This is the third part of a series of articles that I have written on healthcare financing over the past one month, which compares how much Singaporeans are paying into healthcare with other countries and how much they are getting back.

In the first article, I wrote about how the Singapore government puts a cap on how much Singaporeans get to claim from what they pay into national health insurance (Medisave and MediShield) but in the Asian Tigers and Japan, their governments do not put a cap. Instead, they do the opposite – they put a cap on what their citizens have to pay out-of-pocket, and protect their citizens.

This leads on the second article which showed that of the national health insurance premiums that the citizens of the Asian Tigers, Japan and Germany pay, they get back fully the national health insurance premiums that they pay in a year. However, Singaporeans only get back 8.5% of the amount that they pay into national health insurance (Medisave) premiums.

In the third part – which is this article, I show how citizens of the Asian Tigers (Taiwan and South Korea), Japan and Germany pay between 5% and 15% of their wages into national health insurance which then pays for about 50% of the total health expenditure.

But guess how much national health insurance pays into total health expenditure in Singapore?

Well, read on.

Taiwan South Korea Japan Germany Singapore Health Insurance Premium vs Expenditure.png

In Taiwan, citizens pay 4.69% of their wages into national health insurance.

1 Taiwan Health Insurance Contribution Rate vs Total Expenditure.png

Source: National Health Insurance Administration, Ministry of Health and Welfare – How Premiums Are Calculated

And in Taiwan, the national health insurance that citizens pay, pays for 52.6% of total health expenditure.

2 Taiwan Health Insurance Contribution Rate vs Total Expenditure.png

Source: National Health Insurance Administration, Ministry of Health and Welfare

In South Korea, citizens pay 6.12% of their wages into national health insurance.

3 South Korea Health Insurance Contribution Rate vs Total Expenditure.png

Source: National Health Insurance Service Program – Contributions

And in South Korea, the national health insurance that citizens pay, pays for 42.8% of total health expenditure.

4 South Korea Health Insurance Contribution Rate vs Total Expenditure.png

Source: KOrean Statistical Information Service – National Health Care Expenditure by Suppliers and Financial Resources (National Medical Expenses)

In Japan, citizens pay a base 10% of their wages into national health insurance.

5 Japan Health Insurance Contribution Rate vs Total Expenditure.png

Source: Japan Health Insurance Association – Insurance rates 

And in Japan, the national health insurance that citizens pay, pays for 48.6% of total health expenditure.

6 Japan Health Insurance Contribution Rate vs Total Expenditure.png

Source: Ministry of Health, Labor and Welfare – Overview of Medical Service Regime in Japan Financial Situation of Health Insurance

In Germany, citizens pay 14.6% of their wages into national health insurance.

7 Germany Health Insurance Contribution Rate vs Total Expenditure.png

Source: GKV-Spitzenverband – Statutory health insurance

And in Germany, the national health insurance that citizens pay, pays for 58.5% of total health expenditure.

8 Germany Health Insurance Contribution Rate vs Total Expenditure.png

Source: Statistisches Bundesamt – Health expenditure

So, you can see that in these other countries, citizens pay between 5% and 15% of their wages into national health insurance and the national health insurance pays for about half of total health expenditure.

How about Singapore?

It is ugly.

In Singapore, citizens pay between 8% and 10.5% of their wages into national health insurance (Medisave) – which is one of the highest among the countries compared and actually, in the world.

9 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Source: Ministry of Health, Singapore – Medisave Contributions

But in Singapore, the Medisave that Singaporeans pay, pays for ONLY 5.5% of total health expenditure – which would be among the lowest proportionate returns for national health insurance in the world, or possibly the lowest.

10 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Source: Ministry of Health, Singapore – Healthcare financing sources

Isn’t this shocking?

In other countries, the national health insurance that citizens pay, pays for about 50% of total health expenditure.

But in Singapore, it is ONLY 5.5% – or ONLY about one-tenth that of the other countries.

Maybe it is clearer when we put it all in a chart.

Below, you can see that as citizens in a country pay more of their wages into national health insurance, the national health insurance would pay for a higher proportion of total health expenditure.

Taiwan is an exception where healthcare costs are managed so efficiently that national health insurance gives even higher proportionate returns on total health expenditure than the other countries.

However, Singapore bucks the trend on the other extreme – Singaporeans pay one of the highest proportion of their wages into national health insurance (Medisave) in the world but actually get back possibly the lowest proportionate returns, out of total health expenditure.

11 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

In fact, based on the benchmark of other countries, Singaporeans should by right actually be getting back 50% that their Medisave should pay for total health expenditure!

12 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

And as I had written in part two, where the citizens of these other countries get back fully what they pay into national health insurance premiums every year, and if Singaporeans also get back fully what they pay into Mediave premiums, then based on this benchmark, Singaporeans should be getting back 65% that their Medisave should pay for total health expenditure!

(Explanation: (1) Out of the Medisave premiums that Singaporeans pay, they only get to claim back 8.5% of what they pay in a year. If Singaporeans are able to claim back in full what they pay into Medisave premiums in a year, they would be able to claim back about another 11.8 times more. (2) Therefore, if Medisave only pays for 5.5% of total health expenditure now, then when this is multiplied by 11.8 times, Medisave should actually pay for 65% of total health expenditure.)

13 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

But instead, what is happening?

Instead of how Medisave should rightfully be paying for 65% of total health expenditure, it is Singaporeans who have to fork out another 61% out of their own pockets to pay for the total health expenditure instead! (after deducting for government expenditure (and Medifund which is part of government expenditure), Medisave withdrawals and MediShield claims)

14 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Source: Ministry of Health, Singapore – Healthcare financing sources

So where the other countries would take the national health insurance premiums paid by their citizens and return fully to fund about 50% of total health expenditure, the Singapore government instead keeps more than 90% of what they collect from Medisave and make Singaporeans pay another 61% of total health expenditure!

15 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Can you see now how Singaporeans are actually DOUBLE-PAYING for healthcare?

The Medisave that we pay should pay for 65% of total health expenditure, but we only get back 5.5%. What about the balance of 59.5%? (65% – 5.5% = 59.5%)

Instead, the government makes Singaporeans pay in cash out-of-pocket for the balance of 59.5% from Medisave that they should return – we have to pay out-of-pocket another 61%!

16 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Can you see now how Singaporeans are DOUBLE-PAYING?

I have been saying this many times before. But can you see now how it actually works out?

Does this look clearer now? Singaporeans are paying double an amount what they should rightfully be able to get back from Medisave claims.

17 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Now, if you thought that Medisave is bad.

19 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Look at how much MediShield pays.

20 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

And do you know, by right, how much should Singaporeans actually need to pay out-of-pocket?

  1. The government expenditure on health is only 31%.
  2. MediShield pays for 2.14%. But remember, over the last few years, Singaporeans only get back about 50% of what their pay into MediShield premiums. So, if Singaporeans also get back fully what they pay into MediShield premiums, then MediShield should cover about 4.3% of total health expenditure.
  3. And if you add on that Medisave should pay for 65% of total health expenditure, how much should Singaporeans pay out-of-pocket?

ZERO PERCENT!

Singaporeans should be paying S$0 – ZERO – out-of-pocket!

21 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Source: Ministry of Health, Singapore – Healthcare financing sources

However, this is what is happening today:

  1. Government health expenditure takes up 31.1% of total health expenditure.
  2. Medisave covers only 5.5 of total health expenditure.
  3. MediShield covers only 2.1% of total health expenditure.
  4. Singaporeans have to pay 61.3% out-of-pocket.

22 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

But this is what should be happening:

  1. Government health expenditure takes up 31% of total health expenditure.
  2. Medisave should cover 65% of total health expenditure.
  3. MediShield should cover 4.3% of total health expenditure.
  4. All these should cover 100.3% of total health expenditure.

23 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

In short, Singaporeans are paying enough in taxes and national health insurance to get FREE HEALTHCARE today!

We should not even be paying anything out-of-pocket!

In fact, we should get back 0.3% in return. In Germany, this would be returned to citizens as bonuses.

Additionally, seeing now how the Singapore government profits from Medisave and MediShield, then how much does the government profits from the revenue we pay to them? (It is already known that the government has S$20 to $S40 billion in cash surplus every year that it does not declare to Singaporeans as budget surplus, which therefore is not spent back for Singaporeans.)

24 Singaporeans should be getting FREE healthcare.png

And so, what is the net effect with how the Singapore government is profitting from what Singaporeans pay?

Singaporeans pay one of the highest proportion of our wages into national health insurance (Medisave) in the world, and by right the Medisave that we pay should pay for 65% of total health expenditure.

18 Singapore Health Insurance Contribution Rate vs Total Expenditure

But instead, the government turns it around and makes Singaporeans pay the highest out-of-pocket expenditure among the developed countries – 61%.

In comparison, citizens from Taiwan, South Korea, Japan and Germany only need to pay between 10% and 35% out-of-pocket.

And thus Singaporeans actually pay the most dollar amount for out-of-pocket expenditure (after accounting for purchasing power parity) in the world!

25 Singapore Health Insurance Contribution Rate vs Total Expenditure.png

Sources: National Health Insurance Administration, Ministry of Health and Welfare (Taiwan), KOrean Statistical Information Service – National Health Care Expenditure by Suppliers and Financial Resources (National Medical Expenses) (South Korea), Ministry of Health, Labor and Welfare – Overview of Medical Service Regime in Japan Financial Situation of Health Insurance (Japan), Statistisches Bundesamt – Health expenditure (Germany), Ministry of Health, Singapore – Healthcare financing sources (Singapore)

So, all in, this means that whatever Singaporeans pay in taxes, Medisave and MediShield should pay fully for the total health expenditure in Singapore.

Singaporeans should not have to pay a single cent for healthcare!

So why is the People’s Action Party (PAP) ruling government making Singaporeans double-pay on healthcare and profitting from the monies that Singaporeans pay into national health insurance?

Do you think this is ethical?

Do you think that whenever the PAP threatens that Singaporeans have to pay higher taxes in order to get higher subsidies for healthcare, this is fair?

26 PAP Does Not Want to Give Singaporeans Free Healthcare.png

Source: The Straits Times – Free healthcare will mean raising taxes: Tharman

Then what should be done?

The Worker’s Party ‘s Ms Sylvia Lim had already flagged this issue out in parliament in 2012, and asked why the Singapore government’s expenditure is not following international standards.

She said:

Mr Inderjit Singh before me shared how Singapore’s total expenditure on healthcare as a % of GDP was far lower than international standards. More importantly, the government or public expenditure on healthcare is also far lower than elsewhere.

In addition, the Singapore government’s contribution to total health care expenditure has fallen from 51% in 1995 to 41% in 2009. This is much lower than over 60% in many other middle and high income countries.

The Worker’s Party’s Gerald Giam also said in parliament in 2013:

In Singapore, less than one-third of all healthcare costs are paid by the Government. More than 60% of costs are paid by patients out-of-pocket, which includes cash and Medisave. This is much higher than the average of 14% in high income countries, according to data from the World Health Organization.

Both Ms Lim and Mr Giam asked why the Singapore government is underpaying and why Singaporeans are overpaying for health.

In fact, the Singapore Democratic Party (SDP) has even proposed a solution.

Since Singaporeans are already overpaying into Medisave and MediShield today, the Singapore Democratic Party (SDP) wants to reduce the payments that Singaporeans pay into national health insurance.

And it also proposes that Singaporeans should only have to pay out-of-pocket 17% of total health expenditure.

27 SDP wants to reduce out-of-pocket health expenditure for Singaporeans.png

Source: The SDP National Healthcare Plan – Caring for All Singaporeans

The Singapore Democratic Party (SDP) also proposes that Singaporeans should pay only 10% for medical services that they are charged for.

And that there should be a cap of S$2,000 that Singaporeans need to pay on healthcare in a year – Singaporeans should not pay more out-of-pocket beyond that.

28 SDP wants to reduce out-of-pocket health expenditure for Singaporeans.png

Source: The SDP National Healthcare Plan – Caring for All Singaporeans

So you see, the Worker’s Party has pointed out the issues with the PAP government’s discrepancy in the health expenditure financing in Singapore.

And the Singapore Democratic Party (SDP) has also spelt out clearly what the solutions are.

But my dear Singaporeans, why did you choose to hurt yourself?

29 What have you done to yourself