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Reassessing healthcare financing policies in Singapore, 1945 to 2015
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Type
Thesis
Author
Koh, Jansen Zhi Xiong
Supervisor
Blackburn, Kevin
Abstract
This thesis in tracing the developments in healthcare financing policies demonstrates that the People’s Action Party (PAP) was neither entirely transformational nor incremental in healthcare financing in Singapore. Instead, the PAP’s approach to healthcare financing in Singapore was one that is best described by the punctuated equilibrium model.
In the post-World War II period, the British had made much progress in the improvements in healthcare infrastructure and this had then translated into much improved health outcomes for the population. The PAP was in a good position to extend the work of the British after coming into power in 1959. The PAP however gave little emphasis to health, failed to address the issue of medical personnel shortages and health outcomes that improved drastically under the British, and generally showed no improvements for the period of 1959 to 1965. In the period of 1965 to 1983, there was no massive transformation or any significant milestone plan for state financing of healthcare. The PAP though did make incremental changes to healthcare financing throughout the period with an overarching orientation of shifting the responsibility of healthcare financing from the state to the individual.
The introduction of Medisave in the 1983 Blue Paper marked the start of large-scale changes in healthcare financing in Singapore. There was no urgent need for healthcare reforms in 1983 but Medisave was a forward-looking policy implemented to shift the responsibility of healthcare financing from the state to the individual. MediShield was introduced in 1990 to address the shortcomings of Medisave in the short run to provide additional healthcare coverage for those who slipped through the Medisave safety net. Medifund was however introduced as a political tool to win support for the PAP in the 1991 General Election. The introduction of MediShield Life in 2015 completed the supposed healthcare financing transformation to a universal healthcare system.
It appears that the 3Ms comprising of Medisave, MediShield and Medifund were transformational policies enacted by the PAP government that were anchored on the enduring goal of reducing the responsibility of healthcare financing of the state. However, taking a macro view of healthcare financing in Singapore from 1945 to 2015, the PAP was certainly not transformational in healthcare financing. They inherited a healthcare financing model from the British that offered universal healthcare coverage in 1959, and with the transition to MediShield Life in 2015, reverted back to a healthcare financing model that offered universal healthcare coverage, albeit with different mechanisms.
In the post-World War II period, the British had made much progress in the improvements in healthcare infrastructure and this had then translated into much improved health outcomes for the population. The PAP was in a good position to extend the work of the British after coming into power in 1959. The PAP however gave little emphasis to health, failed to address the issue of medical personnel shortages and health outcomes that improved drastically under the British, and generally showed no improvements for the period of 1959 to 1965. In the period of 1965 to 1983, there was no massive transformation or any significant milestone plan for state financing of healthcare. The PAP though did make incremental changes to healthcare financing throughout the period with an overarching orientation of shifting the responsibility of healthcare financing from the state to the individual.
The introduction of Medisave in the 1983 Blue Paper marked the start of large-scale changes in healthcare financing in Singapore. There was no urgent need for healthcare reforms in 1983 but Medisave was a forward-looking policy implemented to shift the responsibility of healthcare financing from the state to the individual. MediShield was introduced in 1990 to address the shortcomings of Medisave in the short run to provide additional healthcare coverage for those who slipped through the Medisave safety net. Medifund was however introduced as a political tool to win support for the PAP in the 1991 General Election. The introduction of MediShield Life in 2015 completed the supposed healthcare financing transformation to a universal healthcare system.
It appears that the 3Ms comprising of Medisave, MediShield and Medifund were transformational policies enacted by the PAP government that were anchored on the enduring goal of reducing the responsibility of healthcare financing of the state. However, taking a macro view of healthcare financing in Singapore from 1945 to 2015, the PAP was certainly not transformational in healthcare financing. They inherited a healthcare financing model from the British that offered universal healthcare coverage in 1959, and with the transition to MediShield Life in 2015, reverted back to a healthcare financing model that offered universal healthcare coverage, albeit with different mechanisms.
Date Issued
2018
Call Number
DS610.6 Koh
Date Submitted
2018