Universal health coverage a great leveller: WHO chief
Singapore
UNIVERSAL health coverage was on Tuesday described as one of the most powerful social equalisers among policy options open to governments, and the "ultimate expression of fairness".
This assessment came from Dr Margaret Chan, director-general of the World Health Organisation (WHO), in her address to some 300 international delegates gathered for the two-day Ministerial Meeting on Universal Health Coverage at the Grand Copthorne Waterfront hotel.
She said inequalities in income levels, opportunities and access to social services within and between countries had reached their highest levels seen in nearly a century, and added: "If public health has something that can help our very out-of-balanced, troubled world, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity and stability."
The shift to universal health coverage has become more crucial as socioeconomic progress raises the incidence of chronic diseases such as heart attack and stroke; drug resistance has set in, as have unhealthy lifestyles, she said.
Dr Chan said that, for universal health coverage to work, it has to be intrinsically country-owned and home-grown along with a country's culture, domestic political institutions, legacy of its existing health system and expectations of its citizens.
Singapore's Prime Minister Lee Hsien Loong, also addressing the ministers, health administrators, practitioners and members of the health-care sector at the event, presented a thumbnail sketch of Singapore's health-care model.
He said the Singapore model relies on mandatory personal savings, a national health insurance scheme and a co-payment component. While these have kept costs from spiralling, an ageing population and changing disease patterns have made it harder to do so. The Singapore government has thus shifted its focus in four areas to deal with these issues, he said:
Firstly, it has begun providing more comprehensive support for outpatient treatment, given that the existing health-care model covers mostly inpatient costs.
Secondly, the national insurance scheme MediShield will be replaced by year's end with MediShield Life, a mandatory universal medical insurance that provides cover regardless of age and pre-existing conditions. Mr Lee said MediShield Life will give patients better protection from growing bill sizes. Insurance premiums will be higher, but the government will offer subsidies, especially to those from lower- and middle-income groups, to keep the scheme affordable.
Thirdly, the government is providing health care in appropriate settings, so patients receive better, more affordable care in their communities. This has created a role for community hospitals, which provide therapy and treatment to patients after their discharge from acute hospitals. Other moves in this direction include expanding nursing homes and voluntary welfare organisations to enable ageing-in-place.
Fourthly, the government is encouraging Singaporeans to take ownership of their health by making healthier lifestyle and food choices, Mr Lee said.
Singapore now spends 4.2 per cent of its gross domestic product (GDP) on health care, with the government share at 1.6 per cent of GDP - what he said was a remarkably low amount; the figure is bound to rise in the next five years, but the government is determined to keep the system sustainable, he said.
Mr Lee said that for the government's health-care efforts to work, there needs to be a supportive political environment - one in which Singaporeans are responsible for their own health, providers deliver cost-effective care and the government adopts a people-centred approach that ensures the low-income have good access to this care.
Dr Chan, citing Bangladesh as an example, said barriers such as a poor population and frequent natural disasters will not stop any country that really wants to move towards universal health coverage.
