Access to Universal Health Care: Analysis of the Singapore System

1. Please read the following carefully to become familiar with what you need to do:

Your “Research Paper” paper should be 5 pages (regular 8.5×11 page, double-spaced, font 12 Times Roman), You may choose to write about any topic related to health care or health policy, market for health care, etc. as long as it relates to economics. For example, you may write about the role of government in providing health care, your analysis of Affordable Care Act ACA, regulation of heath care, health care markets and the structure of the business (such as markets for physicians, hospitals, pharmaceutical, etc.), or health operation (administration of hospitals, managing a small medical practice, etc.) or similar topics. For example, for the last example, you would examine the demand and supply of health care, how it is provisioned, whether or not it is efficient, any creative ideas you may have to improve the provision of health care, etc. Alternatively, you can analyze a particular health care social issue and analyze how our current health care system is responding to it.

The most important thing is to clearly state at least one economic question pertaining to health care and attempt to analyze its various dimensions and issues toward providing an answer. Please be sure to write a title for your paper that gives an idea of what the topic is. For example, it is not sufficient to name your paper: “Obama Care”. There are many issues pertaining to “Obama Care”. Which one(s) are you addressing?

You are welcome to choose one partner and write a joint paper and divide the work equally as you wish. This practice allows you to learn collaborative analysis which is commonplace in the real world. If you do so, however, both authors should submit the same paper on Blackboard, and both names should appear on the front of the paper.

2. Topic: Access to Universal Health Care: Analysis of the Singapore System

Please follow the example essay to so research and write the essay.

Example essay:

Access to Universal Health Care: Analysis of the Japanese System

Universal health care has always been a taboo subject in the United States. About half of the population agrees we should have it and the other does not. With what 2020 has brought to us, the Corona Virus or COVID-19, it is no question that health is a top priority and everyone should have access to healthcare. Health insurance is used to protect an individual if they become ill, but realistically not everyone is able to afford health insurance. Those who are unable to afford health insurance receive fewer health care services due to higher prices, responsible for the full medical bill, and probable provider reductions for medical non-payments. Other parts of the world such as Canada, Brazil, and Japan already have incorporated universal health care and have had success. We will be comparing Japan’s universal health care system and looking at their strategies that are working to get a better idea of what the U.S. can do to follow their steps. Ideally, the goal would be to have universal health care in the U.S. and by doing so the quality of health for everyone would be greater.

Among countries with universal healthcare, Japan is one that truly stands out. After almost 20 years of being introduced to the public as an idea, nation-wide health insurance became a reality in 1961 (Ikegami et al., 2011). Under the UHC system, roughly 120 million people are covered versus Medicare recipients in the United States which is about 43 million people (Kondo & Shigeoka, 2013). Residents can receive insurance through two routes: employee-based and community-based social health insurance. The employee-based route is pretty self-explanatory since the coverage is primarily covered by the employers. The community-based route is essentially led by the community itself, each municipality sets its own contributions which are based on an individual’s income and a flat fee per enrollee (Ikegami et al., 2011). This form of coverage was established when farmers and other self-employed individuals were ineligible to participate through the traditional route. Services provided included inpatient/outpatient visits, prescription drugs, and dentistry while having access to all providers without any limitations.

Meanwhile, the United States healthcare system is constructed on multiple layers. Unlike Japan, there are 4 four main actors who play into the American system: government (federal, state, and local), private insurance, providers, and regulators (Rice et al., 2013). Despite having numerous programs in place, it was reported there was around 50 million people without insurance in 2013. There are many contributing factors in place for the American healthcare system’s failure in protecting the citizens but the major one is the absence of a universal healthcare system. Allowing citizens to pick their insurance plans may sound ideal but the myriad and complex system has created a massive gap in terms of health equity. Unlike Japan, dentistry is also not included in the same medical package, and not all insurance plans cover prescription drugs. This set-up does not address all aspects of healthcare and Americans are forced to choose which sector they will pass upon in order to be within their financial scope. Additionally, keeping an open market for hospitals and healthcare providers only creates an unsustainable outcome. The United States spends the most funding on healthcare than any other country but the results have been nothing but disappointing. In order to prevent the gap from getting bigger, it is crucial to target the main issue at hand – drafting a well-structured universal healthcare plan to the public after analyzing existing plans of other countries.

The question at stake is how did Japan achieve universal health care and what can we do to get there. As previously mentioned, Japan has a universal health care system through either employee-based or community-based social health insurance. Japan’s main goal was to achieve a universal health care system to fairly be available to all and which it must cover the entire population, reduce patients’ costs, and expand coverage to all effective services (Ikegami, 2019). These are goals that every country should aim to achieve, and Japan made sure to do so with their payment system. Based on the history of Japan, in 1922 they initially introduced the fee schedule followed by the enactment of social health insurance or (SHI) in 1922. The SHI initially covered only 3% of Japan’s population of which it was only manual workers (Ikegami, 2019). It later expanded to all of the population when insurance for all was achieved in 1961. The overall goal with expanding their SHI to all of their population was to have everyone have access to health care regardless of costs of care and whether or not they are in the working class. The expansion of the SHI with their universal health care is able to execute cost containment and revise their fee schedule by redistributing their resources.

In comparison to the United States, there isn’t a clear goal as to what they want for health care. Unfortunately, not everyone agrees health care for all can be achieved by creating a universal health care program, rather they are okay with having multiple insurance programs, the Affordable Care Act, Medicare, and Medicaid. Most of these programs including insurance companies whether it is private or government-funded have restrictions and underlying conditions as to whether someone is qualified to receive the services for health care. Too many people in our country do not have their full potential for health due to preventable conditions. In addition, Americans receive just about half of the recommended preventive care, a finding that illustrates the national need for enhanced promotion of health. The Affordable Care Act 2 of 2010 reacts to this need with a strong focus on disease prevention (Koh, 2010). Due to the system, we have here in the United States, not everyone has a fair shot at having access to health care and more so receiving access to preventative care that can help better the quality of life of an individual. The demand for health care insurance has become an ideology instead of a need. The theory of demand for health insurance states that people buy health insurance to protect themselves against the possibility of high financial costs if they get sick (Health care economics, 2012). Demand for health insurance should not have to mean people purchasing something in hopes to not get sick but be able to be financially stable. Demand for insurance should be to have access to it whenever it is needed, regardless of financial stability. Health is not a want, but a need.

Although Japan does not base its healthcare system on multiple payer systems like the United States, they do have a structured financing system that makes sense. The financial system in Japan for health care is based on their fee schedule plan. Almost all medical care is provided under a nationally uniform fee schedule. ‘Uniform means that the same fee is paid by all insurers to all providers, independent of whether the service is performed in a tertiary hospital or a rural clinic, by an experienced specialist or a recently qualified physician. Neither insurers nor providers have the freedom to negotiate a different fee schedule individually (Ikegami et al., 1991). In the account of having a uniform fee schedule, there are three sectors that are part of the plan, based on the individual’s employer, if they are self-employed, and the elderly. Another important contributor to the success of Japan’s universal healthcare is the regulation of hospitals. For-profit hospitals are strictly prohibited and all healthcare facilities are to be owned by physicians only (Health Affairs Journal, 2020). This strategy proves to be effective as the well-being of the public triumphs the need for profit. Meanwhile, the United States has an ongoing issue with the massive market of hospitals which ultimately becomes a race for who is able to generate the most revenue, rather than providing the best healthcare experience for their patients.

Primary care is a big factor in the health care system for both patients and the health industry. The first line of defense in an individual is the immune system, if it is not able to take care of it medical attention is required and that involves having access to care. Assuring the ability to have access to any physician and care if a person gets sick without having to worry if they have the ability to pay or not is a very important factor, but unfortunately is only achieved through universal health coverage. The United States does not have such an advantage.

With everything going on in the world at the moment with the pandemic, the U.S. has not been able to control their number of COVID cases and the numbers just keep rising. Unfortunately, since the U.S. does not count with a universal health care system like Japan does, primary care or access to see a physician is only available to those that can afford a health care plan. Those individuals with no access to care are most likely not able to receive proper treatment or care and will be more prone to have illnesses. In regards to COVID, those who are uninsured will be more likely to not seek care or medical attention due to being afraid of getting denied care because of insurance or out of pocket costs. Although the U.S. made COVID-19 testing free for all residents, it does not account for the medications as well as hospital stays required for an individual who desperately needs it. In order to avoid the high bill, people will wait out their illness at home and only seek immediate medical help when their health is quickly deteriorating, often to the point of no return. The current situation is an unfortunate scenario that paints out how desperately the United States needs universal healthcare for all residents. As the rest of the world continues to pass by, America continues to highlight a flawed system that fails to address important health issues, health inequalities, and unequal access to healthcare.

References

Feldstein, P. J. (2012). Health care economics (p. 142). Australia: Delmar/Cengage Learning.

Ikegami N. (2019). Japan: achieving UHC by regulating payment. Globalization and health, 15(Suppl 1), 72. https://doi.org/10.1186/s12992-019-0524-4

Ikegami, N., Tokei, K., N., I., G.J., S., R., N., A., S., . . . Naoki Ikegami and John Creighton Campbell. (1991). Japanese Health Care: Low Cost Through Regulated Fees: Health Affairs Journal. Retrieved November 30, 2020, from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.10.3.87

Ikegami, N., Yoo, B.-K., Hashimoto, H., Matsumoto, M., Ogata, H., Babazono, A., … Kobayashi, Y. (2011, August 30). Japanese universal health coverage: evolution, achievements, and challenges. https://www.sciencedirect.com/science/article/pii/S0140673611608283 .

Koh, Howard K, & Sebelius, Kathleen G. (2010). Promoting Prevention through the Affordable Care Act. The New England Journal of Medicine363(14), 1296–1299. https://doi.org/10.1056/nejmp1008560

Kondo, A., & Shigeoka, H. (2013, January 7). Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan. Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan. https://www.sciencedirect.com/science/article/pii/S0047272713000029 .

Rice, T., Rosenau, P., Unruh, L. Y., Barnes, A. J., Saltman, R. B., & Ginneken, E. van. (2013). United States of America: health system review. https://pubmed.ncbi.nlm.nih.gov/24025796/ .