Category: medCost

public healthcare: SG^west

Posted on by tiger40490

The analysis helps to explain the low tax rate, and the price control in Sgp public healthcare infrastructure. These factors are actually fundamental to my long-term (retirement) confidence in  Sgp’s healthcare affordability.

— Sgp public healthcare expenditure .. 2021 StraitsTimes: “Mr Ong [MOH] said healthcare expenditure is set to hit $59.1 billion in 2030, up from $20.7 billion in 2018 and $10.5 billion in 2010. The 2030 figure will form about 16 per cent of the Government’s yearly Budget, up from 12 per cent currently.”

— based on https://reason.com/2020/12/12/singapore-is-not-the-model-for-a-more-libertarian-america/

Lee Kuan Yew regarded with disdain both “free” government-provided health care and what he saw as grossly inefficient private models.

Lee said of Britain’s NHS (National Health Service) in a 2001 interview with PBS. “These are scarce resources. You’ve only got a limited number of top-class surgeons or doctors, and if you promise everybody that they are entitled to the same treatment, it’s just not practical.”

Lee wrote “American-style medical insurance schemes are expensive, with high premiums because of wasteful and extravagant diagnostic tests paid for out of insurance.”

Singapore has found that making patients pay a nominal amount for every type of medical service discourages unnecessary consumption, and that the spectrum of service upgrades — from shorter wait times to one-person wards — allows prices to work as a /mechanism/ for allocating resources.

##[19]y U.S.medical cost higher #blackSwan

Posted on by tiger40490
  • #1 reason: excessively commercialized/market-driven/… but healthcare (like education) is more humanitarian than publishing, music, sports, journalism,
    • hospital performance is measured and ranked in terms of profit, efficiency, like any commercial business
    • In other countries the gov negotiates with insurers to bring down premium but in U.S. the “free market” seems to be dominated by insurers and service providers.
  • Healthcare spending is driven by utilization (the number of services used) and price (the amount charged per service). Utilization is similar between U.S. and other rich countries. Price is the main differentiation.
  • reason: admin cost — The number one reason U.S. healthcare costs are so high, says Harvard economist David Cutler, is administration cost.
    • Administrative costs accounted for 8 percent of total national health expenditures in the U.S. For the other 10 rich countries, they ranged from 1 percent to 3 percent.
    • Eg: 1,300 billing clerks at Duke University Hospital, which has only 900 beds. Those billing specialists are needed to determine how to bill to meet the varying requirements of multiple insurers.
    • Doctors spend too much time (cf other countries) on coding/billing so they have less time to see patients, driving up the cost per patient.
    • xp: Boston hospital visit
  • reason: more tests — most U.S. providers make more money by performing more tests, perhaps more than needed
  • reason: defensive medicine – Scared by malpractice lawsuit, doctors order multiple tests even when they are certain they know what the diagnosis is. A 2019 malpractice lawsuit awarded $229M, an amount presumably calculated based on the provider’s capacity to pay.
  • reason: over-utilization of specialists — more people in the U.S. are treated by specialists, whose fees are higher than primary-care doctors when the same types of treatments are done at the primary-care level in other countries
  • reason: hospital (and insurer) mergers reduce competition
  • reason: medical education — U.S.doctors have longer education and need to earn more to compensate.

Healthcare premiums increase faster than both wages and inflation.

https://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp is a good answer.

— black swan (i.e. the time when we need insurance) .. I have never had a major medical event in the U.S. When (not IF) it hits my family, it would be a huge impact, financially and psychologically. It could change my long-term plan for the family.

Note The low-income American families can’t afford the insurance.

— overall medical spending compared to other rich countries

https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-start has good comparative trend lines.

Per capita, the U.S. spent $10,600/Y. That’s nearly double the level in Canada, Germany, Australia, the U.K,. Japan, Sweden, France, the Netherlands, Switzerland, Denmark.

Per capita, U.S. spent $1,443  on pharmaceuticals vs $749 for the 11 countries (including U.S.)

https://www.channelnewsasia.com/news/commentary/us-coronavirus-covid-19-healthcare-system-public-funding-staff-12555738  is an explanation why U.S. response to covid19 had a poor start. It claims

“The US is spending more than any other country for a system that is significantly under-performing… Yet, the system is highly profitable for all players involved… To maximize income, both for- and nonprofits have consistently pushed for greater privatization”

This explanation is mostly focused on public health (rather than private health system), the system needed by ordinary people, including most non-working Americans. As soon as I stop working, I would rely on this infrastructure. I remember the dilapidated Woodhull hospital at Flushing Avenue.

private^public healthcare #US++

Posted on by tiger40490

Am not looking for precise definitions of the differences between private healthcare vs PHS i.e. public healthcare systems.

  • funding — PHS is funded by tax payers. I think private health system is funded by revenue and possibly donation. University healthcare infrastructure might run on university’s endowment.
  • administration — PHS is run by government departments. Private means private institutions including government-owned firms.
  • fees — patients pay zero or low fees (polyclinic, MYS) to access PHS
  • waiting list — given the low fee, service users far outnumber service providers. PHS usually have some kind of prioritization criteria. In private, fees are the natural criteria.
  • doctor compensation — Simple in private case. In PHS, doctors need to be paid adequately but presumably lower, with a higher workload. I would assume some doctors take it as public service and civic duty.
  • advanced diagnostics + treatments — private doctors would use (or recommend) the latest and most expensive options. PHS may not have the same options easily available.

— insurance is a complicated matter

By and large, I would say insurers are commercial (private) companies, whereas many aspects of the operation are regulated by governments — premiums, exclusions, billing, compulsory enrollment,

Many countries’ health insurance is largely run by the government, negotiating with domestic/foreign commercial insurers.

In some cases, a medical insurer is government-owned or government-linked, but I believe every insurer must endeavor to make a profit to be sustainable. Insurer is never a charity. If run carefully, the health insurance business model is sustainable. The members who seldom claim from the “pool” would effectively subsidize those frequent claimers.

US^EU: public healthcare #covid19

Posted on by tiger40490

— https://www.channelnewsasia.com/news/commentary/europe-lift-lockdown-covid-19-coronavirus-spain-germany-france-12723654 claims

(For decades) US has long stood out [3] for the fragmentation [2] and market-orientation [1] of its healthcare system. Its goal has been efficiency and responsiveness to markets[1], not pandemic preparedness.

In contrast, European countries are opening, but with more testing, attention to healthcare capacity and data.

[1] basically private rather than public healthcare

[2] no central government providing, negotiating for the public

[3] from other rich countries

## SG citizenship: $value imt GC

Posted on by tiger40490

I feel lucky to have Singapore citizenship. Now I feel SG citizenship is better than U.S. green card because

  1. — ranked by … strategic value to my family
  2. nanny-state public (+ private) service ..
    • Grade A vs C. It’s possible to put a dollar value on this ‘grade’
    • client service — good, efficient CRM (uncommon in many countries) when I’m in need of help
  3. medical cost relief — Medishield, polyclinics…
    • long-term nursing cost (esp. out-patient) is probably lower based on my personal observation.
    • Without insurance, hospitalization is probably much cheaper in Singapore than U.S.
  4. housing — relatively affordable public housing for citizens
  5. overall lower minimum burn rate, easier to achieve carefree if not absolute ffree
  6. for me, Singapore CPF beats U.S. social security
  7. weather — warm for retirees
  8. low crime rate — important to wife
  9. NRY — thanks to the open and robust economy, foreign professionals represent a stable rental demand.
  10. transport — Reliable and cheap public transport for non-drivers, though gas is costly
  11. college — Singapore universities for my kids
  12. Property tax — much lower than U.S.
  13. inflation control — better control than in many countries
  14. SG government has a large past reserve to protect Singapore against many threats.
  15. if stranded overseas — I can count on SG government to bring me home. U.S. citizens probably have lower confidence.

Q: If SG citizenship offers so many tantalizing carefree features, then why are they unattractive to so many shrewd Chinese professionals?

  • A: even if we agree that SG citizenship contributes to a bare-bones ffree far out in the future, the ffree is too bare-bones, too far out, and contribution are too small and unattractive to most people
  • A: these capable, qualified, elite professionals tend to be well-established in their country. In such a case, the sacrifice is too high, and risk is too high.
  • A: At our age, to abandon the current home country (US or ..) and try out a small SEA country is highly questionable, risky and a long shot. There’s too much at stake.
  • A: there’s a age window for choosing and changing home country. After that window closes, it’s increasingly costly to do that now.
  • A: SG citizenship is hard to get
  • A: SG is seen as too small too vulnerable to be strong, robust and powerful

MYS healthcare for expat retirees

Posted on by tiger40490

If we retire in Malaysia, I feel we should seriously consider relying on Malaysia public and private healthcare.

Obviously, we can always fly (or take train) back to Singapore for reliable healthcare, with citizen subsidies. We don’t have to if the Malaysian services are good enough in most cases. For a chronic condition, we don’t prefer frequent trips.

emergency  —  I believe overseas emergency medical will be covered by Medishield 🙂

bargain — The value/cost ratio of Malaysia healthcare might be a bargain for expats. https://internationalliving.com/the-best-places-to-retire/ 2019 article gave an illustration.

— Time magazine singled out healthcare as Malaysia’s top attraction for expat retirees.

— https://www.retirepedia.com/healthcare-in-malaysia.html is all about healthcare for expat retirees.

Public healthcare is available to expats in Malaysia and is very inexpensive. Nevertheless, many expats prefer private care because treatment is faster, (no long waiting times) and more efficient.

Free health care, other than emergency treatment, is restricted to Malaysian citizens. As a foreign resident, you’ll have to either pay yourself, or purchase local or international health insurance. Local insurance is much cheaper.

The best hospitals in the country are in Kuala Lumpur, which has also become a world class medical tourism destination.

If quick access to the best healthcare in Malaysia is important for you, then you should consider living in or close to Kuala Lumpur. Your next best choice would be other major cities like George Town, Shah Alam or Johor Bahru. There you’ll find many private clinics and hospitals with well trained specialists.

In a Malaysian private hospital, if you share your room with three other patients, you’ll pay as low as RM95 (USD 24).

polyclinic xp: retiree healthcare

Posted on by tiger40490

In early 2019, I spent quite a bit of time on my multiple polyclinic trips and there’s an unexpected ROTI.

For whatever reasons, the patients at TPY polyclinic are mostly elderly. Semi-consciously I started to see myself in them, and recognized, at a physical and emotional level, the SG advantage over U.S. system, where ordinary (mid-curve) old folks get significantly less help than the wealthy old folks able to afford private health care. U.S. health care welfare targets the low-income tail of the bell curve. As the U.S. debates how to make health care more affordable, Singapore is quietly adapting and modernizing an already proven formula of efficient yet affordable health care for ordinary old folks, not only the needy.

The Singapore system is largely based on polyclinics and subsidies at public hospitals + private clinics.

Efficient yet affordable — fast, modern, well-staffed. system is less complicated, more understood.

Many would cast doubt on the waiting time and commute.

  • waiting in clinic — usually 10 – 60 min.
  • waiting list — However, Zeng Sheng cautioned me that older patients might hit a scarce resource constraint and longer wait. I think this is a real, tough challenge in every rich or poor countries, including Canada and Malaysia.
  • commute — bus 238 is about 5-min frequency, 10-min journey from bus interchange.

Conclusion at the personal level — My recent polyclinic experiences help foster a growing self-reassure that as long as we maintain our Singapore citizenship, we don’t need to earmark a huge sum for our elderly medical needs. Until recently, I used mostly private clinics, which are still a fraction of the cost in U.S.

When I visit any U.S. service provider I often feel dis-functional, perhaps a deep-rooted bias.

I would guess very few governments take care of their ordinary old citizens so well.

Q: In 20Y when I grow old will the SG system deteriorate?
A: I have reason to believe it won’t.

I now feel the elderly medical cost + daily living is rather affordable despite SG’s reputation, but this is a feeling not really based on facts

— Oct 2020, i brought my son to polyclinic for 3 issues: 1) acne 2) jock itch 3) BMI
wait time: 5-20 minutes to see doctor. Medicine wait was 5-10m. Appointment counter wait was close to an hour.

Costs and polyclinic subsidies:

  • consultation: $48 – $41 subsidy = $7 payable
  • 5 medicines for acne and jock itch: $23 – subsidy = $9 payable
  • total $71 – subsidy = $16 payable