymakers and purchasers, institutions and clinicians, and patients and consumers. Nambiar & Mander (2017) add that the federal administration maintains electronic information databases aimed at helping clinicians, as well as health care systems to offer quality care. The government plays the role of investing in career development and education with the aim of ensuring steady supply of qualified personnel in healthcare. Low (2015) adds that the government convenes and mobilises various groups towards the attainment of a common objectives. All these roles ensure that the government contribute to the delivery, efficiency, and organisation of health system.  However, it is vital to note that the translation of the general principals associated with the appropriate government’s role into specific measures within the dynamic and decentralised system of health care delivery calls for a unified effort from the private and public sectors. The subsequent section focuses on the role of the private sector in health system in relation to the non-governmental organisations.   

Non-Governmental Organisations’ Role in Health System Organisation, Delivery, and

Efficiency

Non-governmental organisations are also key players in health system in relation to the aspects of organisation, delivery, and efficiency. Khan et al. (2016) assert that non-governmental organisations uphold the current WHO concept associated with primary health care. These organisations embrace the fundamental beginning point that health care aimed at preserving and promoting health is among the most essential human rights, as outlined in article 25 of the Universal Declaration of Human Rights (Singh et al., 2017). According to this article, all individuals are entitled to a living standard adequate for well-being and health of themselves and their families, including medical care, housing, clothing, food, and essential social services, as well as the security right in situations involving disability, sickness, unemployment, old age, and widowhood among others.

The primary roles of NGOs within the health care system in Singapore involve health advocacy and the provision of services. According to Singh et al. (2017), health advocacy involves a combination of social and individuals actions meant to acquire political commitment, social acceptance, system support, and policy support for a given health program or goal. In relation to this, NGOs participate in the establishment of health policy. The service provision role takes into consideration psychological, social, and medical services (Khan et al., 2016). This role also encompasses the provision of integration activities, nursing and care, financial and material support, information and educational services, as well training. Khan et al. (2016) assert that the ever growing role of NGOs in the provision of social services and engagement in political processes leads to the need to ascertain the credibility and validity of their activities. Singh et al. (2017) add that NGOs can operate for positive attitudes towards and greater comprehension of primary health care by enhancing dialogue among and within NGOs, sustaining dialogue with governmental agencies, offering information, and establishing novel ways of illustrating primary health care to individuals. These roles contribute to the effectiveness of NGOs in ensuring organisation, delivery, and efficiency in health system. 

Evaluation of the Performance of Singapore’s Health System

Singapore’s system of health care has been performing better for the past 50 years (Lee & Satku, 2016). The success of Singapore’s health care system is evident in the various awards and the global ranking of this health care system. According to Tan (2017), the health care system of Singapore has won world accolades with the inclusion of the award by the WHO which ranked Singapore sixth among the 191 nations in relation to the overall performance of health system in 2000. In the annual healthcare efficiency ranking in Bloomberg, Singapore was ranked first out of the 50 nations, while the Economist Intelligence Unit ranked it second in relation to health care results out of the 166 nations in 2014 (Tan, 2017). Singapore’s Life expectancy happens to be among the leading in the world, while infant mortality ranked at 2% for every 1000 births was considered among the lowest in 2015 (Tan, 2017). Singapore’s health system not only offers access, but also possesses exemplary health care standards both in prevention and curative medicine. Lee & Satku (2016) argues that 50 years ago, Singapore’s rate of infant mortality was 26 for every 1000 live births. Currently, the country’s infant Mortality Rate is at 2.  Besides, life expectancy, which was at 64 in the last 50 years, is presently at 83 (Lee & Satku, 2017). Moreover, the country’s Medicine brand has managed to receive global trust, and patients form various world regions often visit Singapore. All these accomplishments demonstrate successful performance of Singapore’s health system (Lee & Satku 2017).            

Analysis and Critique of Singapore’s Health System Initiatives and Policies

Singapore’s heath system is characterised by initiatives that impact positively and significantly on the primary institutional, cultural, social, political, and economic spheres. While many nations struggle to fund their health systems, Singapore has established a health system model that enhances the affordability of health care for all individuals (Klein, 2017; Lee & Satku, 2017). This system also grants sustainability to the system of health care. Reliability is offered by a professional taskforce that aims to constantly learn and improve, as well as being more proficient or efficient with novel technologies, while highlighting the relational elements of health system by maintaining high integrity standards and nurturing compassion. Safety and convenience are facilitated by an integrated IT system which enables the movability of medical records and information across institutions within the health system.

According to Hwee et al. (2014), Singapore’s healthcare system is founded on a philosophy consisting of three pillars. The first pillar is that Singapore is aimed to establish a preventive health care, healthy population, and promote healthy lifestyles. The second pillar is that the country stresses personal obligation towards healthy living via the 3M system comprising Medifund, Medishield, and Medisave (Summot, 2015). The third pillar is that the Singaporean administration has to maintain the costs of health care at a lower level by regulating the health care services’ supply side and offering heavy subsidies at institutions within the public health system. This philosophy ensures that Singapore has a robust health system. Klein (2017) argues that Singapore’s health system requires people to be responsible for their health and their expenditure on medical care. Singapore is considered the world’s only truly system of universal health, as patients bear the expenses associated with routine care. Contrary to other nations where the main role of the government is to manage insurance interventions, Singapore’s government pays and controls for the medical system are overwhelmingly public. Yap & Nurjoni (2015) assert that a significant portion of the country’s doctors operate directly for the government. As such, patients can only employ their Medisave accounts in purchasing preapproved drugs. Thus, it can be noted that the policy and initiatives associated with Singapore’s health system covers adequately the cultural, social, economic, and political spheres

Analysis of the Future and Past Health System Reforms in Singapore

            Singapore’s past reforms in healthcare have been influenced by politics and the need to meet the citizens’ needs. For instance, in 2011, the government’s reform in healthcare was responsive to the electorate’s concerns in relation to the provision of affordable care for the families experiencing financial strains and the elderly (Tan, 2017). Opposition parties aligned themselves with issues of the eldercare costs and healthcare affordability. In 2012, the Singaporean administration responded with a novel program associated with increased spending (Yap & Nurjono, 2015). Long-term care subsidies were offered even for patients receiving care at homes. Middle-income families, day care, home-based care, rehabilitation care and nursing homes were also covered by this provision. Health care reforms in Singapore have also focused on bringing primary care services near the people by establishing a network of child and maternal health clinics, as well as satellite outpatient dispensaries.  Examples of services provided are pharmaceutical, dental care, psychiatric counseling, family planning services, clinical laboratory, and nutritional advice. The Singapore administration has also focused on the introduction of user fees in public clinics. In the past, services offers at outpatient clinics have been free (Sammut, 2015). This model was in line with the British healthcare system’s practice. However, recent time have seen the government changing the model to ensure that people pay for health services. Singapore has made tremendous improvements in policy reforms in its health system despite not investing enormous amounts in health care. Nevertheless, just as in the case of many developed countries, Singapore experience the twin challenge of rapidly shrinking workforce and aging population, which in turn results into the soaring of medical expenses and slowdown in economic growth. For instance, Tan (2017) predicts that by 2030, Singapore will have 900,000 individuals aged 65 years and over, which will double the present number. Since this country possesses enormous financial muscle and formidable reserves, future health care reforms should focus on enhancing more investment in healthcare in relation to development of programs for the elderly and investing in research and education to compensate for the shrinking taskforce in health care (Hwee et al., 2014).

In conclusion, Singapore’s health system has experienced significant transformations which have contributed significantly to its effectiveness, efficiency, and robust organisation, thereby making it one of the world’s best health care systems. This health system has experienced significant improvements over the last 50 years, and is presently among the globe’s leading health care system.  This success can be attributed to Singapore government’s roles such as funding and policy reforms. The philosophy of this health system along with the adoption of a robust insurance system (that is Medisave) have also contributed the success. Singapore’s health systems is evidence in many areas such as low infant mortality rates and high life expectancy. While the past policy reforms have been focusing on the citizens but limiting investments in health care, future reforms should encourage more investments in Singapore’s health system. Such an undertaking will contribute largely to addressing the health issues arising from the rapidly aging population.