89 12 17 89 12 22 90 4 1
2
1 2 2 3 4. 4 1.. 4 2..5 3..6 4..7 3M Medisave, Medishield, Medifund (Medisave 2. 3....21 1... 21 2...24 3....26 4....27 3
5....28..33.. 33.. 34..34.....36.....37.....38 4
Medisave Medishield Medifund 5
6
12/17 12/18 1. 1. Singapore Ministry of Health Medisave, Medishield 2. and Medifund Singapore General 2. Hospital Central Provident 7
Fund 3. 12/19 12/20 1. Prof. Phua 1. National University of Singapore 2. 2. National University Hospital 12/21 Mount Elizabeth Hospital 12/22 2000 8
20% 9
5% 10
Medisave 7.3% 80% 20% 80% 11
Medishield Medifund M GDP 3.1% 8% 23% 87% 80% 64% 12
14.0 6.6 3,708 79.2 72.5 0.80 10.4 8.2 3,036 79.5 73.0 0.53 9.9 7.8 2,550 81.9 74.0 0.50 7.3 5.7 2,952 82.8 76.4 0.43 6.7 5.8 1,365 79.7 74.3 0.60 5.3 3.4* 613 77.8 71.9 0.64 3.1 0.7 635 79.2 75.0 0.36 1997 OECD 1995 1996 GDP 1993 1998 1993 1998 56.8 61.5 28.4 35.3 75.0 83.9 5.8 18.9 38.5 48.8 13
11.7 34.4 72.1 86.8 60.3 80.7 28.9 53.3 M Medisave, Medishield, Medifund 14
12% 20% 24% 2% 6% 32% 12% 20% 23% 2% 7% 32% 12% 20% 22% 2% 8% 32% 4.5% 12.5% 9% - 8% 17% 2.5% 7.5% 2% - 8% 10% 2.5% 5% - - 7.5% 7.5% Medisave Medishiled) Medishield Plus (MediFund (Medisave) Medishiled Medishield Plus Medifund (Medisave 15
6% $360 7% $420 8% $480 $24,000 2003 $30,000 16
1A 1C 2A 2C $150 - $250 $350 - $600 3A 3C $800 - $1,200 4A 4C $1,400 - $1,800 5A 5C $2,000 - $2,400 6A 6C $2,800 - $3,600 7A 7C $4,000 - $5,000 2B $450 3A $800 17
4A $1,400 18
.. NTUC Incomeshield, NTUC Managed Healthcare System, AIA Healthshield. 19
$12 $36 $60 $18 $54 $90 $36 $108 $180 $60 $180 $300 $96 $288 $480 $132 $396 $660 $204 $612 $1,020 $240 $720 $1,200 Deductible Co-insurance 20
20% 80% $2,500 $4,000 20% 20% Gamma 21
$100 $300 $400 $200 $600 $800 $400 $1,000 $1,300 $500 $1,500 $2,000 $500 $2,000 $3,000 $600 $3,000 $4,000 $600 $4,500 $5,500 $1,500 $2,500 $3,500 Gamma $4,800 $9,600 $12,600 $20,000 $50,000 $70,000 $80,000 $150,000 $200,000 22
23
202 20% 74,308 52.4 4.2% 1.9% 1.5% 19% 24
1999 75,730 98.9% 73.5% 26.5% 1999 11,747 1999 25
7,853 20.2 6,268 16.1 1,585 4.1 3,168 8.1 3,114 8 54 0.1 726 1.9 178 0.5 548 1.4 11,747 30.2 9,560 24.6 2,187 5.6 80% 80% 20% 15%-20% 80%-85% 26
1999 1,158 1,367 5,325 1 730 942 1,043 15,947 1999 5,325 2,535 2,606 184 27
942 167 726 49 1,043 219 598 226 15,947 8,692 3,872 3,383 % 2,535 47.6 1,284 24.1 28
1,078 20.2 173 3.2 2,606 48.9 1,170 22 988 18.6 251 4.7 197 3.7 13 0.3 171 3.2 5,325 100.0 National Health Expenditure, NHE,292 1,347 4.3% Restructuring Restructuring Privatization Health Corporation of Singapore,HCS 29
Decentralized Woodbridge H. Alexandra H cluster cluster 30
2000 National Healthcare Group Singapore Health service restructured hospital /institutions Voluntary welfare organization,vwos A 0 100% B1 20% 80% B2 + 50% 50% B2 65% 35% C 80% 20% 31
, case- mixed per-diem Australian National DRGs AN-DRG V3.1 s 32
Singapore General Hospital Singapore Health Service Pte. Ltd Singapore Group National University Hospital National HealthCare Group Mount Elizabeth Hospital Singapore General Hospital,SGH Singapore 33
Health Service Pte. Ltd or Singhealth, 59-60% 4.8-4.9 95% 91% 6.8 7.9 A B1 B2+ B2 C 34
250-280 150-170 100 50 25 1 4 5 6 9 Day Surgery Financial Counselling Medisave Medishield Medifund 35
Medisave Authorization Form Medishield Financial Counselling Acknowledge Form Medifund Application Form National University Hospital National Health Group deluxe suite 36
Minimally Surgery Invasive Centre, MISC John Hopkins Hospital Mount Elizabeth Hospital Parkway Group Healthcare ISO9002 37
Medisave Medisave (Medishiled) Medifund) EIU The Economist Intelligence Unit Healthcare Asia 1 st quarter 2000 Medisave 90% 350% 51% 43% 20% 38
Healthcare Asia 1 st quarter 2000 MSA GDP OECD 2 WHO MSA 1. 2. 39
3. 40
Year 1999 Table1 Bed Complement at Hospitals and Specialty Centres Public Sector Hospitals & Specialty Centres Bed Complement Singapore General Hospital SGH * 1,438 National University Hospital NUH * 957 Tan Tock Seng Hospital TTSH * 1,312 include Communicable Disease Centre and TTSH Rehabilitation Centre at AMKH Changi General Hospital CGH * 801 Alexandra Hospital AH * 404 KK Women s and Children s Hospital KKH 898 Ang Mo Kio Community Hospital AMKH 178 Woodbridge Hospital WH -Psychiatric 3,114 National Cancer Centre NCC 85 National Heart Centre NHC 188 National Neuroscience Institute HNI 185 Singapore National Eye Centre SNEC - National Skin Centre NSC - 41
National Dental Centre NDC - *Acute general hospitals Table2 Bed Complement at Hospitals and Specialty Centres Private Sector Hospitals Bed Complement Mount Elizabeth Hospital MEH 505 Gleneagles Hospital GEH 328 Eastshore Hospital ESH 157 Mount Alvernia Hospital MAH 300 HMI Balestier Hospital HMI BH 62 John Hopkins Singapore Clinical Service s 14 Thomson Medical Centre TMC 191 Ren Ci Hospital RCH 234 St Andrew s Community Hospital SACH 60 St Luke s Hospital for the Elderly SLH 224 Kwong Wai Shiu Hospital KWSH 30 Adam Road Hospital ARH -Psychiatry 49 Raffles Surgicentre 25 42
ORGANISATION STRUCTURE MOH Holdings Western Cluster National Healthcare Group Eastern Cluster Singapore Health Services National University Ang Mo Kio Singapore General Bedok Hospital Bukit Batok Hospital Bukit Merah Tan Tock Seng Choa Chu Kang Changi General Hospital Geylang Hospital Clementl KK Women s & Institute of Alexandra Hospipal Jurong Children s Hospital Health Woodbridge Hospital Hougang Ang Mo Kio Community Marine Parade /institute of Mental Toa Payoh Hospital Health Woodlands Singapore National Eye Queenstown National Skin Centre Yishun Centre Tampines National neuroscience institute National Heart Centre National Cancer Centre National Dental Centre 43
1. OECD Health Data, 1997. 2. Health Facts, Singapore Ministry of Health, 1997. 3. The Economist Intelligence Unit, Healthcare Asia 1 st quarter 2000. 4. The World Health Report 2000, Health Systems Improving Performance. 5. 6. 44