Healthcare Systems of Singapore and the United States - Essay Example

Health Care System in Singapore and United s The health care systems of Singapore and United s have striking differences in their programs. The World Health Organization (WHO) global report of 2000 ranked Singapore and United States at position six and thirty-seven respectively. The same report placed Singapore at top most position in the Asian Continent. Another Global Competitiveness Report of the year 2006-07 positioned Singapore at the top slot for infant mortality, eighth for life expectancy and at position nine for adult mortality rate (World Economic Forum, 2008:1). The WHO Report revealed that U.S health system spends a higher portion of its Gross Domestic Product than any other country of the 191 countries. The report ranked U.S at position 37 according to its health care performance. Bureau report of 2006 revealed that 15.8 percent of citizens had no insurance cover. This represented an approximate of 47 million people (DeNavas-Walt et al, 2007:27). This paper compares the health care systems of United States and Singapore. It will look at the organisation, funding, regulation, and quality. Organisation The organisation of the health care system in United States and Singapore differs markedly. To start with, the structure of the health care systems in Singapore encourages her citizens to take responsibilities for their well-being. Singapore health care system comprises of both private and public hospitals. The organisation of health care system embraces three central components of the health care that include Medisave, Medishield, and Medifund. Medislave is a compulsory saving plan while Medishield is a low cost, catastrophic health insurance scheme while Medifund is a welfare scheme. The three accounts augment government’s system of subsidies for health care. Medifund provides funds when individual Medisave and Medishield are insufficient to cater for health expenses care (Kristine and Karch, 2011:364). Medislave accounts are fundamental to the health care system organization. They only permit the expending of these funds to access the expensive outpatient services. It is government’s initiative to ensure that there is achievement of universal health care for all citizens. The health care system offers rehabilitative, curative, and preventive health care services through public hospitals and polyclinic. The polyclinics account 20 percent of the primary health care provision while the private sector captures 80 percent. However, the public health care accounts for 80 percent while that of private health care is 20 percent in the expensive hospital care (Usa, 2009:111). The structure of health care system in United States is very different from that of Singapore. The health system in United States are very fragmented and decentralised. The health care system concentrate on making profits and patients pay for all health care services. Although the government of United States invests many funds in the health care system, the outcomes are dismal. The organisation of health system in United States embraces private and public insurers in the health care system. The health insurance systems include the Medicaid and Medicare (Barr, 2011:14). The Medicare program, which the government of United State oversees, caters for the elderly and disabled people. The payroll taxes and federal revenues and premiums finance the Medicare insurance. On the other hand, Medicaid covers the low-income earners and the disabled. The federal law dictates that Medicaid should insure parents, disabled, poor pregnant women, and the aged people only. This program is under the State and the District of Columbia. This insurance covers about 13 percent of the American people that makes about 20 percent of total health care spending (Barr, 2011:166). In addition to the public Medicare and Medicaid, United States has private insurance system. This cover caters for 58 percent of the American population amounting to 33 percent of the total spending of health expenditure (Niles, 2010:300). Funding There are different modes of funding of Singapore and United States funding of health care system. The health care financing system in Singapore embraces universal medical accounts. There are four payers of health care services in Singapore, which comprise of government, insurer, individual, and the employer. The financing system accounts in health system include Medisave, Medishield, Medifund, and ElderShield. Employers give premium for the worker medical insurance schemes and thereby contributing directly to the Medisave. Individuals pay their medical expenses directly; inform of co-payments or deductibles, insurance premiums, and Medisave contributions. (Woodman, 2008:320). Singapore launched the Medisave program in the year 1984. This program stipulates that individuals should deposit about 6-8 percent of their monthly earnings to their medical savings account. Medisave a mandatory program that covers the bills of individual hospitalisation, mortgages, and pensions (World Bank Group, 2003:2). The funds cover maternal services, chemotherapy, kidney dialysis, and HIV drugs. The aim of these savings is to avoid needless access of the medical services. However, there is a limit to which individual can withdraw to cater for physician fee, hospital charges, and surgical fees. Medisave account funds the primary health care in Singapore. This is very essential for the quality, universal health care (Usa, 2009:106). Employees and employers deposit their contributions to the Central Provident Fund that goes directly to Medisave Accounts. Singapore exempts the Medisave accounts from income tax. The country provides higher percentage rate of interest on Medisave, which encourages economic growth and justice. Citizens of Singapore use the Medisave accounts to acquire services in both private and public hospitals. The patients pay a portion of their medical bills through the savings in the Medisave whereby inpatients in Singapore use 85-90 percent of their funds to offset their hospital bills (Lim, 2004:83-92). Medishield program is another way to fund the health systems in Singapore. Since its launch in the year 1990, the program has been catering for the risk of catastrophic illness. The health care system in Singapore encourages the citizens under the age of eighty years to purchase Medishield insurance and to pay their premiums through the Medisave accounts. Medishield fund covers the hospital bills such as surgery and intensive care services, and other expensive outpatient treatments. The health care system limits the amount of spending from this account. According to health care system in Singapore, patients have to pay for about 20 percent of their catastrophic expenses that exceeds deductible levels. The WHO report of 2000 revealed that there were about 87,000 Medishield claims with payments amounting to 35 million U.S dollars in Singapore (Lim, & Tang, 2004:12). The third way of health care funding is through Medifund program, which the government of Singapore set up in the year 1993 to cover the health care bills of the destitute. It was the initiative of Singapore government to subsidise health care services for the poor citizens. The amount of funds in this account have increased remarkably following years of overall budget excesses. The government of Singapore uses the income interest from Medifund to cater for the health care expenses for the disadvantaged patients. This ensures that the country achieves its goal of universal health care (Lim, 2004:75). The fourth mode health care funding is through the ElderShield. The government introduced this program in the year 2002. This program caters the hospital expenses for the people with disabilities. ElderShield stipulates that Singaporeans who possess the Medisave account should enrol to this mode of funding after they reach the age of forty years. The policies of these program states that the disadvantaged patients should receive the health care services both at their homes and at hospital settings (Lim, 2004:83-92). The funding of health care in United States includes the Medicare and Medicaid. United States spends about 16 percent of its Gross Domestic Product (GDP) in the health care. Federal funds provide support to Medicare while federal and state funds finance the Medicaid. Medicare insures the aged and disabled citizens while Medicaid program covers the American people who earn low incomes (Barr, 2002:16). It is evident that the Medicaid and Medicare get their funding from the government of United States. This therefore means that the government has a wider control of the health care systems. For instance, the government of United States can place limitations on particular health services in order to maximise profits or keep the cost low. Medicaid is the biggest insurer of low-income children and expectant women. In addition, it covers health expenses of disabled people, AIDS patients, and elderly who require nursing home care. In the year 2004, Medicaid catered for about $37 billion health care expenses for the elderly (Cleverley et al, 2010:38). The children’s and public hospitals benefit from Medicaid funding. The program also finances other health care services such as public clinics, health care centres, and other health care providers that serve low-income earners. However, it is worth noting that not everybody benefits from the Medicaid. For instance, the adult without children and over the age of twenty-one years, physically fit and young are not eligible to Medicaid. The program also disallows immigrants accessing the insurance services before a period of five years elapses. The Medicaid program does not involve itself directly to the healthcare system. The program pays physicians, hospitals, nursing homes, and health care providers for covered services to eligible patients (Jonsson, 2008:128). Regulation There are different modes of regulation of the health care system between Singapore and United States. The government of Singapore regulates the health care systems. It plays a crucial role in ensuring that her citizens to save funds through Medisave. This is a government plan to deduct forty percent of every Singaporean income to transfer it to Singapore’s Central Provident Fund. The Central Provident Fund allocates this money to programs such as Medisave (World Bank Group, 2003:1). This shows a government commitment to ensure that the health care utilises funds well through directing savings and funds in the health care systems. The government asserts its mandate of universal wellness of the people through re-distributing compulsory contributions to the individual health care accounts. The government of Singapore has been reforming its health care system from time to time. Since 1984, Singapore has introduced programs such as Medisave, MediShield, and Medifund (Gauld, 2005:12). In addition, the government of Singapore develops agreement with the health sectors that seeks to streamline the health care delivery to the Singaporeans. The discussions between the health care and government are patient centred to ensure access to universal health. The regulation of health care system in United States happens at diverse levels. For instance, at federal level health care regulations occur at the Department of Health and Human Services, Centre for Medicare Medicaid services, the Centre for Disease Control and Prevention (CDC), and Food and Drug Administration (FDA). Other levels of health care regulation include Environmental Protection Agency, and the Occupation Safety and Health Administration. Each State in U.S has departments of health, insurance, and insurance. Numerous professional boards and societies regulate the private health services. These include Joint Commission on Accreditation of Healthcare Organization, and the National Committee on Quality Assurance (Field, 2007:253). It is evident that there is no defined system of regulation of health care services in United States. This is unlike the case of Singapore where the government plays a critical role. The system in United State is a disjointed set of programs, which create unnecessary overlap in the health care system. There is likelihood for the different levels of regulations to work at cross-purposes and thereby jeopardising the achievement of quality health in United States. Many regulators of the health system in United States may present competing policies, which dooms the process of attaining the goals of health care sector. Quality The quality of health care in Singapore and United States health care systems differ markedly. Singapore ranks the top most position in the Asian continent and sixth globally. This is according the WHO report of 2000. The same report placed United States in the thirty-seven position worldwide (Woodman, 2008:320). This report infers that Singapore provides the better health care services than United States. The objectives and goals of the health systems in Singapore are patient centred but not on profit. Singapore shows a government’s commitment in ensuring universal health care for the Singaporeans. This is unlike in United States where profit making drives the health care systems. United States provides poor health services despite its endowment with quality technology and competent health professionals (Konvner et al, 2011:70). In addition, health services are very costly in United States. On top of this, deaths from medical errors are very common in United States. Statistics reveal that the negligence of medical practitioners contributes to about 98,000 deaths annually (Sultz & Young, 2010:39). The comparison the quality of health care in Singapore and United States provides an answer to the poor ranking of United States relative to Singapore. Although United States has the best doctors and sophisticated medical equipment and technology, it registers poor performance in health care. Singapore has quality health care as compared to United States. Largely, the good performance of Singapore health system is attributable to government sound initiatives to regulate the health care system. The reliance of both private and public funding of Singapore gives the patients a responsibility to finance a portion of their health expenses (Patel & Rushefsky, 2006:455). Lessons for United States and Singapore There are important lessons that the two countries should learn from each other. This is despite the genuine disparities in their health care systems. To start with, United States should realise the importance of a systematic way of regulation of health services. This is because such a system has created an extremely and effective health care in Singapore (Callick, 2008:1). The government of Singapore considers both public and private services equally. This depicts that government involvement is central to devise sound policies on health care systems. Participation of the government of Singapore in health care delivery ascertains that health sector does not enact policies to jeopardise Singaporeans wellbeing. The second lesson that Americans should pick from the Singapore form of health care is importance of universal health care. Singapore has proved wise in promoting mandatory saving of funds through introduction of Medisave accounts. This is in addition to other accounts such as Medifund and MediShield accounts (World Bank Group, 2003:1). It is a prudent plan of the Singapore government to make sure all Singaporeans access quality health care, which they pay. Through these medical insurance programs, citizens do not transfer their medical burdens to the government. It is inculcation of responsibility to the Singaporeans, which United States should embrace and encourage her citizens to adopt. Medicare and Medicaid depict inefficiency towards attaining sound heath care in United States. The third lesson that United States should learn from Singapore health care system is on insurance coverage. American health care system relies very much on the employer to support the insurance programs. On contrary, Singapore does not depend on employers a lone to contribute to her health insurance programs. The employers in Singapore do not assume the role of employees’ safety net. The employers therefore make a small tax contribution to the fund that covers their employees (World Bank Group, 2003:3). United States has been grappling with the complications of employer-employee insurance schemes. This system of coverage, which affects both full time and part-time employment, contributes to the escalating numbers of uninsured persons in United States. Singapore should learn a lesson from the health systems in United States. The presence of great innovative technologies does not always culminate in quality health care. This is because United State has failed to deliver quality health care despite the fact that it has the best medical practitioners across the globe. Singapore should realise that sound regulation of health care system is critical to delivery of quality health care. Americans have failed on this issue because of incorporation of different players in the health sector who have competing interests. Limitations There are limitations in the implementations of the lessons learned from either country. To start with, the difference in organisation of the health care between the people of United States and Singapore can hinder transfer of lessons gained from either country. This is because the two nations have diverse structures and therefore it is difficulty to duplicate the lessons. Second, divided views of policymakers can be a challenge to implementation of the learned lessons. Some of the policymakers may view elimination of employer-provided coverage may doom the provision of insurance services in United States (Patel & Rushefsky, 2006:452). Conclusion It is evident from the essay that Singapore’s health care system is better than that of United States. Singapore health care system is not a panacea for the poor health care in United States. 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