Singaporeans, The Truth About Our Healthcare Financing, Retirement Funds and Money All Revealed! (Part 1)

Introduction

In this article, I would show you the real statistics of Singapore’s healthcare financing, retirement funds and wages to show you the truth about how our money is being used, or actually, being taken away from us. I do not intend to pretend that this article is neutral. It is not, because as I found out more information, I needed to take a stand.

I had initially started writing this article as an article on our healthcare financing, but as I dug out more information and started piecing things together, it went beyond my original scope. Thus the article would start off with some healthcare statistics, but will eventually reveal other statistics on our retirement funds, wages and money.

It is very easy to read this article. I will guide you through each chart, so that you can understand at one glance what each is saying.

I promise that you will go away from this article with more insights about the monetary situation in Singapore. Please have some patience to read this. It will only take you 10 to 15 minutes to read this article.

I have split this article into two parts, so that in case you might find the article too long, you can take a break before proceeding onto the next part. But please come back and read it. Do not close your browser as there is very important information that you need to know in this article.

The article is structured into 7 sections:

  1. Healthcare Outcomes
  2. Health Expenditure
  3. Medisave Financing
  4. Can The Poor and Elderly Afford Healthcare in Singapore?
  5. Are We Paid Enough to Afford Healthcare in Singapore?
  6. Where Is Our Money Really Going?
  7. Do We Really Have Good Health?

Here goes. First, I will show you very quickly the achievements that Singapore has made in our health outcomes. This is the (only) rosy part of this article. If you want to skip to the ‘real’ insights, you can jump to Section 2.

For charts in the first half of the article, you can quickly identify Singapore by the red bar, red line or red dot.

(1) Health Outcomes (Charts 1 to 4b)

In Chart 1, you can see that Singapore has one of the lowest, if not the lowest infant mortality in the world.

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Chart 1: World Health Organisation World Health Statistics

Chart 2 shows that we have a reasonably low maternal mortality rate, and one of the lowest in the world. According to the recently released ‘State of the World’s Mothers 2013’ report, Channel NewsAsia had reported that, “Singapore is the safest place to be born and the best place to be a mother in Asia … (as) Singapore has the lowest first-day mortality rate in Asia.”

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Chart 2: World Health Organisation World Health Statistics

In Chart 3a, you can see that we have one of the highest life expectancies in the world.

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Chart 3a: UNdata

In Chart 3b, you can see that our healthy life expectancy is lower-ranked than our life expectancy. The healthy life expectancy is the number of years we stay healthy.

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Chart 3b: UNdata

You can see why this is so in Chart 3c – because we live slightly more unhealthy years than some of the other countries.

But more importantly, with more unhealthy years, is there affordable healthcare in Singapore to tide Singaporeans through these years? Read on to find out.

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Chart 3c: UNdataUNdata

In Chart 4a, you can see that the adult morality rate of Singaporeans is average and on par with the other developed countries.

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Chart 4a: World Health Organisation World Health Statistics

In Chart 4b, I had highlighted the morality rate for communicable diseases because it had stood out. This is perhaps not surprising because of our high population density.

The question then is that as the Singapore government plans for 6.9 million people by 2030, do we have adequate healthcare facilities to prepare for the high probability of an even higher morality rate for communicable diseases than we do now and do we have plans to structure the built environment to reduce this probability?

photo 2 (11)

Chart 4b: World Health Organisation World Health Statistics

So, generally, you can see that our health outcomes are quite good.

But things don’t look as good from here on.

(2) Health Expenditure (Charts 5a to 18c)

In Chart 5a, you can see that the number of hospital admissions had been increasing for the past 3 years.

(Note: I am not able to locate statistics for beyond the last 3 years on the Ministry of Health’s website. I am not sure why the government had chosen to only show statistics for the preceding 3 years and had chosen not to reveal the statistics prior to 2010. It does not allow Singaporeans to have a clear picture. It is in Singaporeans’ interest that the statistics are fully revealed. This is undemocratic and an intrusion into the rights of Singaporeans for free information.)

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Chart 5a: Ministry of Health Singapore Admissions and Outpatient Attendances

In Chart 5b, you can also see that attendance to the accident and emergency (A&E) units had also increased.

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Chart 5b: Ministry of Health Singapore Admissions and Outpatient Attendances

In Chart 5c, you can see that the hospital admissions and attendance to A&E had increased at a faster rate than the population growth in Singapore. This can be seen by how the blue bars are taller than the yellow-orange bars.

photo 5 (10)

Chart 5c: Singapore Department of StatisticsMinistry of Health Singapore Admissions and Outpatient Attendances

This is where it starts to get interesting.

Even though there are more and more patients visiting the hospitals, the number of physicians per 10,000 population had remained the same (Chart 6a – data for 2011 and 2012 is unavailable).

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Chart 6a: World Health Organisation World Health Statistics

The number of hospital beds per 10,000 population had also remained the same (Chart 6b – data for 2012 is unavailable).

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Chart 6b: World Health Organisation World Health Statistics

More importantly, if you look at Chart 6c, you will see that Singapore has the lowest number of physicians per 10,000 population.

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Chart 6c: World Health Organisation World Health Expenditure Database

Not only that, we also have one of the lowest number of hospital beds per 10,000 population (Chart 6d).

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Chart 6d: World Health Organisation World Health Expenditure Database

But why do we have so few physicians and hospital beds per 10,000 population, when the number of patients to the hospitals are increasing at a faster rate than the population in Singapore? Shouldn’t we have more?

If you look at Chart 7, you can see that Singapore has the highest GDP per capita as compared to the other countries compared, and one of the highest in the world.

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Chart 7: The World Bank Data

But when you look at Chart 8a, you can see that even though we are the richest (highest on the chart), we have the fewest number of physicians per 1,000 population (most left-to-the-side of the chart). By right, if a country is richer, shouldn’t it be able to provide for more physicians?

On the other end, you can see that Norway is similarly rich but have one of the highest number of physicians per 1,000 population. Even other countries which are less rich have more physicians per 1,000 population.

photo 1 (9)

Chart 8a: UNDP International Human Development Indicators

But no wonder we have such a low number of physicians per 1,000 population (lowest on the chart) because even though the Singapore government is very rich, it spends the least proportion of GDP on healthcare (most left-to-the-side of the chart) (Chart 8b). This is why we do not have enough doctors and hospitals beds.

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Chart 8b: UNDP International Human Development Indicators

(Note: From charts 9a to 16b, I would be showing dual-comparison charts of the (1) year with the latest information and the (2) trend from 1996 – so there would be two charts which will present the same information differently.)

Indeed, in Chart 9a, you can thus see that our government spends the lowest proportion of GDP on healthcare.

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Chart 9a: World Health Organisation World Health Expenditure Database

In fact, our government had consistently spent the lowest proportion of GDP on healthcare for the past two decades, at least (Chart 9b).

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Chart 9b: World Health Organisation World Health Expenditure Database

What’s more, even though Singapore is the richest (highest on the chart), our government spends the least on healthcare (most left-to-the-side of the chart) (Chart 9c).

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Chart 9c: UNDP International Human Development Indicators

It is even more glaring when you look at Chart 9d – we have the largest amount of reserves (highest on the chart), but yet we spend the least on healthcare (most left-to-the-side of the chart).

photo 1 (8)

Chart 9d: UNDP International Human Development Indicators

And for our healthcare bills, how much does the government contributes? – The government only spends 31% on our healthcare bills (Chart 10a) – the lowest among all the developed countries, and one of the lowest in the world.

photo 2 (8)

Chart 10a: World Health Organisation World Health Expenditure Database

In Chart 10b, you can see that not only does the Singapore government spends the lowest proportion on our healthcare bills, the proportion has fallen rapidly over the past two decades to the lowest ever in the past few years.

If you look at the other countries, most of them have maintained the same proportion since 1996 and some have even increased the government’s proportion of expenditure, but the Singapore government has chosen to go the other way and deny its support to the people.

photo 3 (8)

Chart 10b: World Health Organisation World Health Expenditure Database

Again, you can see in Chart 10c that even though Singapore is the richest country (highest on the chart), our government spends the least for our own healthcare bills (most left-to-the-side of the chart).

Yet again, all the other countries which are less rich (lower on the chart) spends more on their people as well (more right-to-the-side of the chart).

The Singapore government had recently announced with fanfare and grandeur that they would increase the government’s proportion of healthcare spending to 40%. So, what, Singaporeans? So, what? It will still be the lowest.

photo 4 (7)

Chart 10c: UNDP International Human Development Indicators

So, what does this mean for YOU and your own spending on your healthcare bills?

This means that Singaporeans spend the highest proportion on our healthcare among the developed countries (Chart 11a) – the Singapore people are faced with the highest burden on healthcare among peoples of the developed countries – even though our country is the richest!

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Chart 11a: World Health Organisation World Health Expenditure Database

You can also see that the burden on Singaporeans has been increasing drastically since 1996 in Chart 11b.

Yet, in other countries, their people need to fork out for a smaller proportion for their healthcare bills at a consistently low proportion, and for some, the proportion has fallen.

But our government is unable to do more for us – or rather, is unwilling to.

photo 1 (7)

Chart 11b: World Health Organisation World Health Expenditure Database

It gets even more glaring in Chart 12a. You can use insurance to pay for your healthcare bills. But you can see that even after deducting for insurance, Singaporeans have to pay the highest proportion of our healthcare bills out of our pockets, whereas the insurance would help to heavily reduce the bills for our peers in the other developed countries.

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Chart 12a: World Health Organisation World Health Expenditure Database

The picture becomes so much clearer in Chart 12b when we look at the trend over the past few years.

As the richest country in this comparison, the government cannot do more for its people but expect the people to shoulder the burden by themselves – and increasingly so over the years!

photo 3 (7)

Chart 12b: World Health Organisation World Health Expenditure Database

Why then are we buying insurance if the insurance does not provide us with adequate coverage? What are the insurance companies really earning?

In Chart 12c, you can see that Singapore has one of the lowest growths in insurance claim payments among the developed countries.

photo (3)

Chart 12c: OECD Global Insurance Market Trends 2012

Now, let’s turn our attention from the proportionate expenditure to the actual amount of money spent.

In Chart 13a, you can see the per capita expenditure on healthcare. Apparently, Singapore has the second lowest per capita expenditure on healthcare. Sounds good, right? Healthcare must be really cheap in Singapore!

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Chart 13a: World Health Organisation World Health Expenditure Database

So, the per capita expenditure on healthcare might have remained low in Singapore over the past few years (Chart 13b).

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Chart 13b: World Health Organisation World Health Expenditure Database

Yet, to be able to have a clear understanding of why per capita expenditure on healthcare is low, we would need other statistics such as whether people would see a doctor once they feel unwell or if they would delay seeing a doctor for other reasons (such as the inability to pay, for example). Unfortunately, I am not able to locate these statistics.

However, are Singaporeans fortunate that per capita expenditure on healthcare is low? And can people afford to pay to see a doctor in Singapore?

Read on to find out.

In Chart 14a, you can see that in terms of actual dollars and cents, our government spends the least among all developed countries on the per capita expenditure on healthcare. This is even so that we are the richest country and the government can afford to do more for the people.

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Chart 14a: World Health Organisation World Health Expenditure Database

In Chart 14b, you can see that whereas other governments had increased the actual amount that they spent on healthcare for their people faster, our government had increased their contributions at the slowest rate. You can see this from how much flatter the red line is, as compared to the others.

The governments of other countries have been providing more and more for their people, while the Singapore government had turned the other way and provided comparatively lesser and lesser for the people.

photo 2 (6)

Chart 14b: World Health Organisation World Health Expenditure Database

So, what does this mean as to how much Singaporeans have to pay? Obviously, if the government is paying lesser, we will have to pay more, right?

Then, you might say – thankfully we have a very low per capita expenditure on healthcare in Singapore, so even if we have to pay more, it won’t be that high an amount right?

That’s where we are so wrong. Because we pay the highest proportion on our own healthcare bills, even with the one of the lowest per capita expenditure on healthcare, we actually pay the highest amount on our healthcare!

You can see this in Chart 15a.

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Chart 15a: World Health Organisation World Health Expenditure Database

Isn’t this shocking? We have one of the lowest per capita expenditure on healthcare but our people have to pay so much more than people in the other developed countries! How does this even work?

Not only that, if you see in Chart 15b, you can see that the increase in our private expenditure is very steep – the steepest amongst all the countries compared.photo 4 (5)

Chart 15b: World Health Organisation World Health Expenditure Database

So, our government had allowed themselves to increase their contribution to our healthcare bills at the lowest rate, but they had forced us to pay more and more for our own healthcare bills at the fastest rate, so much so that from being comparable with the other nations, we have outstripped them.

This is from a country where the country is so rich that the government can afford to give back to the people but the government wouldn’t.

If you look back at Chart 7 again, you will see that Norway also has one of the highest GDP per capita in the world, so it is as rich as Singapore. And the Norwegian government also forks out the most to pay the people’s healthcare bills (Chart 10a and 14a). The Norwegian government is responsible and knows that it has to share what the country earns – because of the people’s efforts – with the people.

In Singapore, this is not the case. The government asks us to contribute to the(ir) economy, and then keeps the money for themselves. Well, is it coming back?

In Chart 16a, you can see that after deducting for insurance, again, it’s even more glaring. We fork out the most money out of our own pockets to pay for healthcare bills, almost twice that of the next country.

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Chart 16a: World Health Organisation World Health Expenditure Database

Again, in Chart 16b, you can see how this has shot up dramatically. Dear Singaporeans, welcome to legalised daylight robbery.

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Chart 16b: World Health Organisation World Health Expenditure Database

Has our government taken self-reliance too far? According to a study, “Co-payments remain central to healthcare funding in Singapore in keeping with its philosophy of “shared responsibility” between government and the public, and there is evidence that Singapore’s funding model exacerbates inequity.”

Earlier, I had asked – is our healthcare affordable? What do you think of it now?

We are one of the richest countries in the world. Yet, our government spends the least on its people and even though on paper, we have one of the lowest per capita expenditure on healthcare, we are forced to fork out, out of our pockets, the highest amount among the other countries to pay for our own healthcare bills. So, even though initially, it looks like healthcare is affordable in Singapore (before we breakdown the bills), is it really?

Do you know why the per capita expenditure on healthcare is low? This is because the government wants to keep healthcare prices relatively low in Singapore to grow Singapore as a medical tourism destination. However, while we keep costs low for the rich who can afford to travel to Singapore for healthcare, our own people are then forced to take on the burden of shouldering the increasing healthcare costs in Singapore – are we subsidising the healthcare costs of the rich medical tourists?

Amidst all these, where is the government? It has conveniently thrown our market open to attract more tourists to earn from them – ‘Your Singapore(ans)’ are so “shiok” to take advantage of, and whilst they keep the money earned, very little comes back to us.

Why are we made to shoulder the burden, while the government cuts its support for Singaporeans, at the expense of rich tourists?

There’s even more. Can the government do more? It can but it doesn’t want to. Let me show you.

In Chart 17a, the blue line shows, as had been discussed, that the overall per capita expenditure on healthcare has risen steeply. The red line shows how little the government had increased its expenditure – the line is almost flat.

So, you can see that the per capita expenditure is rising steeply but the government’s contribution hasn’t risen as fast.

photo 2 (5)

Chart 17a: World Health Organisation World Health Expenditure Database

In Chart 17b, the green line is how much we have to pay out of our own pockets. Again, as compared to what the government pays (red line), we are made to pay much more.

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Chart 17b: World Health Organisation World Health Expenditure Database

But do you know how much our wages have been increasing?

Chart 18a shows the growth of the median gross monthly income. (Note: Data from 2005 and 2006 is unavailable.)

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Chart 18a: Ministry of Manpower Singapore Income

In Chart 18b, I compare the growth in our income (pink line) to the increase in per capita healthcare expenditure (blue line).

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Chart 18b: Ministry of Manpower Singapore IncomeWorld Health Organisation World Health Expenditure Database

You can see that healthcare expenditure is rising faster than our wages. In other words, what we need to pay for healthcare is increasing faster than our wages. This means that with the slow growth in our wages, we have to fork out more and more to pay for our healthcare bills, which means we would have lesser to save every year.

Now, do you know why it looks like our savings haven’t increased over the past few years? But this isn’t the only reason, as we will see later.

In Chart 18c, you can see that the proportionate change in the real median gross monthly income. This means that after accounting for inflation, our wages had remained stagnant.

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Chart 18c: Ministry of Manpower Singapore Income

Why is this important? Read on.

In the next part, I would share with you where else we are forced to pay for rising healthcare costs. Also, we would see that our wages are not growing on par and then find out where our money is really going to.

You can read the next part of the article here.

Key Points for Part 1:

  • On the overall, Singapore’s health outcomes are good.
  • However, with an increase in the hospital attendances which is faster than population growth, this means that we would require more doctors and hospital beds.
  • However, Singapore has the lowest number of doctors and one of the lowest number of hospital beds per 10,000 population among the developed countries.
  • This is even so that Singapore has one of the highest GDP per capita in the world, but we spend one of the lowest proportion of GDP on healthcare, which explains the low number of doctors and hospital beds as well.
  • For our healthcare expenditure, the government also spends the lowest proportion among the developed countries, which leads Singaporeans to spend the highest private and out-of-pocket expenditure on our healthcare bills.
  • When we look at the actual dollar spent, Singapore has the second lowest per capita expenditure on healthcare among the developed countries compared.
  • Yet, our government spends the lowest expenditure per capita on healthcare.
  • Because Singaporeans pay the highest proportion on healthcare bills, this means that even though we have the second lowest per capita expenditure, Singaporeans spend the highest private expenditure and fork out the highest amount out of our pockets for our healthcare bills – which means Singaporeans pay the most for healthcare as compared to the developed countries.
  • Per capita healthcare expenditure has risen rapidly over the past few years but the growth in the government’s per capita spending on healthcare has been significantly slower.
  • Per capita healthcare expenditure has also been rising faster than the growth in the wages of Singaporeans, which means that Singaporeans have to fork out even more out of their stagnant wages to foot the growing healthcare bills.

21 comments

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  3. anonymous

    A chart showing the healthcare insurance premiums for all countries will be helpful in making a more objective comparison. In countries that are paying much higher insurance premiums, it is also expected that the payout from insurance is also higher.

  4. Kathy

    Bro, i want to make a candid remark. Thank you for writing. To make your lengthy discourse more not worthy and easier to read, i suggest you put them up on a powerpoint slides and upload or provide a link to upload as most singaporeans prefer reading long charts and writing in a powerpoint slide than on a white screen. This way, your slides can be emailed and passed over many people fast and you get a larger crowd. Do it! Your fan.

  5. Kathy

    A comparison with other countries, notably with Japan, Canada, Australia, Taiwan, Malaysia would go a long way.

  6. jhontan

    Our Ministers are not interested in our healthcare expenditure because they and their family are covered for life with free VIP class medical services under their pension schemes available only to the Ministers.

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  8. Kenneth Kok

    Hi Author,

    Really good post, great information and analysis you have there! (:
    Just curious, did you take into account the social security and taxes that other countries pay (in % of their income) vs Singapore? (:

    Best Regards,
    Kenneth

  9. Juha

    Hi there!

    Thanks for a very interesting presentation! I’m from Finland, where there are a lot of hospital beds & doctors, and we get them for free! However, that’s not the whole truth.

    We have one of the highest tax rate in the world. That’s because all the “free” stuff the goverment gives to people. You can imagine, if an average guy earns $100, he has to pay $56 for taxes. That leaves him only $44 to spend himself.

    Our health care is very inefficient, because it’s run by the goverment. The cost would be much cheaper, if it was run by private companies. You have to wait for weeks just to see doctor and months, sometimes even years, if it’s a major procedure. That’s why there are private companies coming up, because people are tired of waiting.

    You get the picture? We pay terrible taxes to get inefficient treatment and have to wait to get it so long, that we’d love to pay extra for a private doctor to treat us. Also, because the goverment (taxpayers) pay for your health, we have all kinds of prohibitions or “health taxes” for unhealthy products like candy, ice cream, soda, alcohol, tobacco, to make them even more expensive. The people also have no incentive to take care of themselves, because you get free treatment anyway. It causes a lot of people to ignore healthy habits and end up to hositals, where other people have to pay their treatment.

    This really sucks, man. I would take your system any day, if it was possible.

    • Roy Ngerng

      Hi Juha,

      Let me give you a clearer perspective of Singapore.

      We pay low tax rates but whatever we are paying out-of-pocket for healthcare and education, for which the Nordic countries receive for free, when added up, the tax and out-of-pocket expenditure that we pay is equivalent to what the Nordic countries pay as taxes.

      From a cash flow perspective, there is thus no difference.

      Because of the low spending by the government on health in Singapore, waiting times are made longer and longer, and doctors are pushing patients out of the hospitals faster. There are more misdiagnosis, and because the poor cannot afford healthcare, many of them have been left out of the system.

      Such is the system in Singapore where the low government financing has created inequalities in Singapore.

      The problem you face with the inefficiencies is a matter to be dealt with by better organisation all capacity, and is not completely related to the tax infrastructure.

      Roy

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  17. Bard Henriksen

    The same happens in all countries. The short answer is int’l “fiat economy”. The challenges described are much bigger in Norway. For example we pay very high taxes but have the most expensive dentist prices in the world.

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