Health Care System: Where is the role of PAP Govt in taking care of Singaporeans?

The following is the report from Taiwan's media on the conference held in Singapore with regards to Health Care in Asia conference.

This report is an alternative report to our local MSM's spin on our health care system. The Taiwanese Minister of Health has criticized the Singapore's system as one that the government has shirked off their social responsibility towards the citizens in terms of providing basic health care.

Incidentally, I have been studying the Taiwanese Medical Insurance system which has provided a Universal coverage for ALL its citizens as well as foreign workers. I have put up my proposal to NSP manifesto committee on revamping the Medishield system.

The basic idea of this new Medical Insurance scheme is to have the government and employers to share part of the premiums paid as Medishield for their Singaporean workers. As for Foreign workers, the government will not share the burden of their premium while the employers will take up more of the responsibility.

This is a fair system whereby the Government and employers take up their social responsibility towards the citizens' health care insurance. The workers will still pay the bulk of the Medishield follow by their employers and the Government. For family members who are not gainfully employed, there will also be a co-payment of Medishield premiums.



The Medishield coverage should be widen. The payout by Medishield is only close to 55% of total premium collected for each year. This is lesser than Group Medical Insurance scheme, which has a much higher payout rate of 75%.

Anyway, the details of my proposal would be finalized in NSP manifesto in time to come. For the time being, here is the media report in Chinese, by Taiwanese online media (I have translated the important part mentioned about Singapore in the text below):


楊志良分析全球健保制度引起熱烈迴響

* 2010-03-30
* 新聞速報
* 【中央社】

　衛生署長楊志良今天在經濟學人資訊社（EIU）的亞洲醫療論壇討論健保財政課題時，清楚的把現存4種制度的優劣進行分析，引起迴響，多國代表並希望參考台灣的健保制度。

　正在台灣推動二代健保的楊志良，受邀在經濟學人亞洲論壇的閉門會議中，討論亞洲政府健保財政的難題。

　楊志良把全球現存的健保財政制度分為4種，他說，第1種是英國和大英國協國家實施以稅收劃定一定比例作為健保費的國民保健服務制；第2種是社會保險制度，例如台灣的健保；第3種是使用者付費和私人保險搭配的制度；第4種是結合上述3種的綜合體。

　楊志良分析，英國這套制度，雖以稅收作為健保預算，感覺非常公平，可避免道德危害，但缺點是由於醫療保險預算是固定的，醫院和醫生多看病人收入也不會增加，因此不願意多看病人，讓等候看病的名單過長，造成政府失能。

　楊志良說，社會保險制度則是站在社會福利的角度來照顧全民的健康，也照顧到低收入者的醫療，這是台灣為什麼要採用這套制度的原因。

　但是楊志良也坦承，這套制度的缺點，是會造成公民失能（civic failure），因為人民都有政府的健保照顧，所以就不會注意照顧自己的健康，浪費醫療資源，導致醫療消耗愈來愈高。

　不過，楊志良指出，台灣的健保制度實施迄今，滿意度超過70%，代表這套制度確實有可取之處。

　談到第3種制度，楊志良說，這項制度的概念就是使用者付費，結果造成低收入者無力負擔醫療費，政府等於沒有在照顧人民的醫療需求；而先進國家採取的私人保險制度，更導致貧富產生醫療差距。

　由於在席間有人提起新加坡的3M（保健儲蓄、健保雙全和保健基金）架構，楊志良不改直言本色，分析新加坡醫療制度的優劣。

　

楊志良表示，新加坡的3M制度基本上就是強制人民有保健儲蓄，也就是從人民身上拿錢，等於是使用者付費的觀念，那政府照顧人民的責任在哪裡？

Yang Ziliang (Taiwan Minister of Health) said that Singapore's 3M system is basically a system that forces its citizens to pay for their own Medical Insurance (Medishield). i.e. taking money from the people. Thus, it is basically a system that consumers pay for themselves. If that is so, where is the Government's role in taking care of its citizens?

　楊志良指出，這種模式在許多國家實行有困難，因為這個制度必須強迫人民醫療儲蓄，但收入低卻達不到領取社會救濟金的族群，薪水已經夠低，還被迫扣除一部份薪資作為保健儲蓄，生活更加困難，有違社會福利和社會照護的精神。

Yang Ziliang pointed out that it would be difficult for many countries to implement such a system because this system needs to force citizens to pay for their own medical insurance. But some of the lower income group who are not eligible for social welfare may have too low an income to have any deductions made from their salaries to pay for their own premiums. It would further lower their standards of living and this is against the spirit of social welfare and social responsibility (of the government).

　由於楊志良的直言，也引起在場與會各國代表的迴響，甚至延續到後面的分組討論，與會者在討論時，「台灣的部長」至少被提到4次。

　

包括印尼、馬來西亞代表在內的多個國家代表最後認為，新加坡的制度也許很好，但只能適合在新加坡使用，其他國家無法仿效，有人並以中國為例，指中國曾經仿效最後宣告失敗。

At the end of the conference, many representatives including Indonesian, Malaysian and other countries concluded that Singapore's system may be good but it may only be implemented in Singapore as other countries may not be able to emulate it. Some have even used the failed experiment used by China as an example to reiterate this point.


　此外，印尼、馬來西亞、澳洲等國代表，也都發言表示，希望自己的國家能參考台灣的健保制度。

On the other hand, Indonesian, Malaysian, Australian and other countries' representatives have indicated that they hope their own countries could take Taiwan's comprehensive Health Care Insurance scheme as a reference for their reform.

Goh Meng Seng