I woke up, feeling a gnawing pain in my stomach. It was about 3am in the morning. I gave my stomach a rub and grimaced. The pain had woken me up from my sleep. I laid in bed, as the sheering pain came and went, and this repeated itself for the next hour.
If this had happened while I was still employed, I would have gone to the hospital to seek emergency help. I would be able to claim from the company health insurance.
However, as it was, I had lost my job and I couldn’t make such a quick decision. What used to be an easier decision as to whether to go to the hospital became a very serious consideration.
Whether To Go To The Hospital Is A Very Careful Decision For Many Singaporeans
Should I go to the hospital to seek medical help, or should I stay at home and wait out the pain, so as not to bear the heavy medical fees?
I began to think through what medical procedures I would need to go through if I were to go to the hospital. I would have to pay for the consultation fees, for any tests that would need to be done, for the medication etc. But how would I know how much these will cost? Tens of dollars? Hundreds? Will it go above a thousand?
I had some savings to tide me through, but if I had to spend a thousand dollars in one shot, it would set me back heavily, in my current circumstances.
Then, I started thinking about how I would need to get the information on the costs. I could call up the hospital and ask them to detail to me the procedures that I would need to go through if I had gone to them, and how much each step of the way would cost. Or I could try to ask around if anyone knew about the costs.
But it doesn’t matter, would it? The costs would still run into the hundreds, at least.
But you know, this situation might be new to me, but it’s not to many Singaporeans who have to go through this on a constant basis. Just a few weeks ago, a friend was telling me that before the family had to send his father to the hospital for his cancer operation, they had to do the sums to determine how much the operation would cost, how much they would be able to pay, and how much more they would need to source for funds to cover for. They then had to decide if they could afford to send their father to the hospital. This took time and wasted precious time which could have allowed the family to send their father immediately to the hospital to seek urgent medical help.
In the end, if the costs are deemed too exorbitant, or a person fears the escalating costs just to see a doctor, a person might choose to continue being unwell, rather than see a doctor.
Citizens In Other Developed Countries Are Protected For Their Healthcare
This got me thinking. In Hong Kong, for every visit to the hospital, a citizen would need to pay only a maximum of $20. In Norway, a citizen would only need to pay a cap of about $400 in a year. The system in these countries give you a peace of mind, where you know that you can still seek medical help if you need to, no matter whether you are rich or poor. You do not need to fear that costs can grow uncontrollably.
However, in Singapore, there is no cap or maximum amount that Singaporeans need to pay. It was revealed that there have been people who had to pay more than $10,000 for their medical bills, or even $20,000. How on earth were they able to get that sort of money?
In Singapore, the average a cleaner earns is $850. A research has shown that for the poorest 30% of households in Singapore, they have to spend 105% to 151% of their incomes. This means that low-income Singaporeans would never be able to save for their whole lives.
Where would they be able to have the savings to pay for their medical bills? I had asked a financial adviser before as to whether low-income Singaporeans would be able to buy insurance. He shared with me that they would either buy the most basic of insurance to cover any work-related accidents, or that they would not be able to afford insurance. This means that they wouldn’t be able to have any additional medical coverage.
There is Medisave and MediShield, but of total health expenditure, Medisave only covers for 5.5% and MediShield covers for only 2.1%. The government might champion Medishield as being universal but when it covers only 2%, this is hardly universal and hardly adequate.
Today, Singaporeans have contributed $66 billion into Medisave but last year, we could only use 6% of this. Worker’s Party’s Gerald Giam had also revealed that Singaporeans had paid nearly $4 billion into MediShield premiums but are only able to claim back $2 billion in claims.
Should Singapore Do More For Singaporeans For Healthcare?
As I laid in bed, these thoughts ran through my mind. Now that I am unemployed, I’m placed in a situation that has allowed me to look at things from another perspective.
Whether or not to see a doctor is no longer such a straightforward decision as to just walk down to the clinic or take a taxi to the hospital. All these cost money. And if you are not paid adequately in wages, and healthcare is not adequately subsidised, then all these decisions have to be very carefully and tediously considered.
It is no wonder that we hear of stories of many Singaporeans who have chosen to forgo seeing the doctor, and had to remain sick. It is no wonder that many Singaporeans have chosen to die instead of seek medical help. Some families have also resorted to selling their homes so that they could seek medical help.
I can’t help to ask – is this something that should happen in Singapore, when we are today one of the richest countries in the world, and have the highest concentration of millionaires in Singapore? We might be proud that we are a rich country but where the poverty is estimated to be as high as 26% in Singapore, this seems almost inhumane.
Today, the Singapore government subsidises only about 30% of total health expenditure. Other countries of similar wealth spend about 85%, so their citizens are adequately covered. Also, companies in Singapore are made to shoulder a heavy burden of the medical costs through purchasing health insurance for their employees. But for low-wage workers, such insurance doesn’t always happen. And thus low-income Singaporeans have to bite the bullet instead of go to a doctor and have to stay in bad health.
But, is this necessary?
I laid on bed for the next hour, hunkering down with the pain. For me, this might only be for an hour (until the next bout comes again), but for many Singaporeans, they have been going through this on a constant basis, throughout their whole lives, or for some, the later part of our lives.
Low wages, low health subsidies, health insurance schemes such as Medisave and MediShield that provide little protection – these all add up together to prevent a segment of Singaporeans from being able to adequately take care of themselves, no matter how hard they try. Self-reliance then becomes a broken concept, when one doesn’t even have enough to rely on for oneself.
The government needs to understand that Singaporeans are not envious. The large majority of Singaporeans do not need the wealth that the politicians have, and do not aspire to have so. However, what Singaporeans want to know is that our government is taking care of us. If the government believes that it’s doing its best, but where the people think otherwise, then there is a mismatch of expectations, and a lack of understanding of the needs of the people.
What Should Our Values On Healthcare Be?
It makes one wonder, what then is a government’s responsibility? What should their priorities be? To take care of the people? To protect the people, at least in the basic areas, for healthcare, education and retirement?
If so, how should a government prioritise it’s funding areas? Are we overspending in defence (Singapore spends the highest, as a proportion of GDP among developed countries)? Are we underspending on healthcare (Singapore spends the least, as a proportion of GDP and total health expenditure among developed countries and one of the lowest in the world)?
Also, in 2012, there was a surplus of $36 billion in the government’s coffers. In 2013, there was an estimated $30 billion in surplus. Increasing spending for healthcare will only amount to a small proportion of the surplus.
The question now isn’t whether the resources are available, but for the government and as a country, what are our priorities? What does our heart tell us to do?
I’ve always believed that we need to increase health expenditure to protect a larger segment of Singaporeans. But now that I am placed in a vantage situation to understand this, I am even more convinced of this.
The Government’s Role And The Need For Transparency And Accountability In Our Health Finances
A government cannot govern in a way where they believe in giving the people just enough wages to pay for what they need, and subsidise essential services so tightly that its citizens live in fear, by each day, not knowing if there’s enough to get by.
A government needs to calculate how much its citizens would need to be able to life adequately and with dignity, and provide the subsidies required that would allow them to feel secure, so that they can continue to give back to society.
Indeed, how are the Medisave withdrawal limits and MediShield claim amounts calculated? Why are there still significant amount of surpluses in the Medisave and MediShield balances? When the Medisave was introduced in 1984, Mr Toh Chin Chye had spoken up and said that the government was was running “two parallel welfare schemes”. If so, are Singaporeans paying double into tax and Medisave, but receiving only one time of what we have paid back? This once again, calls for transparency and accountability in how the government manage our health finances.
Is the government able to provide reports on how their calculations for the health subisdies, Medisave and MediShield? Can the government provide a full cash inflow and outflow reporting of our health finances?
When the people’s health are taken care of, they become more productive and they will only help to grow the country. As much as welfare states seem frivolous to some, this is their thinking, which is why they spend on healthcare and education, with the understanding that in the long term, this will only benefit the country and sustain the growth into the future.
When we understand the lives of others, and when we step into their shoes, this gives us a new perspective. Is health economics the best way to run our healthcare system? Or should we go back to the basics of what healthcare should be about – to protect the health of the people?
To me, the answer is now clear. But would the government be willing to change its ruling fundamentals? Or do more people need to become unemployed or be pushed into poverty (as is happening now) for this realisation to take root?
Roy Ngerng
*The author blogs at www.TheHeartTruths.com