Friday, 15 May 2015

An American Expat's View of Singapore Health Care and the Recent "ObamaCare" changes at home

How up to date are you with the health care back in America? This article outlines the noticable differences between the US & Singapore to bring you up to speed. Enjoy reading!



Most of my life I did not pay attention to healthcare matters in America. At an early age I landed a job within Citibank in the mortgage division. I was given an excellent health insurance plan which I rarely used. Because of my age, healthy status and being an avid gym member for much of my life I didn’t find myself needing to deal with healthcare. I had a major surgery to remove a binomial tumour in 2003. My insurance through the employer paid for it all.

The noticable differences between America and Singapore

Upon moving to Singapore the first big difference I noticed between American & Singapore health care is in Doctor visits. A lot of people in Singapore get sick and go to the doctor automatically for something like common cold, flu. The doctor typically gives anti-biotics. In America the citizens don’t generally do that. I don’t know anyone who goes to the doctor for a flu or cold, unless it's something really bad that goes on for days. We go to our neighbourhood drug store and buy over the counter medicines without a prescription. I’ve been to the doctor a few times in Singapore but only because that's the culture here. If I am sick, apparently everyone wants a doctor’s note to prove it. In America that doesn’t happen, you call in sick, you come back when you are better in 2 or 3 days. No one ever asks for a doctor note. The couple times I’ve had a flu here in Singapore, if I had been back home I just would’ve bought flu medicine from a drug store and stayed in bed. This is one noticeable difference between healthcare in USA and in Singapore.

Healthcare in America has undergone a big change. Until now healthcare in America is something you get from your employer. It’s a common benefit at most companies. We’ve had little intervention in health matters from the government, at least in my humble opinion. A plan similar to what President Obama has signed into law in 2010 was first attempted by President Nixon in 1974 but his plan was never passed. President Clinton had some healthcare reform ideas that went mostly nowhere in the 90’s. One healthcare change that did occur in 1985 under President Reagan was COBRA.

COBRA stood for Consolidated Omnibus Budget Reconciliation Act and what it did was make mandatory insurance coverage for people leaving employment. COBRA imposed an excise tax on employers whose health plan failed to allow its employees to keep their coverage for designated time frame after leaving employment. When I was downsized 10 years ago I had the option of keeping coverage for up to 18 months. However, many people can’t afford the premium after they lose their job so a lot of Americans don’t take advantage of the act. The act that President Obama signed includes a 65% subsidy for employees who are terminated for COBRA enabled insurance for up to 15 months. To qualify the employee’s termination has to be involuntary & they are in no other health insurance program.

The health insurance portability & accountability act, also known as HIPAA became law in 1996 under President Clinton. HIPPA requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. It’s intended to help people keep their information private. Another goal of this plan was to prevent fraud.

Here is some of what the recent healthcare reform signed into law will do, known as "ObamaCare":

  • Insurance companies are no longer going to be able to drop people when they get sick. 
  • Insurance companies are barred from not covering children for pre existing conditions. 
  • Young adults can stay on their parents plan till age 26. Most plans currently drop them at age 19 or whenever they finish college. 
  • A tax credit is now available for small business to provide healthcare to their workers. 
  • Medicare, a current govt. program will provide 10% bonus payments to physicians and general surgeons 
  • Medicaid which is directed at people in poverty category will undergo a change. A new program under the Medicaid plan for the poor allows states to offer home and community based care for the disabled that might otherwise require institutional care. 
  • The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions. 
  • Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients. 
  • All insurers are fully prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions. 
  • All insurers are fully prohibited from establishing annual spending caps. 
  • Expand Medicaid eligibility; Individuals with income up to 133% of the poverty line qualify for coverage. 
  • Everyone is required to purchase health insurance much like we are required to purchase car insurance. 


How Singapore's system differs...


By contrast, Singapore’s health care system seems to me, to place shared responsibility between the citizen, the employer and the government to make healthcare affordable for all. According to WHO (World Health Organization) Singapore has the world’s highest life expectancy rate and the lowest infant mortality rate. It should be noted however that Singapore is a small country with approximately 3.8 million residents. The rest of Singapore's 5 and a half million population is made up of foreign workers. Singapore has set up Medisave in which a portion of a Singaporean’s income is diverted into an account that is specifically established for healthcare matters. Medisave can be used for hospitalization, day surgery and certain outpatient expenses. Singaporeans can choose between 13 private hospitals or 10 public/government hospitals. This Medisave program is also available to Permanent Residents of Singapore.

If you are a foreign worker in Singapore, depending on your type of employment you will either have (A) medical insurance for up to SGD 15,000 hospitalisation expenses extended to you by your employer or (B) you can buy your own private plan or (C) you have some type of insurance extended to you through an Employment Benefit package.

Something I very much like about living in Singapore is that the doctors here charge less. A typical general practitioner doctor visit with medication has never cost me more than $40.00. In America it’s probably double that to visit the doctor.

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