4 myths about national health insurance

Perhaps a properly structured national health insurance scheme can encourage the proactive management of health, translating into lower costs due to earlier detection of complications. — PHOTO: AGENCE FRANCE-PRESSE

4 myths about national health insurance

Singapore’s 3M model does not need major surgery, only targeted therapy

NATIONAL health insurance (NHI) has been in the media limelight, with no less than Ambassador-at-Large Tommy Koh calling for reform, saying health insurance was one area Singapore ‘didn’t get it right’.

In the other corner, academics Lim Meng Kin and Eric Finkelstein have urged restraint, highlighting the strengths of the 3M (Medisave, Medifund and MediShield) model.

As the debate grows more heated, it is worthwhile to strip away the rhetoric and the misconceptions so that Singaporeans can have a proper national conversation about the direction our health-care system should be heading. Four myths in particular need to be challenged.

Myth #1

NATIONAL health insurance is a ‘free for all’.

This pernicious myth arises from the misunderstanding that NHI provides a free-for-all buffet. It does not.

Mitigating mechanisms like co-payments exist in virtually all systems: In Germany, patients pay €10 (S$16) per inpatient day and co-payments of between €5 and €10 per prescription drug. In Sweden, another country with NHI, patients pay 100 krona (S$18) for a general practitioner visit and 250 krona for seeing a specialist.

Countries with NHI, just like those without, recognise the very real risk of ‘moral hazard’ and institute co-payment measures to dampen excessive and inappropriate demand.

Myth #2

NATIONAL health insurance is unaffordable.

The bogeyman of European ‘welfare states’ is often raised to justify why Singapore cannot go down this same path.

Of all the countries in the Organisation for Economic Cooperation and Development (OECD), only three do not have universal health coverage: the United States, Turkey and Mexico. Do they spend less than the rest? Unfortunately for critics of NHI, there is no pattern: These three countries bookend OECD health- care spending.

The US surges ahead, spending 21/2 times more than the OECD average while Turkey and Mexico hold up the rear.

Let us look at another OECD country, Israel. Israel enacted its National Health Insurance Law in 1995. What was the impact on health-care spending? In the 10 years preceding the law (1985 to 1994), health-care spending was 6.6 per cent to 7.8 per cent of gross domestic product (GDP). After 1995? It was 7.6 per cent to 8 per cent of GDP.

Taking the first and second myths collectively, it is clear that what is crucial for cost control and ‘affordability’ is not the presence or absence of NHI.

Rather, the critical factor is determining what should be covered and what should not, and having good governance and government to tailor to the country’s financial health.

Where do we draw the line on what to cover? In health care, demand is infinite and resources finite.

Regardless of the model of health-care financing, difficult trade-offs have to be made.

Australia, South Korea and Britain all have universal health coverage; they also all have national agencies which examine the clinical and economic data to determine which treatments should be included for national coverage.

Such cost-effectiveness analyses help governments decide what to include in national health coverage and what to exclude.

The coat can be cut to the cloth to ensure long-term financial sustainability.

Myth #3

NATIONAL health insurance precludes competition.

Critics have warned that a national model would eventually grow bloated and wasteful due to a lack of competition. This is not what the facts bear out.

Germany has mandatory health-care coverage but the country also has about 200 ‘sickness funds’ which have to compete for members. But there is a caveat; as German magazine Spiegel simply puts it: ‘The system only works if everyone takes part.’

Allowing exclusions enables insurers to take the easy way out and simply leave the higher-risk cases out in the cold, to the detriment of equity and the national interest. Markets can work very well to serve citizens and countries, but only under the watchful eyes of a benevolent government.

Myth #4

RADICAL reform is needed for national health insurance.

Eminent policy commentators, Professors Lim and Finkelstein, have argued that there is no need to throw the baby out with the bath water.

I agree. Implementing NHI does not necessitate an overhaul; it can be overlaid to achieve greater equity and coverage for all Singaporeans.

Singapore’s health-care financing system has the correct fundamentals and rather than radical surgery, precise targeted therapy would suffice.

Where can this start? Preventive health and primary care are two areas: Health screening and basic care of chronic conditions such as diabetes merit greater funding. Basic childhood immunisations in Singapore are free; why not mammography and Pap smears?

There will be abuse if funded by NHI, critics will rail, but the data shows no parent subjects her child to multiple vaccinations simply because they are free. Likewise, no woman would seek excessive mammograms because they are free.

Coverage for children with congenital illnesses, Singaporeans with pre-existing diseases and Singaporeans over 85 years of age? MediShield can be harnessed for mandatory inclusion with the premiums appropriately pegged. Singaporeans who cannot afford these higher premiums could be subsidised.

Will it cost more? Perhaps, properly structured NHI can encourage the proactive management of health, which may translate into lower costs due to earlier detection of complications. The jury is still out.

Either 3M or NHI is a false dichotomy. We can build on the 3M model to make it even better and more inclusive. These four myths confuse and merit dispelling so that society can debate the sort of health system it wants.

At its core, a national health system is as much about equity as it is about economics. Perhaps it is appropriate to end by recalling the words of Pope John Paul II:

  • ‘A society will be judged on the basis of how it treats its weakest members and among the most vulnerable are surely the unborn and the dying.’

How will future generations of Singaporeans judge us?


The writer is CEO, Fortis Hospital Singapore.
By Jeremy Lim, For The Straits Times, Published on May 31, 2012 

*Related Articles *

Govt should rethink resident engagement. Don’t isolate those in need of care and love.Vital to locate nursing homes in heartland

Govt should rethink resident engagement

THE petitioning by some residents of Bishan Street 13 (‘No to nursing home, say Bishan residents’; Monday) has led me to wonder if the Health Ministry and grassroots leaders have got it wrong in engaging residents affected by the plan to locate a nursing home there.

Such engagement on the building of eldercare facilities will attract only the noisy minority. What about the quiet majority who do not mind having the nursing home, or who are supportive of it, like me?

Instead of investing all resources into such face-to-face engagement, which inevitably turns out to be a platform for the naysayers, the Government should consider asking all residents to vote on the plan.

Call it a referendum, something similar to the Housing Board’s call for a vote by residents to approve lift upgrading. Information on the proposed facilities could be channelled to residents, and they should be asked to send in their feedback or votes.

While the decision must ultimately rest with the policymakers, it is unproductive to craft feedback mechanisms in which only the views of a loud minority are aired.

Yeo Chiat Wei

Source : The Straits Times –  Govt should rethink resident engagement

Don’t isolate those in need of care and love

LET’S step back a little in time to 1992, when a hospice was planned to be built in Dover Road (‘No to nursing home, say Bishan residents’; Monday). Vehement objections ended in the hospice being ‘exported’ to another location.

If one were to go to Hougang, just behind and ‘below’ Yio Chu Kang Road, there exists a road named Napiri where the Salvation Army’s home, a hospice and other buildings for the mentally challenged and the aged are cloistered.

Farther away in Buangkok, on a hill suitable for a country club, we find the Institute of Mental Health. And there lies a cluster of homes for the aged and physically challenged.

My point is this: We are relegating people in need of care and love to isolated places. We have ‘botoxed’ seniors into buildings that look good outside but lack a heart inside, that is, the people who complain thus: Whatever you do, please don’t do it near my home.

The Housing Board’s pricing policy exacerbates the problem because flats with a good view are sold at a premium.

The day we relented in moving the planned hospice away from one crowd of objectors, that decision set the pace for public ‘consultations’ and the objections that followed.

It is not a matter of ‘if you don’t give me what I want, don’t give me what I don’t want’. Rather, it is ‘give me what I want and give others what they don’t want’.

Chen Sen Lenn

Source : The Straits Times – Don’t isolate those in need of care and love

Vital to locate nursing homes in heartland

WE ARE encouraged that the Health Ministry is engaging Singaporeans on nursing homes for the elderly (‘No to nursing home, say Bishan residents’; Monday). We know that many family caregivers would support its intention for nursing homes in every constituency by 2030.

Singaporeans who have cared for elderly people would also like to see progress in a wider range of eldercare and housing options to meet the growing needs of a rapidly ageing population in Singapore.

While home-care is preferred by most families, there will be situations when such care is not possible. All families will face decisions about care for parents, grandparents and siblings as they age and become frail. It is something that each individual will need to reconcile.

This is when the availability of nursing homes in housing estates will provide family caregivers with a viable option to have their elderly parents and close relatives cared for at nearby round-the-clock facilities with professional nursing staff led by doctors specialising in geriatric medicine.

In the absence of these facilities, more family caregivers might be compelled to leave the workforce to care for their loved ones full time. This could financially strain middle-aged Singaporeans with school-going children and elderly parents to support.

Having such facilities in housing estates will give family caregivers the option of working part- or full-time, while earning an income to help pay for the care of their loved ones.

Initial feedback from some Bishan residents appears heavily weighted against the nursing home project. We stand with current and future family caregivers in urging Singaporeans to be more accepting of nursing homes, just as we have embraced essential childcare services, schools, shopping malls, wet markets and food centres in our estates.

Given the social reality of an ageing population, eldercare facilities are becoming an equally essential and familiar feature in our neighbourhoods.

We wish the Government well in its continuing efforts to engage residents on accessible locations to site such facilities to support family caregivers, who can visit their loved ones on the way to or back from school and work. We also look forward to more Singaporeans accepting such facilities as part of the evolving heartland landscape, reflecting a truly inclusive Singapore.

Manmohan Singh
Asian Women’s Welfare Association Centre for Caregivers

Source : The Straits Times –  Vital to locate nursing homes in heartland

Singaporean is first foreigner to top cohort: US naval academy

US Defence Secretary Leon Panetta (L) congratulating Lt Tan (R)during USNA 2012 Graduation and Commissioning ceremony in Annapolis.

Naval officer Sam Tan Wei Shen became the first foreign student to achieve top graduate honours at the prestigious United States Naval Academy (USNA) on Tuesday.

Lieutenant Tan, 24, topped his batch of 1,099 American and foreign cadets. Studying at USNA is very competitive as candidates vying for top honours are cadets handpicked by American and selected foreign navies worldwide.

Lt Tan’s cohort included 14 cadets from 12 countries, including Pakistan, Taiwan and Romania, reported The Straits Times (ST).

“I was surprised because the guys I was training with were Navy Seals and some were even going to be astronauts. To be training with the best and brightest, and still come up tops is pretty amazing,” Lt Tan told ST from his hotel in Annapolis, Maryland in the US.

Former graduates of the academy include US former presidential candidate and Arizona Senator John McCain, former US President Jimmy Carter, and the first American to journey into space Alan Shepard.

Lt Tan graduated from the Officer Cadet School here in 2008 and received the Singapore Armed Forces Merit Scholarship to study in USNA.

He began his training at USNA in 2008. There, he became the first foreign cadet in USNA’s history in charge of administrative duties of the 4,400 cadets, the “size of the Republic of Singapore Navy”, said Lt Tan. One of his tasks as the brigade adjutant was to command the 4,400-strong ceremonial parades.

“I was put in an environment in which I challenged and pushed myself beyond my limits and became stronger physically and mentally,’ said Lt Tan. He also told ST that he hopes to take part in international peace support operations like the anti-piracy operations in the Gulf of Aden.

His mother, a housewife, and his father, who owns a cleaning firm, were present at the full-regalia parade in the academy. He was also awarded a Bachelor of Science in Ocean Systems Engineering.

Lt Tan will be flying back to Singapore tomorrow, and said that he will miss the friends who helped him cope in the US. “We shared jokes, helped each other do laundry or iron our clothes… these were small gestures that mattered a lot and kept us going for so long,” said Lt Tan.

AsiaOne, Thursday, May 31, 2012

Link : Singaporean is first foreigner to top cohort: US naval academy


  •  In a meritocratic system, a person’s ability (and willingness to apply it) is the cornerstone that defines his/her influence. You may not be held responsible for where you start out in life, but you are responsible for where you end up.

    Congratulation, Lieutenant Sam Tan Wei Shen.

    ~ Fabrications About The PAP 


Lianhe Zaobao, 21 May 2012 


Minister of State for National Development and Manpower Tan Chuan-Jin said that in order to reduce the number of people who lose out on subsidies due to breaches of the CPF Act by their employers, the Ministry of Manpower will expand the size of its investigation team and step up enforcement such that the number of enforcement actions each year will be increased from around 500 now to 5,000.

The government will soon be stepping up protection of the rights of low wage workers including ensuring that employers pay their CPF contributions regularly and that the workers get the subsidies they are entitled to.

Many subsidies and incentives targeted at low-wage workers in Singapore are issued through the CPF system. Minister of State for National Development and Manpower Tan Chuan-Jin revealed in an interview with Lianhe Zaobao that in order to reduce the number of people who lose out on subsidies due to breaches of the CPF Act by their employers, the Ministry of Manpower will expand the size of its investigation team and step up enforcement such that the number of enforcement actions each year will be increased from around 500 now to 5,000.

He said: “Strengthening the enforcement of the CPF Act is part of the review of the Employment Act. A large part of this is actually aimed at low-wage workers to ensure that they get the CPF savings and other financial subsidies that they are entitled to.”

Mr Tan pointed out that enforcement will focus on industries where violations are more severe, such as F&B, retail, cleaning and security. These sectors traditionally hire a larger number of low wage workers.

Currently, enforcement is being carried out by staff from the Manpower Ministry and the CPF Board. In order to step up enforcement, the Manpower Ministry will be issuing a tender to strengthen its investigation resources. Other than checking on whether employers are making CPF contributions regularly, the enforcement personnel will also conduct spot-checks at workplaces to find out whether employers are complying with the Employment Act, including regulations on working hours, working conditions and annual and sick leave.

With the average life expectancy growing in Singapore, the issue of whether seniors have sufficient savings has become a growing concern. Mr Tan pointed out that if individuals fail to accumulate sufficient CPF savings when they have the ability to work, then this will ultimately affect the retirement years of Singaporeans.

Last year, the CPF Board managed to recover $9.5 million in CPF contributions owed to 10,000 employees. There were 3,700 errant companies, a 42% increase from 2010.

Ministry of Manpower (MOM) figures show that if a 55-year-old worker making $1,000 a month does not have a CPF account, then he will have lost out on more than $9,000 in financial and Medisave subsidies issued under Workfare over the past five years. If this is added to the amount of CPF that his employer should have paid him, his losses would total more than $20,000, or almost a third of his wages.

Despite this, there are still some low-wage workers who come to agreements with their employers not to have CPF so that they can have more cash each month.

Mr Tan stressed in the interview that such arrangements are against the law. Other than enforcement, MOM and the CPF Board will also step up public education efforts with the tripartite partners to correct any misconceptions about the CPF system among Singaporeans and raise awareness in workers about their rights under the CPF Act.

Incentive scheme to be reviewed next year

The government introduced the Workfare Income Supplement (WIS) scheme in 2007 to allow those who work at least two months a quarter and who make less than $1,700 a month on average to get subsidies through their CPF account. Last year, 40,000 low-wage workers received a total of more than $400 million under the scheme.

Though this programme has helped low-wage workers raise their income, it has also been the target of criticism. For example, some feel that the cash subsidy component is too low and sufficient to effectively deal with daily expenditures. For every $100 received by an individual under WIS, $71 goes into the CPF account and only $29 is disbursed in cash.

The government will be reviewing this scheme next year. Mr Tan pointed out that one way of drawing more people to the scheme is to raise the cash component.

Mr Tan said: “It is understandable that low-wage workers would be concerned about how much cash they get in their hands. Can we adjust the subsidy percentage such that workers get more cash? I think this is a possibility that we can explore.”

The government has said that it will focus more on the industries where wages are low, such as cleaning and security, and take targeted measures to help workers in these sectors raise their wages.

When asked how much of a wage increase he hopes to achieve for these low-wage workers, Mr Tan cited the example of the cleaning sector. He said that the accreditation of cleaning companies will be linked to the wages of their workers. Through “best sourcing”, the government will outsource work to accredited contractors or those with good track records.

Lim Meow Nar


Singapore Taxes : Part 3, abolish GST for bare neccessities

At Five Stars and A Moon, we are well in touch with the ground. We know that there are groups advocating the abolishment of GST for necessities.

They ask: “Why is GST imposed on bare necessities, don’t the rich eat the same as the poor?”

Let us first define “bare necessities”.

(No student has graduated without these necessities)

Lets take rice for an example. There are many types of rice. Basmati rice, Vietnamese Rice, Thai Rice, Sushi rice (or Koshihikari Rice, a premium rice from Japan) and even Organic rice. Which one should be the necessity?

The Thai Rice (most) Singaporeans consume is actually a premium rice, not at all a “necessity”.

(Rice is the bread of Asians)

Bureaucratic nightmare
A mobile phone is a necessity. So is a mattress. So is water, electricity and gas. To be able to classify, update and manage dispute of articles for tax exemption would mean IRAS setting up another department and system – this also means: someone needs to pay.

Many, many companies will want their products exempted from tax to boost sales. Tax free shampoo and conditioner anyone?

Maybe the Restroom Association of Singapore (Yes, such an organization does exist) will then want toilet cleaners, brushes and toilet paper also exempted from tax. Don’t you think GST on these products discourage “Good toilet behavior”. There will be no end to all the petitions.

Does the rich eat the same as the poor?

Even if we might eat the same amount (arguably), but how about the cost?

(the only thing fishy about this, is the price)

So if we decide to exempt fish from GST. This means the rich will save $85.68 (on this $1224 Sultan Fish) while the rest of us save a few cents from a $3.50 fish soup porridge.

GST Credits
Remember the GST Credits you received not too long ago? If you ran out and bought a shiny new iPhone, you’re probably not one of those that need help with taxes. This several hundred dollar cash handout by the Government is for Singaporeans to offset whatever they spend on GST, thus nullifying the tax altogether – specifically for expenditure on “basic necessities”.

In a nutshell,  if we were to exempt GST from “necessities”:

1. Less overall GST collected due to people exploiting loopholes etc.

2. Rich pay much, much, much less GST while poor saves little

3. Higher cost for collecting GST including setting up GST assessment centres for new products as well as mediation and arbitration courts for GST and enforcement centres.

4. More bureaucracy, administration and difficulty of starting and running a businesses

5. GST Credits are available to help the needy nullify their GST expenditure

Editor’s Notes:

  • Income tax is a tax on your earning power. GST is a tax on your spending power, thus can be seen as a tax on the rich.
  • Instead of inefficiently spending more to create a brand new bureaucracy, this Government has decided to just give real money in the form of GST Credits for Singaporeans, needy or otherwise.
  • Unless your business makes more than S$1m a year, you do not need to charge GST
  • But let us not forget WHY we have GST in the first place. This tax brought in $8b to the country last year: it helped pay to keep this country running, clean streets, functioning lights, security, defense and a peace of mind for you and me.

by Five Stars & a Moon
Link :   Singapore Taxes : Part 3, abolish GST for bare neccessities

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Low Thia Khiang’ roti-prata act, Peng Lai Peng Ki

Gather Comments from Fabrications About The PAP :

  • If  MSM is biased why did LTK need to clarified his statement after his BE victory speech attacking MSM with:
    “Low Thia Khiang clarified during an interview yesterday morning, after thanking the HG voters, that “Lianhe Zaobao” reports during the election campaign have been balanced. ”
    Another roti-prata act? Peng Lai Peng Ki?
  • DPM Teo challenge LTK to pursue his unhappiness after he charged PAP of character assassination, sue him…..
    LTK response…”let’s work with the PAP”…
    Typical like GE2011…all the tiger moves before and post victory…but the timid cat once Parliament started and thereon…work with the PAP…lol…
    of course lah…complain, blame, tai chi to PAP..this is known as workering...Good Luck SG..:-P
  • Some people take reporting the truth as being bias.
    The opposition has done nothing. By reporting that and it become bias.
    Png fumble on NCMPgate. By reporting that it become bias.
    Yaw engaged in “Internal Party Affair” and by reporting that it become bias.
    Who is really the bias one?
  • Didn’t MSM report on all the scandals from MIW?
    Else where did the alternative media get their ammo on MIW from?
  • LTK is really confusing me...Let’s see, i tell the truth, i’m considered bias?
    So if Boy-A copied from his classmate B & hit him up.
    Classmate C (supposingly A’s best friend), reports the whole incident to the teacher.
    Boy A admits and confirms that what C said are true.
    Teacher reports exactly what C told him to the principal.
    Boy A & his parents now slam the teacher for being bias & make a big hoo haa, complaining to MOE.
    Now, am i missing something here? Is that how i’m supposed to teach my children?
  • The Workers’ Party Creed: “We believe in transparency and accountability.”
    If they were selling a “product” they would have gone bankrupt for misrepresentation.
    Unfortunately, it is all about politics and many treated the election like the American Idol contest.
    The winner gets million dollars of recording contract and those who voted him get to feel “song” in Hokkien.
  • When is reporting the news of YSL factually became bias.There was a rumour of YSL’s internal party affairs.YSL did say “No Comment”
    WP did say “No Comment”
    LTK did say “you said youself it is a rumor, why are you still asking me?”

    YSL did resigned from the CEC
    YSL, LTK, SL did said “Nothing to add”
    YSL, LTK and WP gang did celebrated CNY together singing Karaoke and Lohei and Yum Seng.
    YSL did disappear without a word.

    WP did not do or promise to do any investigation till date.Png did say his name is not on the ballot.
    Png say he took himself out of the ballot

    The Minutes are real.

    Png was indeed on the ballot and got 1 vote only.
    LTK did say, the selection of NCMP is up to the CEC and not up to individual.
    What LTK said did contradict what Pnd claimed to have taken his name off the ballot.

    Reporting all these facts are bias?
    If you want the media to report favourably, then do something worthwhile of praise.

But I gave up on sense and sensibility anyway. That’s what the Hougang BE had shown.

  • When Lim Guan Eng took over Penang as chief minister, Penanites immediately saw real and effective changes. Parking improves with honest strict regimental law enforcer. Corruptions were thing of past! People saw real change from a BN rule. Immediately.

    Yet when LTK took over hougang since day 01 till now, he’s still crying no funding from PAP government and keep playing the victim card! I’m sadden why so few people saw through his lies? 

    He did not want to increase conservancy fees to pacify the residents then when he get additional source of income for other improvements?

    Now they merged the sinking funds of aljunied GRC carefully squirreled away by GY team, dare he still cry no monies?

    No monies can find funds to change redundant light boxes to workers party colours for VANITY?

    But I gave up on sense and sensibility anyway. That’s what the Hougang BE had shown.

    An electorate totally absorbed and worship WP lies!
    ~ a  netizen


  • I think opposition,over the years, started a hate government campaign. A persistent blaming government and never praising culture – that has now become a trademark with many young adult Singaporeans. 

    Thats why some people become forgetful and unappreciative of all the benefits and previleges we are enjoying as Singaporeans.

    An overpampered Gen Y & Z are now moulded into a new breed of many xenophobic, materialistic, self serving, self centered and narcisstic individuals.

    I fear for the worst when these generations take over management of Singapore in 30 years time.. It may be the beginning of the end of a once prosperious and respected nation.
    ~a  netizen