Healthcare Systems

CONTENTS

1. A Snapshot of Healthcare in Asia

2. Singapore’s Healthcare system

3. The Asian silver tsunamie.g of Japan

Healthcare in Asia is going through a period of unprecedented change…

Rapid economic growth

Rapid population growth

Increasing affluence and demand for better, and in some cases, private healthcare

Public healthcare sector reform and broadening

The introduction of ‘new’ healthcare challenges…

Healthcare in Asia

ASEAN TOTAL HEALTHCARE SPEND – OVER $68 BILLION

Data from World Bank 2011 (latest available)

605 million people

Average age < 27yo

ASEAN TOTAL HEALTHCARE SPEND AS % GDP = Public + Private

Vietnam spends the most, while Myanmar spends the least. Looking at public and private spending, private spending is higher, with the exception of Thailand and Brunei, where public spending is higher.

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Data from World Bank 2011 (latest available)(Total health expenditure is the sum of public and private health expenditure)

ASEAN GOVERNMENT HEALTHCARE SPEND % OF TOTAL GOVERNMENT EXPENDITURE

Data from World Bank 2011 (latest available)Health expenditure, public (% of government expenditure)(Philippines data not available)

Government expenditure on health shows a different – but equally revealing – picture of healthcare provision. Thailand spends the most, Myanmar spends the least. Indonesia again is low down on health spending, coming in second last. The top three – Thailand, Vietnam, Brunei – all have well developed public healthcare systems. As a comparative, the US and UK are spending around 19-16%, against the ASEAN average of 6.7%.

ASEAN Average 6.7%OECD Average 17.2%

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ASEAN SPEND PER CAPITA

USA

OECD Ave

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Brunei

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Indonesia

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Data from World Bank 2011 (latest available)Health expenditure per capita (current US$)

ASEAN Average $422.4OECD Average $4593

We made this graph to give you an indication of just how far behind ASEAN is in terms of real healthcare spending. As you can see, the comparison between the US and UK is extreme. Singapore is the only ASEAN country that comes anywhere close on comparable terms. This does not mean that healthcare in ASEAN is ‘small beer’; on the contrary, it just goes to show the huge growth potential there is! All ASEAN countries - with the exception of Myanmar, Cambodia and Laos - are opportunity markets for healthcare and demand is rising rapidly.

Singapore is rightly proud of the efficiency of its healthcare sector: excellent outcomes

achieved at a closely managed cost

Part 2:Singapore’s Healthcare system

Individual responsibilityOut of pocket,Insurancee.g. USA

State responsibilityTaxes, social insurancee.g. UK

Shared responsibilityTaxes, medical saving accounts, catastrophic insurance

e.g. Singapore

SINGAPORE• Despite the relatively low level of spending on healthcare in Singapore, it has one of the best

healthcare systems in the world. • Economically, Singapore many people travel to Singapore for ‘medical tourism’ due to efficient

healthcare system world class facilities

• Around 70-80% of Singaporeans obtain their medical care within the public health system via the 3M.

• Overall, the ‘Healthcare 2020 Masterplan’ aims to cater toward the aging population. • four new acute hospitals between 2020 and 2030.

• Pioneer Generation Package, which will pay for healthcare bills for those in the late 60s and older.

• For low-income families, Community Health Assist Scheme (CHAS)

Key Facts 25 total hospitals 10,756 hospital beds 15 public hospitals 10 private hospitals

Health Issues ‘Developed country’ ailments such as

cancer, cardiovascular diseases and strokes; these account for 60% of all deaths

Health expenditure, total (% of GDP) 4.56Health expenditure, public (% of government expenditure) 8.82Health expenditure, private (% of GDP) 3.15Health expenditure, public (% of GDP) 1.42Health expenditure per capita (current US$) 2286.38

• Medisavecompulsory saving plan

• Medishield lifecatastrophic insurance plan

• Medifunda health endowment fund

3M Eldershield & Governent subsidies

The Asian silver tsunamiSingapore,Japan

Silver tsunami• Asia’s furious development development and urbanization

for the past 30 years lead to a falling birth rate

• Rapid advancement of medical care caused life expectancies to soar.

• Asia is on track to become the ‘oldest region in the world’ by 2050 projected to hit 922.7 million by the middle of this century.

• Japan, Thailand(2030),China(2030),Singapore(2030) and Malaysia(2050) face an increasingly elderly population

• This means more age related diseases and healthcare needs; needs which are currently largely ignored and in short supply.

Silver tsunami• Japan started grappling with this issue 30 years ago

• Universal medical insurance coverage• Pay between 10-30% copayment

• Long term care insurance (LTCI)• Mandatory scheme, premium starts at 40 yo & topped up

by subsidies from government• LTCI then reimburses bulk of medical expenses to

hospitals/medical institutions

Learning point

Silver tsunami• Hospital sector’s low profitability & inefficiency issues• Too reliant on hospital care• Average hospital stay -> 20 days, world average of 7 days• A third of 1 million beds used for long-term elderly care

Additionally,• Shrinking of population• Fewer working adult : elderly (ratio)

• To fund increasing expenditure, taxes increase• Healthcare cost rise, no amount of saving is sufficient

Japan’s challenges today

Silver tsunami• Policies can consider more schemes for

wide ,encompassing policies• Healthcare 2020• Surveying mindsets of younger Singaporean to paying

higher premiums

• Infrastructures such as community hospitals/hospice closer to home.

• Assist healthcare providers in cost-cutting or process improvement initiatives.

e.g. use of robotic arm in sorting out prescriptions at the pharmacy

Singapore’s response to aging

The End