Creating a healthier future
In response to the rapid expansion of its greying population, Singapore has introduced compulsory healthcare insurance for elderly citizens. CareShield Life, an enhanced version of the existing eldercare programme, will require all Singaporeans aged between 30 and 40 to be enrolled from 2020. Policyholders who become unable to manage basic daily functions will receive S$600 (14,320 baht) a month, increasing over time to keep pace with long-term care costs.
The plan is considered essential, given statistics suggesting that 1 in 2 healthy Singaporeans aged above 65 could become disabled and 3 out of 10 of those will live for at least a decade.
Singapore already has one of the world’s best healthcare systems and the government continues to improve it. Coverage is based on a sustainable hybrid financing system, balanced between the public and private sectors. Strong governance encourages free-market competition to make services affordable.
Healthcare spending in Singapore is a modest 4.95% of gross domestic product (GDP), about one-third that of the United States. Coverage is largely financed by tax revenue and supplemented with co-payments through programmes that make medical savings compulsory.
Yes, Singapore is a rich country and it’s not totally fair to compare it with Thailand, but it’s depressing nonetheless to ponder the inefficient system we have to endure, and our lack of preparation for an ageing society through a properly structured long-term care fund.
The three healthcare schemes in Thailand — self-financed social security, tax-funded government officials’ fund, and taxfunded universal health coverage (UHC) — offer different benefits, or unfair privileges depending on your point of view. The financial burden on the government is heavy. But while many point fingers at UHC, the civil service scheme covers just 10% as many people but with a budget that is more than half of what is spent on universal coverage.
The Thailand Development Research Institute estimated this year that expenditure for the three schemes could explode to between 1.4 trillion and 1.8 trillion baht annually in 15 years (the total national budget for fiscal 2019 is 3 trillion baht), as we enter an era when over 20% of the population will be over 60 and many will suffer from chronic and non-communicable diseases (NCDs).
The need for a more sustainable system is obvious, but entrenched bureaucracy, overlapping roles and conflicting interests make reform very difficult.
According to the Bloomberg Health-Care Efficiency Index, based on life expectancy, spending per capita and relative spending as a share of GDP, Thailand ranks 41st among 55 countries surveyed. By comparison Malaysia is 19th and China 22nd.
In Hong Kong, which tops the list, most healthcare spending is funded from progressive income tax and free treatment is available to all citizens, keeping the healthcare cost to GDP at 5.4%. In South Korea, 97% of the population is covered by UHC, supported by government subsidies, individual contributions, and a tax on tobacco.
The quality of care under UHC also needs major improvement in Thailand, which is still one of the world’s most unequal countries. The yawning gap between public and private hospitals is just part of the divide.
For the less fortunate majority for whom UHC is the only option, a visit to an overcrowded public hospital can mean a whole day spent waiting in exchange for a three-minute chat with an overworked doctor and free medicine. Some treatments simply aren’t available at public facilities but few UHC members can afford to pay extra to private providers.
Walk into a top private hospital, meanwhile, and you might mistake it for a hotel, spa or shopping mall. Yet private hospital charges are spiralling despite the prevalence of technologies that should improve efficiency and make healthcare more affordable. Could the government impose a tax on the enormous profit margins earned by hospital tycoons, with the money going back into the system that helps the less fortunate?
Moreover, the government should make preventive healthcare promotion a priority to rein in future spending. “Healthcare is everything around you,” a doctor once told me. It’s the way we lead our lives, what we eat, how often we exercise and the environment we are in.
It’s also worth considering even more stringent regulations, taxation or fines on anything that harms public health, from pesticides to carbon emissions, tobacco and alcohol.
Studies have proven that NCDs such as cancer, heart disease, high blood pressure, obesity and diabetes are preventable as they are mainly caused by unhealthy habits. In Japan, for instance, a programme that improves eating and exercising habits to reduce diabetes cut the health costs in one city alone by ¥170 million.