CHAPTER 1 The Singapore Healthcare System: An OverviewRead more at location 186
Note: Sanità di S.: costi bassi qualità eccellente. Perchè?... Unità politica di lungo termine. Consente di programmare... Stabilire razionalmente delle priorità. Il che significa: prima lo sviluppo economico poi un SS all'altezza... Medisave: conto individuale sanitario. Serve per pagare gli ospedali e le assicurazioni. Il contributo privato al finanziamento del sistema è sostanziale... Cinque punti: 1) cultura della salute 2) responsabilità individuale 3) competizione 4) intervento pubblico x calmierare il mercato... Incentivate solo le assicurazioni con franchigia e co-payement... Esiste un piano base garantito ed economico fornito da privati accreditati... Competizione nella fornitura dei servizi. Molte scelte disomogenee possono aumentare i costi anzichè diminuirli (vedi Hanson) cosicchè il governo si occupa di rendere omogenee le categorie d'intervento e trasparenti i prezzi. Qs pregiudica l'innovazione? Pazienza, sull'innovazione si può "parassitare" oppure si stabiliscono programmi a parte (premi, sussidi)... Altri interventi: sussidia gli ospedali, premia i migliori, incentiva gli ingressi. Disincentiva o incentiva la domanda e regola l'ingresso dei medici accompagnando gli aggiustamenti demografici Edit
Singapore has achieved extraordinary results both in the high quality of its healthcare system and in controlling the cost of care.Read more at location 187
They are long-term political unity, the ability to recognize and establish national priorities, and the consistent desire for collective well-beingRead more at location 193
Health would be affected by almost every aspect of life in an urban setting: housing, water supply, food supply, air quality, waste disposal, road traffic, parks, tree planting, and more.Read more at location 209
Wisely, the initial focus in Singapore was on public health: putting proper sanitation procedures in place, controlling infectious diseases, all successful efforts. Early initiatives were launched to provide clean water, develop a vaccination program, and guarantee access to basic medications, clean food, and more.Read more at location 234
Promoting a Sense of Collective Well-Being and Social HarmonyRead more at location 242
A competitive, winner-takes-all society, like colonial Hong Kong in the 1960s, would not be acceptable in Singapore…To even out the extreme results of free-market competition, we had to redistribute the national incomeRead more at location 248
One important solution Lee and his ministers found was the Central Provident Fund (CPF). It was set up during British colonial rule as a compulsory savings program for workers to build a nest egg for retirement.Read more at location 252
The CPF has become one of the key pillars supporting social stability.Read more at location 256
Mandatory contribution rates have risen over the years and now stand at 16 percent of wage for employers and 20 percent for employees. After age 50, the rates decrease.Read more at location 258
it helps control costs by instilling in patients a sense of responsibility about their spending—after all, it is their money to save or spend;Read more at location 260
Specifically, women's health education was deemed essential to the future of the country.Read more at location 266
But first, in the remainder of this chapter, I will walk you through the ideas and the history of social planning that created the foundation for today's healthcare system.Read more at location 273
If anything may be identified as the guiding philosophy behind Singapore's success, it is Lee's conviction that the people's desire to achieve and succeed must never be compromised by an overgenerous state. The government made certain that Singaporeans developed and retained a sense of responsibilityRead more at location 290
An early move was to bring primary care services closer to the people by developing a network of satellite outpatient dispensaries and maternal and child health clinics.Read more at location 296
The ideal of free medical services collided against the reality of human behaviour, certainly in Singapore. My first lesson came from government clinics and hospitals. When doctors prescribed free antibiotics, patients took their tablet or capsules for two days, did not feel better, and threw away the balance. They then consulted private doctors, paid for their antibiotics, completed the course, and recovered.Read more at location 310
active disease prevention and promotion of a healthy lifestyle.Read more at location 349
the Plan announced the creation of Medisave, Singapore's individual medical savings plan.Read more at location 370
Workers contribute a certain percentage (set by the government) to their individual accounts, as do their employers. The money can then be used to pay for health services as well as health insurance plans.Read more at location 371
Medisave enables patients to pay their share of their healthcare bill.Read more at location 373
It has also had the effect of keeping national healthcare costs low by shifting a large portion of expenses to individuals and their employers.Read more at location 373
Promote Individual Responsibility for One's Own Health and Avoid Overreliance on State Welfare or Third-Party Medical InsuranceRead more at location 401
making patients pay directly a part of their healthcare expenses, excessive demand for services could be mitigated and overreliance on state welfare or third-party medical insuranceRead more at location 404
To avoid overreliance on comprehensive insurance programs that provided first-dollar coverage, the government incentivized the purchase of health insurance schemes with features such as deductible and co-payment components and guaranteed renewals by restricting the use of Medisave to only plans that met these requirements. Insurance plans that provided first-dollar coverage were viewed as playing a major role in raising costs in countries where they are readily available.Read more at location 406
Ensure Good and Affordable Basic Medical Services for All SingaporeansRead more at location 414
The basic package had to be affordable and be provided by hospitals receiving government subsidies.Read more at location 418
The package should be reviewed frequently to reflect, among other things, the purchasing power of Singaporeans and productivity increases in medical science.Read more at location 420
Engage Competition and Market Forces to Improve Service and Raise EfficiencyRead more at location 430
Market forces should be used to promote efficiency, improve quality of services, develop more choicesRead more at location 432
patients rely on doctors for advice and are themselves generally unaware of better or competing alternatives.Read more at location 434
Oversupply or overabundance of choices would in turn drive healthcare costs up rather than keep them in checkRead more at location 436
One step the Ministry of Health has taken to stoke competition is to provide price transparency by publishing the hospital bills for common illnesses on its website.Read more at location 437
Intervene Directly in the Healthcare Sector, When Necessary, Where the Market Fails to Keep Healthcare Costs DownRead more at location 442
I view Singapore's chosen approach to the healthcare market as a kind of highly-calibrated capitalism.Read more at location 443
This approach is seen in the fact that it funds public hospitals and other care facilities but also encourages the participation of private hospitals and clinics.Read more at location 444
Situations that might demand government action included preventing an oversupply of healthcare services, moderating demand, and creating incentives to keep costs down.Read more at location 445
For example, over the years, intervention has included creating and adjusting medical savings programs, sponsoring insurance programs, providing subsidies to hospitals and polyclinics, determining the number of beds and their distribution in public hospitals, funding new medical schools, regulating the number and type of doctors who can practice in the country, and regulating and limiting the type and number of private insurance programs available to Singaporeans.Read more at location 447
Ability to recognize and establish national priorities, giving the economy time to grow before investing heavilyRead more at location 457
a system that would not be “free” to consumers and would not contribute to a welfare state mentalityRead more at location 460
