1. Healthcare Provision
(Singapore and UK)
Should the State provide…?

2. Lesson Agenda
 After the lesson, students would be able to:
 Appreciate the various stages of healthcare provision in
Singapore.
 Understand the various schemes to support healthcare
in Singapore.
 Practice an approach to Comparison questions (SBQ).

3. Healthcare Provision in
Singapore
 1960’s
 Healthcare measures linked to public housing
because Singapore was overcrowded.
 Healthcare programmes focussed on public hygiene
 Eg. govt. cleared squatters and slums – citizens
relocated to HDB flats. Clinics and hospitals were
built to meet growing pop.
 Effects of overcrowding reduced - public health
improved and spread of major diseases minimized.

4. Healthcare Provision in
Singapore
 1970’s
 Economy improved & standard of living went up –
citizens now wanted better quality healthcare. (F)
 Polyclinics built conveniently within HDB estates
to replace “out-patient dispensaries” (E1 + E2)
 Better facilities in government hospitals –
sophisticated equipment and treatment. Healthcare
costs rising. (L)

5. Healthcare Provision in
Singapore
 1980s to the present
 Government observed - population is ageing.
healthcare costs will rise.
 Government resources would be taken away to pay
for healthcare.
 1980s, Govt. developed a new approach to
healthcare:

6. National Health Plan
 Healthcare = Shared responsibility.
 The Individual + the Government + the
Community = Healthcare provision in
Singapore

7. Healthcare Provision in
Singapore
 The Individual
 Self-reliance:
 1984 Introduced MediSave Account. 8% of monthly
contribution to CPF channelled to MediSave.
 Singaporeans to take charge of their own healthcare.
 MediSave further enhanced - includes Medishield (for those
who do not have CPF Accounts) and Eldershield (for those
above 40 who have disabilities)

8. Healthcare Provision in
Singapore
 The Individual (Self-Reliance) - MediShield:
 This is a national healthcare insurance scheme.
 Just like insurance – Singaporeans pay for
MediShield from monthly contributions from
MediSave.
 Allows greater financial cover for rising
healthcare costs.

9. Healthcare Provision in
Singapore
 The Individual (Self-reliance) - Eldershield
 This is another insurance scheme. Targeted for those above 40.
 It uses CPF MediSave accounts to pay premiums. Caters for
those who have not built up enough savings in their MediSave
accounts.
 Provides assistance for those who cannot pay for high
Medishield premiums.

10. Healthcare Provision in
Singapore
 The Government
 Keeping healthcare affordable (Government Subsidies)
 Provide government subsidies to hospitals, polyclinics
and nursing homes.
 Government saved $200mill and from the interest it gets
it provides Medifund to subsidize hospital wards.
 Hospital authorities decide how to use funds for
individual cases.

11. Healthcare Provision in
Singapore
 The Government
 Keeping healthcare affordable (Restructured Hosp.)
 Restructuring means – Hospitals now have freedom to
reorganise to better meet needs to Singaporeans
 Government has flexibility to reduce the amount of subsidies
when necessary
 Keeping healthcare affordable (Means testing)
 Govt must ensure fairness in subsidies.
 Lowest income receive most. Higher income receive less.
 Important because - Subsidies must benefit patients who are
in most need of them.

12. Healthcare Provision in
Singapore
 The Government (Promoting Healthy Lifestyle)
 A healthy person does not need a lot of medical care
 Government encourages citizens to keep healthy.
 This means a well-balanced diet & habit of physical
exercise.
 This will reduce the reliance on healthcare provision in
the later years. This keeps healthcare affordable.

13. Provision of Healthcare in
Singapore
 The Community- healthcare support
 Some patients require help to fully recover after
discharge.
 Voluntary & private organizations given grants to operate
these facilities.
 Grants given to provide specialised healthcare services:
NKF and SATA (Singapore Anti Tuberculosis Assoc.)
 Eases the burden of healthcare costs to the Govt as many
agencies are providing these services.

14. Making Comparisons
 What is a comparison?
 It is a way of evaluating two (or three) items or
subjects
 using a category or classification. For example:
 You can compare two bags according to their colour (one
classification) or
 according to their prices (second classification).
 You are not describing the differences or similarities!
You are stating what makes them different or similar

15. Making Comparisons
 Note: The two bags are different in colour.
(Inference). Bag A has a bright red colour
while Bag B has a dull blue colour. (Support)

16. Let’s practice!
 Alfred always kept to himself and never spoke
to anyone. Melissa spoke only when spoken to
 Inference? Alfred & Melissa are similar in the
way they deal with others
 Support: I know this because, Source A tells me
that “Alfred kept to himself…”
Similarly, Source B tells me that
Melissa “…only spoke when spoken
to…”

17. Let’s Practice
 Can you come up with your own examples?
 Come up with two sources and figure out how you
are going to compare them
 Present to the class…

18. Lesson Re-cap
 What is the challenge of governments in
providing healthcare?
 What was Singapore’s healthcare system like
in the 1960s and 70s?
 What are the principles healthcare provision
here…since the 1980’s?

19. Welfare State & Healthcare
Provision in UK
 Before the 20th Century, the British government did
not provide much medical care for its citizens.
 The poor, aged or homeless had to depend on private
charities, friends or family to help them pay for
healthcare.
 After the war – Government felt it was necessary to
look after these groups of people. The state would
look after its citizens – for free

20. Welfare State & Healthcare in
the UK
 In a Welfare state, the government looks after
its citizens from ‘cradle-to-grave’.
 This means that the government would ensure
that every citizen would have a minimum
standard of welfare to live a ‘decent’ life:
 Each citizen would have a job
 Each citizen would have a home
 Each citizen would have access to healthcare.

21. NHS in the initial years
 Initial success: It was popular with the people.
The government provided free basic medical
service for all citizens.
 Free medical treatments: This means that all
medical services, dental and even optical
treatments were FREE.

22. Buzz Break
 What are the advantages and disadvantages of
living under a welfare system?
Advantages Disadvantages

23. Initial years of NHS
 Govt. expected demand to increase & then
stabilize.
 However increases went beyond expectations.
 Too many people wanted healthcare services
 Treatments prescribed without consideration for costs.
 By 1951 NHS could not meet expectations.
 “Free at the point of service” was not working
 Now had to charge for some treatments

24. Britain and the NHS now
 Ageing pop & rising health costs affects Britain
too.
 The British approach is to ensure that healthcare
spending is put to good use:
 No wastage or unnecessary expenditures.
 Resources cater for specific patient needs.

25. Managing healthcare in UK (1980s)
 Managing government spending:
 The government is expected to provide healthcare
to everyone.
 Healthcare costs rise. This means government has
to collect more taxes.
 In the 1980s – new government in Britain wanted
to reduce expenditure in healthcare.

26. Managing healthcare-Thatcher’s policies
 Prime Minister Thatcher’s approach :
 Cut back on government spending on welfare
benefits including healthcare.
 Return some services to be provided by private
companies (privatization).
 Healthcare should also be the responsibility of the
individual.

27. Challenges faced by UK
 Challenge 1: Loss of people’s support :
 Reduction in healthcare spending = NHS could not
continue to provide free health services.
 Citizens used to receiving free healthcare – now
very unhappy.
 Government concerned about losing the support
from citizens.
 Healthcare policy needed to be carefully balanced
to meet citizens’ expectations & managing costs

28. Challenges faced by UK
 Challenge 2: Cost increase & increasing tax
contribution:
 Healthcare costs are rising.
 Britain's National Insurance contributions (which
partly paid for NHS services) also had to increase.
 This was not always popular. Increases meant
there would be less money for people to spend on
other things.

29. Challenges faced by UK
 Challenge 3: Increasing efficiency
 Demand for healthcare grew with an ageing
population.
 Numbers of people paying taxes to support the
NHS was declining.
 Despite cuts to healthcare spending - still not
enough resources to support the demand.

30. Challenges faced by UK
 Challenge 4: Privatization.
 The aim was to reduce government subsidies.
 To save costs and make NHS more efficient.
 Private companies would now provide some services
to the public.
 E.g. All non-medical services would be supplied by
private companies under a contract
 Cleaning services and catering.

31. Challenges
 Challenge 5: Providing Quality Services
 By the late 1980s demand for services was high.
 NHS system could not cope with this demand.
Lead to declining standards in the NHS.
 Govt responded by providing patients with info on
their treatment - they can monitor rising costs
themselves. But long queues still common.

32. Response of Challenges
 NHS Plan (2000)
 Based on feedback from patients, staff and doctors.
 Increase government spending up to 2004.
 To offer patients more convenient services
 Could make use of facilities in private hospitals
without the patients paying for it.

33. Response to Challenges
 NHS Plan (2004)
 Patients had a choice of 4 different healthcare
providers. Treatment paid for by NHS.
 Every patient have access to their own records on
the Internet (HealthSpace).
 Patient’s with minor illness can get advice from
doctors over the phone (NHS Direct).

34. Let’s Compare
 No one system is better than the other. The UK
system works in there because:
 people’s expectations are different
 Standard of living is high etc.
 Singapore system of healthcare works here
because of our different cultural and social
characteristics

35. Comparison 1:
How citizens participate in the system
UK S’pore
 Citizens make use of benefits –  Promote self-reliance among
Govt. manages costs by citizens – Govt. plans for citizens
carefully controlling to share the costs of their own
government spending. healthcare
 Citizens pay two types of taxes:  MediSave and Medishield from
Income tax & National citizen’s CPF contributions.
Insurance tax

36. Comparison 2:
Keeping Healthcare affordable
UK S’pore
 Privatization to reduce:  Government subsidies
 given to nursing homes, polyclinics
 Operating costs
 Govt. subsidies  Medifund
 Given to hospitals to use to off-set
 Increase efficiency
patient’s bill (needy cases)
 Every individual encouraged to  Restructured hospital
be responsible for welfare and  Govt. is able to give less subsidies.
health (except for expectant
mothers, mothers with young
 Means Testing
 ensure that Govt. subsidies given to
children and students below 19)
patients who need.

37. Comparison 3:
Lifestyle choices and role of community
UK S’pore
 Citizens encouraged…but no  Government provides support by
government programme or championing healthy lifestyle
policy to promote healthy choices through Health Promotion
lifestyles. Board (a govt. agency)
 Community provides nursing  Government gives grants (sums of
support, social services etc…but money for specific purposes) to
these are self-funded. VWOs to operate: day
rehabilitation centres, nursing
homes and community hospitals
 Government (through NHS)
for discharged patients
still seen as the main provider
of healthcare services and
aftercare

38. The Comparison Question
 3 Steps to answering the question:
 Step 1: Identify the type of comparison required
 Step 2: locate similarities and/or differences
 Step 3: Write out the answer – do not describe
differences or similarities.

39. Comparison Questions
 Type 1 (Similarities or Differences ONLY):
 Provide, support & explain similarities only; or
 Provide, support & explain differences only
 Possible question words:
 What are the similarities between these 2 sources?
 In what ways are Sources A and B similar?
 How do the 2 sources differ?
 What are the differences between the 2 sources?

40. Comparison Question
 Type 2 (Similarity & Differences):
 Provide, Support & Explain 2 Similarities + 1 Diff.
 Provide, Support & Explain 2 Differences + 1 Sim
 Possible question words:
 How similar are these 2 sources?
 How different are Sources A and B?
 To what extent are the 2 sources similar?
 How far are these 2 sources different?
 How far does Source A support/differ from Source B?

41. Comparison Question
 Step 2: “locate” similarities and/or differences.
 Read the sources – search for:
 What the sources have in common
 What makes the sources different
 look for POV (point-of-view),
 tone (Negative tone, positive tone etc.)
 Don’t describe the differences!
 Common mistake: A is red in colour and B is blue in
colour, therefore they are different.
 Try: The difference bet. A and B is colour.

42. Comparison Question – Type 1
Template and guiding words
Common factor Support Explain
Both sources differ or are This is shown in Source A, Source A (Make explanation
similar in (state criteria for “…” However as seen in linking inference of Source A
comparison) Source B, “…” to the issue of the question)
…However, Source B
Infer highlights/comments that
(Make explanation linking
Source A shows that (state inference of Source B to the
inference) …whereas issue of question)
Source B comments (state
inference)
Repeat Infer, Support and Explain (ISE) for every similarity/difference inference
that has been identified.

43. Comparison Questions
 Conclusion for comparison questions:
 Link similarities/differences back to the
question issue
and;
 Highlight the connection difference or
similarity) with the issue.

44. Lesson recap
 Are there any differences between the
Singapore healthcare system and that of the
UK?
 What are the features of Singapore’s National
Healthcare Plan?
 What were some of the challenges that British
governments faced in managing the NHS?