By Dr Tan Cheng Bock
Health care cost really worries Singaporeans and it is going to get worse. The Ministry of Health (MOH) wants to bring down health care cost but can Health care cost really come down? My personal take is a likely ‘NO’. The reason is because MOH is looking at health care management from the wrong end of the stick. MOH is just putting money to support a national health system which has evolved into a very, very expensive commodity. They have just got their priority wrong. MOH have created an expensive health care system that have changed patient behaviour towards health and illness and if MOH persist in looking at health management this way, then MOH will be forever CHASING health care cost and not CONTAINING high cost..
The hard truth is MOH spending too much money and effort on how to TREAT sickness and not how to PREVENT illness. As this is the expensive option, MOH is spending a lot of resources on hospital subsidy at each yearly health budget. This is confirmed by the health minister’s own admission when he said and I quote “Today the bulk of our subsidies go towards hospitals, where the cost per episode is high” unquote.
How then can the ministry bring down cost if the current emphasis on hospital institution care has not changed? MOH is not containing the situation, but allowing health financing instruments like Medisave, Medifund and insurance to fund the system. This may actually help to drive up costs. Also, this dependence on the CPF savings of Singaporeans will affect their retirement savings.
The current discussion on health is always focused on how to finance the health cost and not how to contain and check the rising health cost. It is always how to use or expand the use of Medisave, Medifund, Medishield or the type of insurance coverage needed to pay the medical bills. It is a very simplistic approach to a problem.
My advice is for the Minister and MOH to take a critical look at their current policy and how it has affected the lives of Singaporeans. Think of the people first. Why is it that people are so worried about their health bills if our system is that good? Why do our people have no ‘peace of mind’ on health as admitted by the Minister?
Building more hospitals is the answer? Not really. Hospitals see the end point of illnesses but illnesses start in the community. This is the source of the problem and here lies the answer. This is where MOH should put more of their subsidy. MOH must change its strategic approach to health priority and pay equal attention on the community level of health care. This will be cheaper and in the long run more effective. Very simply, make preventive healthcare an equal health partner. MOH have always claim to have provided primary health care but compared to hospital or institution care it is only a low priority with minimal funding usually about 30%.. Look at our health budget and you will notice the imbalance in funding primary health compared to hospitals. Currently the MOH subsidises 80% of hospital stay in the public hospitals.
Today ST reported that last year, patients paid around 271,000 visits to public specialist clinics, a marked increase on the 74,000 visits in1994. This increase could be due to the increase in population or it could mean that our control at the community level has not been very successful resulting in early hospital admissions.
So if the government continue to subsidise the hospitals heavily at the expense of primary health care, it would be like using generals (hospitals) at the HQ to fight the war against the enemy (disease) instead of the frontline troops (primary care) which prevent diseases from attacking our community. Today it is a very expensive exercise. How then can Singaporeans not worry about high health cost?