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the heart truths to keep singaporeans thinking by roy ngerng yi ling 鄞义林 about august 11, 2016 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. in taiwan, citizens pay 4.69% of their wages into national health insurance. 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. source: national health insurance administration, ministry of health and welfare in south korea, citizens pay 6.12% of their wages into national health insurance. 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. 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. 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. 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. source: gkv-spitzenverband – statutory health insurance and in germany, the national health insurance that citizens pay, pays for 58.5% of total health expenditure. 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. 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. 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. 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! 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.) 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) 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! 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%! 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. now, if you thought that medisave is bad. look at how much medishield pays. and do you know, by right, how much should singaporeans actually need to pay out-of-pocket? the government expenditure on health is only 31%. 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. 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! source: ministry of health,

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https://thehearttruths.com/2016/03/26/a-short-note-on-budget-2016-and-update-twelve-of-defamation-funds/#comments
https://thehearttruths.com/2016/08/02/singapore-profits-from-health-insurance-premiums-other-countries-return-them-fully-to-citizens/?share=twitter

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Domain Name: THEHEARTTRUTHS.COM
Registry Domain ID: 1732830440_DOMAIN_COM-VRSN
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Updated Date: 2018-06-10T09:38:31Z
Creation Date: 2012-07-10T00:13:29Z
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