The other day, a friend complained to me about Tan Tock Seng Hospital. He said that his father-in-law needed to be hospitalized and he had to wait 24 hours in the waiting area before a bed could be available.
His conclusion was that our healthcare system is bad and wants the government to spend more on healthcare. I told him that this was the “Ah Beng” way of thinking. You cannot pass judgement on something so complex with your own negative experience with it. You are just one person. What about other people’s experiences? In statistical jargon, his example is not statistically significant.
The correct way to determine the quality of our healthcare system is to check what the experts have to say. The World Health Organization (WHO) last did an expensive and thorough study in 2000. Singapore’s health care was rated 6th best in the world. So my friend was wrong. I have no doubt that hospital bed shortages occur in other rich countries as well, let alone poor ones.
But what is meant by ‘best’ is subjective and the criteria the WHO selected were criticized. For example, the WHO placed a great deal of weighting on equity. A country where the poor have equal access to good health care is given a higher ranking. Thus the US was ranked 37th even though their doctors and medical facilities are the most advanced. The US does not have “free” health care like the British National Health System.
Bloomberg has come up with a simple way to judge health care systems and Singapore was ranked number 1. They simply looked at two things. The first was the life expectancy of each nation and the second was how how much money the country spent to achieve that.
A good healthcare system would save lives and increase the average lifespan of the people. An average Singaporean can expect to live to 84 years of age. According to the WHO, Singaporeans have the third highest life expectancy in the world.
So our healthcare system cannot be lousy as what my friend thinks. Of course our lifestyle also plays a part. But no matter how much we exercise or avoid fatty foods, the healthcare system plays an important part in extending our lives.
For example, it would be unusual for someone in Singapore to die of Malaria. But this is not uncommon in some parts of Africa. A robust 30 year old man could die of Malaria in Africa simply because there are no hospital beds or qualified doctors in his area.
The second thing Bloomberg looked at was money. Obviously, it costs money to build more hospitals and employ medical staff. The more you spend on healthcare, the more healthy the people are and hence the longer they live.
While Singaporean’s life expectancy is 3rd highest, we spend very little on healthcare compared to other rich countries. Bloomberg compared total healthcare spending of different countries. Total healthcare spending means the total of what you pay and what the government pays for health care. Singapore spends only 4.5% of GDP on healthcare as compared to 17.2% of GDP in the US and 9.4% in the UK.
In dollar terms, the US spent US$8,895 per person while Singapore spent US$2,426 per person on health care. Again, Bloomberg took total spending in order to compare apples with apples. The US has an insurance based system, though the poor are helped by the Medicaid scheme. In the UK they have the National Health Service (NHS) which provides “free” healthcare. But that “free” healthcare costs taxpayers US$3,647 per head.
It should be remembered that “free” healthcare is not really free because you are paying for it indirectly with higher taxes. That is why VAT (equivalent to our GST) is 20% in the UK.
I want to point out that despite only spending 4.5% of GDP on healthcare, Singaporeans live longer than Americans and British. We get more results for each dollar spent compared to all other countries.
That is why Bloomberg considers our healthcare to be the most efficient.
So in terms of efficiency, our healthcare is the best.
My friend’s comment about building more hospitals also got me thinking. From the perspective of someone whose relative had to wait 24 hours before getting a hospital bed, this seems like a no-brainer. But we have to think beyond our personal needs to see the big picture.
Spending more money on healthcare by building more hospitals would of course save more lives. We all want to live as long a life as possible.
But a longer life also means that we must retire later. This means that the withdrawal age for our CPF will also have to be later. When our life expectancy was 65, the CPF withdrawal age was 55, which was the then retirement age.
But our life expectancy is now 84. Therefore, we can no longer retire at 55. Otherwise, we won’t have enough money for our retirement years. This also means that it is unwise for us to withdraw our CPF money at 55. A lot of Singaporeans fail to understand this and complained about not being able to withdraw all our CPF at 55.
So our desire to live longer is in conflict with our desire to retire and withdraw our CPF earlier. Spending more money on healthcare will mean more and better hospitals. Finance Minister Tharman Sharmugaratnam has predicted that the government will be spending $20 billion on health care in 2020, up from $4 billion in 2011.
This was done in response to public pressure. But it would increase our life expectancy even more. What if we increase our lifespan to say 95 years? It means that we now have to retire at 75!
That would also mean that the CPF withdrawal age will now be 75. A longer lifespan also means more years being sick.
In Sierra Leone, the average lifespan is 38 years. A young man of say 30, may after a mosquito bite simply die because there are no hospitals in his area to treat him for malaria. He may get a few days of fever before he passes away. Apart from this brief bout of illness, he was in robust health.
But the situation is different for someone who lives to 95 years of age. He may have spent the last 10 years in a wheelchair before he goes. Let me give you a personal example. My granny lived till 85. She suffered a stroke at 80. But thanks to a great healthcare system in Singapore, her life was saved. But her last five years were spent in a state of coma. I don’t think it did her any good.
What would be the result of spending more money on healthcare and building more hospitals? You live longer, but have to work longer. When you retire, you will find that your CPF savings will be spent, not on enjoying yourself, but on your doctors.
Having said that, I note that we have an ageing population. So we have to build more hospitals to cater for the increasing demands for more healthcare. Otherwise, our life expectancy will fall. But it may not be wise for our government to over do it. Otherwise, our average life expectancy will increase further. This means later retirement, more years of chronic illness and more of our savings going to the doctors instead of enjoying our retirement.
We already have the 3rd highest life expectancy in the world. For the time being, till medical science improves to allow a better quality of life in our old age, I think that may be good enough. What do you all think?
Cass Owary
TRS Contributor