Singaporeans Pay High Rates for Health Insurance, but Get Back Low Returns; Other Countries Pay Low Rates, Get High Returns

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

 

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21 comments

  1. Terry

    Keep up the good work
    You ought to do articles on
    1. president Dr. Tony TAN and how he is protecting the country’s assets and
    2. Temasek Holdings
    Timely for the Presidential elections coming up

  2. PAPer dollhouse

    NSmen are also keen to know what kind of reservist activities did tony tan’s son, the infamous patrick tan, perform 🙂

  3. Singapore Citizen Mr. Teo En Ming (Zhang Enming)

    OFFICIAL COMPLAINT AGAINST THE SINGAPORE GOVERNMENT FOR ALLEGEDLY FALSIFYING TEO EN MING’S MEDICAL RECORDS

    Mr. Teo En Ming (Zhang Enming)
    Singapore Citizen
    TARGETED INDIVIDUAL (TI)
    Mr. Teo En Ming (Zhang Enming) @ sgvideoman is Persecuted, Targeted, Blacklisted, and Condemned by Prime Minister Lee Hsien Loong and the Singapore Government
    8 September 2016 Thursday Singapore Time
    9:09 AM GMT+8

  4. Singapore Citizen Mr. Teo En Ming (Zhang Enming)

    ***SUBTLE*** DENIAL OF MEDICAL TREATMENT BY THE SINGAPORE GOVERNMENT FOR MR. TEO EN MING (ZHANG ENMING)

    Mr. Teo En Ming (Zhang Enming)
    Singapore Citizen
    TARGETED INDIVIDUAL (TI)
    Mr. Teo En Ming (Zhang Enming) @ sgvideoman is Persecuted, Targeted, Blacklisted, and Condemned by Prime Minister Lee Hsien Loong and the Singapore Government
    8 September 2016 Thursday Singapore Time
    9:09 AM GMT+8

  5. sgbreadblog

    lol @ the previous comment. It’s Mr. Teo again.

    @ Roy, not sure why there’s no update from you side.. hope it’s not that the case where your blog account has been surrendered to the people who wants you to be silent. Hope to see more of your updates and research results soon.

  6. TNP

    Why can’t u ban this Teo En Ming? He is spamming ur site and driving away readers. Also, he has sabotaged u previously by triggering M Ravi’s bipolar condition and jeopardizing ur case. He could be a mole for all u know.

  7. The Reality

    Dear Roy,

    Hope you’re ok. My experience: The wife had a miscarriage. She took a cab and went to KKH. I arrived 20 mins later by taxi. I came to see the receptionist who asked me how I would make payment. At the time, I had $46 000 in medisave. I told her she can billed from that account. The bill was $1500 for one night CNG operation. I was told that to perform that operation procedure was capped. I was told that the government doesn’t allow us to deduct all of that $1500 to save my wife’s life. It was a state of emergency. But I was not allowed to fully use my own medisave money to fully finance the operation. Why did I learn about this only when it happened to me? Absence of information is how this policy operates. I paid $900 in cash. I didn’t vote for them in GE 2015 because of this. It happened twice to us.

    In Singapore today, we practise economic caste system. Just look at which races are doing what jobs? Marginalization in the civil service is common fare. If you’re a minority race, it’s even worse. Do I accept this? Nope. We’re leaving.

  8. Catherine

    Excerpt from 5000 teachers leave service, Strait Times facebook: Comment [the comment was actually allowed on the facebook site but others could not see it even though the commenter sees that her post was actually successful.] Am mirroring it here. Commenter was a Singaporean lady who apparently left MOE.

    “Research on teacher education is scattered and fragmented and usually directed towards policy that would improve teacher education. There is a dearth of investigations that deal with the unique Singaporean situation and the unique factors that affect the learning of Singaporean students. All these non-Singaporean lectures in NIE are not researching much of the singapore context and thus do not add value to teacher education. Even the Academy of Singapore teachers have had much research work done. Tweaking syllabuses of English 2010 to meet the requirements of PISA rankings seem to be our forte at the moment. Teachers are semiprofessionals in MOE; they are held accountability to their superiors and not to the profession itself. It is no longer a work of the heart as propagated in MOE advertisements on local TV. What’s worse, MOE teachers are tasked to run election duties and presidential elections as well. Professional teachers don’t do this in other countries except in MOE. Imagine a doctor being tasked to do election duties. Such, teachers are not able to have autonomy in making professional decisions. This is why in the private discussions of the public, teaching is no longer a priviledge vocation as it faces competition of talents from other industries that pay better and does not lock a person within the 4 walls of a classroom. MOE needs to fix these issues. Perhaps it could start by not putting in place an ex-SAF officer to head its ministry of education. Many come into MOE when the economy is bad and leave when opportunities are better. What MOE seems to be good at is not in retaining talented teachers (apart from its own institutional definition of what a good teacher is which is nothing but being a good civil servant and a public officer rather than a professional teacher – this definition in itself is incongruent). MInd you, the Departmental Management MOdule at NIE that trains head of departments addresses fellow teachers in the fraternity as SUBORDINATES not teachers. The whole climate has been corporatised and parents are called stakeholders, mind you. After 50 years, MOE can’t even eradicate kiasuism and kiasism but has in fact perpetuate it in its hegemonic testing-culture of exams and CAs one after another. IF you’re smart, don’t join MOE. DOn’t be fooled by this monetary hook.

    The system is unmeritocratic at the same time. I witnessed a lot of talented and educated male Indian colleagues who were marginalised for promotions. The chinese HODs promoted their own race. There is clearly a chinese priviledge in promotions. One of the D ranskings is often given to a minority race teacher. There are also problems of teachers falling ill and on MCs in all schools because of the overwork. That’s why the climate surveys in schools is bad. And it has been so for the past 15 years. Recent studies in NIE by Dr Jason Loh and others have shown that the 10% to 15% of teachers leave the service. That’s at least 3000 teachers resigning and the perm sectary and above and playing down on this for years.

    The unspoken and sad silent reality is that many teachers get hypertension in their 30s, high blood pressure in their 40s and god forbid a hint of heart attack and stroke by their mid-50s as there are too busy, they can’t find time to exercise or rest. Teachers’ passions are being abused in the name that teaching is a calling. They’re on tight deadlines for marking and countless exam papers setting, CCAs, extended committees, departmental duties, in some cases double department duties or committees, competitions, disciplining, meetings for PLCs, staff meetings, department meetings (two departmental meetings for those teaching 2 subjects), file checkings for hundreds of files/worksheets, remedial sessions after school more repetition of teaching because of these systemic issues causing them) etc.. We haven’t cover the administration work. Talking to parents as students are absent each day, etc.. In addition to the subjects you are assigned to teach, you’ll be asked to teach many other non-teaching subjects such as CCE, etc. The problem is that teachers are not treated as professionals. They are not. They are constantly audited and really treated as ‘semi-professional’. If you want to be a professional, think three twice.

    The good poor teacher can’t teach. Hopefully MOE fix. Us moms don’t even have time for our children. But I doubt it as this problem has been going for 2 decades. Now, they are luring newbies with diverse tracks in teaching. This is not true as leadership track, only a handful can apply and the specialist track is a fallacy as even lesser can access that track as MOE is a monopoly. 80% of teachers will remain in teaching in the classroom and repeat what they say each year. Although the ministry say that they encourage teachers to further studies, this is not true. It is disingenuous. Many teachers can’t even get part-time teaching to study at NIE. Principals and management frown on this. It’s sad.Teachers try to go on holidays to somehow mentally break off and survive. There is a lot of discipline issues because there is a lack of male teachers in schools and the boys lack male role models.

    eachers also do not have time to mark students’ homework because of the numerous meetings in the afternoons. Teachers do not have time to prepare lessons. Yet, lesson observations are used to measure teachers’ performance when time is not given to prepare lessons of a daily basis. Lesson observations becomes a performance. Many passionate teachers leave MOE. As a result, the billion dollar tuition industry is growing. And thanks to tuition, we are top in PISA but we will never produce a Nobel winner or anything of that sort.

    Many of these young teachers feel trapped in the system as they learnt it was all empty talk. There is a lot of hypocrisy. New teachers are bonded for 3 years – the only country that bonds teachers for 3 years. So these beginning teachers suffer in silence as they lose quality sleep and their emotional well-being. Even when they are promoted to subject heads or head of department, they resign. Even the heads are struggling in schools that they leverage on whatsapp messages and text messages to cut corners in their work planning, messaging teachers past office hours, oft times, at 9 and past 10 p.m. at night when it’s meant for family. This is becoming an abuse on the part of incompetent school management heads. A teacher can have 9 whatsapps chatgroups to reply to that runs into the weekday nights to reply to. Is that exploitations? The teachers struggle to manage the basic workload and during performance appraisal they are asked what did they do and what more they can do. Isn’t the workplan for the year decided earlier? Expectations are unclear just like the EPMS. It’s worse for teachers teaching English language and the humanities. Their marking workload is disproportionate compared to music and PE teacher who has ZERO homework or class work to assign. Yet the pay is the same. MOE should provide a subject allowance for teachers teaching two subjects as no other countries has teachers in high school teaching two teaching subjects. As such, there are many women who missed the boat in marriage when they join teaching and the opportunities to set up a family because of the overwork. They go on to become single women principals who have no experience raising families of their own and don’t understand the predicament of the teachers with families and children to raise. Surely, a wiser option be made for selection of management to lead schools and communities. Most parents do not respect single women principals due to the lack of exposure to raising kids. These principals repeat the grueling cycle back to those below her charges. The problem is that one is not a teacher when one signs up with MOE. One is a public officer – a civil servant. That is not what teachers sign up for. So they experience, unfortunately, hundreds of role conflicts because they thought they were teachers. Many teachers do not get support from schools to do their masters in order to teach better. There’s a lot of empty talk of support.

    Don’t think smart. Think wisely. All the best to those still struggling in there. Hang in there! And hopefully this was of help to those who are sincere about learning the realities of teaching and concern in having a fulfilling career instead of being locked within the 4 walls of a classroom. All the best! Cheers! “

  9. Pingback: Roy Ngerng has been in Taiwan since October 2016 | Mothership.SG
  10. Cailin

    The admins are doing their best to keep this place as non-commerical and for the benifit of Singaporeans. They do the clearing of spamm and suspicious personale day in and out. So pls, read the rules. Thanks

  11. FeathersFlocked

    The creep reacted. One caught, the rests also in the can, with him. Of course, it is every site.What a lawless nation beneath its gleaming “clean” exterior. How can liars prosper? How they raise their kids anyway? Like their leaders, creepy creatures. Flock

  12. Creep

    You hypocrite! First take the beam out of your own eye, and then you will see clearly to remove the speck from your brother’s eye. Do not give dogs what is holy; do not throw your pearls before swine. If you do, they may trample them under their feet, and then turn and tear you to pieces.

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