High Healthcare Cost – What went wrong with our health system?
By Dr Tan Cheng Bock
Some background is important to understand our healthcare system. The big change in health care came when the government decided in the late 1980’s to make health an INDUSTRY ie medical industry to add value to our GDP. To do that Singapore must be a centre of medical excellence. So the ministry sold the idea of medical excellence to the extreme and embarked on huge hospital buildings with unnecessary frills and high administration costs. Government also restructured many hospitals into hotel like complexes.
But were these hospitals built for the people? I think it was more for the medical industry. Thus these were grand, impersonal general hospitals with equally big specialist wings. Not only the public sector but the private hospitals were encouraged to expand. Let the private hospitals chase the medical tourism dollar but our public hospitals must take care of our citizens first.. To justify the cost of such big hospitals with expensive special medical equipment, demand was created through their PR unit and the press.
Singaporeans were so taken up by this change that everyone wants to go to hospital even for minor ailments like minor cuts, coughs and colds. As Medisave was allowed to be used for hospitalisation only, many procedures which could be done outside hospital, were done in hospital at much higher cost. I remembered then, many Singaporeans opted for A class when they could use their medisave. Very quickly their medisave(their own money) were depleted. Also as nursing homes stay could not use Medisave many plead with hospital authorities to allow their sick relatives to stay longer. So hospitals face overcrowding. Over time Singaporeans tend to regard hospitals as a better choice to go for treatment than elsewhere .
Thus MOH have impressed upon Singaporeans the wrong thinking that the management of their health problems is at the hospital or specialist level. This mindset behaviour to opt for hospital/specialist treatment must be reversed or cost will continue to rise and people’s CPF & Medisave drained.
This mindset change can only happen if Singaporeans find value in the way we look after their health needs at the community cost level, effectively and efficiently. This is a challenge for MOH as primary health care is a less visible program than hospitals. It takes time, commitment, adequate funding, hard work and a strong political will to change. MOH must do something to bring about this change.
We must shift expensive hospital care to less expensive non hospital care through an efficient primary care program or Singaporeans will have no peace of mind.
The way to bring down health cost is to cut down hospital/specialist visits through an island wide Preventive Care Program. How much we pay for our health bills depend on the system we have. I believe the current system is expensive, depend too much on CPF to fund and we should review.