Healthcare in Singapore
The healthcare system in Singapore is globally renowned for its compelling design, which satisfies both conservatives and liberals. The universal healthcare system provides economically efficient and high-quality medical care in both private and public facilities.

Objectives of Healthcare

According to the Affordable Healthcare passage from Singapore’s Ministry of Health, the five fundamental objectives of the healthcare system include:

  • To nurture a healthy nation by promoting good health;

  • To promote personal responsibility for one’s health and avoid over-reliance on state welfare and medical insurance;

  • To provide good and affordable basic medical services to all Singaporeans;

  • To rely on competition and market forces to improve service and raise efficiency; and

  • To intervene directly in the health care sector; when necessary, where the market fails to keep health care costs down.

To summarize, the government acknowledges the strengths and limitations of the public and private sectors in health. Overall, healthcare in Singapore has a multipayer financing structure, where a “single treatment episode might be covered by multiple schemes and payers, often overlapping.”

Specifics of Singapore’s Success

The system is known as the 3Ms, which consists of:

  • MediShield Life – a universal basic health care insurance that is mandatory for citizens and permanent residents and provides lifelong security against large hospital bills and specific costly outpatient treatments.

  • MediSave – a mandatory savings plan consumes between 7 and 9.5% of worker’s wages, helping cover out-of-pocket payments. These tax-exempt, interest-bearing accounts can be used to pay for family members’ health care expenses or routine care.

  • MediFund – the government’s safety net for Singaporeans who cannot cover their out-of-pocket costs, even with MediSave.

Healthcare in Singapore is ranked among the best healthcare systems in the world, according to the World Health Organization (ranked 6th in 2010) and Bloomberg’s list, “These Are the Economies With the Most (and Least) Efficient Health Care.”

However, several factors beyond its structure contribute to Singapore’s successful healthcare system. Singapore is a small island city-state with a population of 5.6 million. Singapore’s physicians per 1,000 people ratio is 2.294, compared to the U.S’s, 1.565. Additionally, rates of smoking, alcoholism and drug abuse are relatively low, as well as the obesity rate. The healthier population predisposes “the country to … lower health spending.”

Limitations of Healthcare in Singapore

Although healthcare in Singapore receives acclaim for its ability to fund its systems through private markets, there are several limitations to consider, especially concerning Singapore’s underserved population. The lack of hospital beds in the emergency section of public hospitals causes patients with basic insurance plans to have limited financial protection. Since the spending on healthcare in Singapore is one of the lowest in the world (SGD 9.8 million out of SGD 400 billion), subsidies for patients are substantially limited.

Additionally, Singapore prides itself on its multipayer financial system; however, patients pay more than 60% of healthcare costs out-of-pocket. Thus, as Rachel Ngu, a writer for Mims Today (healthcare news across Asia), explains, “patients will need to pay an initial amount based on a subsidized class, as well as co-pay the rest of the bill. Aside from that, they will have to pay 10% of the rest of the bill for Integrated Plans.” Therefore, patients with basic coverage are not able to afford urgent medical attention because of the financial strain of medical bills, notably those without add-on integrated plans for more expensive hospital procedures.

Healthcare in Singapore is effective because of the efforts of the government and the people. Singapore has created a functioning healthcare system that regulates the supply and prices of healthcare services. Also, the system seeks to provide its citizen with security in the face of large medical bills. Though healthcare in Singapore is replicable on some levels, the system tailors to the specific needs of the economy and the demands of the people.

Mia Mendez
Photo: Flickr

Medical Tourism in Costa Rica

When people think of the country of Costa Rica, they often picture its lush and beautiful terrain. Each year, approximately 1.7 million people visit the country. That is almost a third of their total population. Although many people visit Costa Rica for its natural beauty, there is another side of tourism that may be less familiar. Medical tourism in Costa Rica is thriving. This type of tourism involves patients traveling to receive faster or more cost-effective medical care.

Medical Tourism in Costa Rica: Fast Facts

Healthcare in Costa Rica

Costa Rica has socialized healthcare. The basis for their nearly universal coverage comes from CCSS (Costa Rican Social Security Administration) legislation. The constitution of Costa Rica does not protect healthcare. However, social security is guaranteed. Article 21 of their constitution provides a basis, although not explicit, for the right to healthcare.

Costa Rica has three levels of healthcare: primary care, regional hospitals, and national hospitals. The primary care tier focuses on testing and a smaller percentage of the population. The second tier centers around emergency services and deeper diagnostics. Finally, the third tier serves those with serious health complications.

The country has been cited as a leader in healthcare of the region. With reforms in place, infant mortality swiftly decreased by 69 percent. Shockingly, the percent of deaths as a result of infectious disease fell by 98 percent.

Following the initial reforms, funding for healthcare grew dismal and economic crisis began in the 1980s. Throughout this period of economic decline, foreign aid helped the population of Costa Rica and kept public health steady.

Even with the contributions of other countries, the CCSS was still struggling financially. Policy changes have since been implemented with the goal of providing financial stability for the CCSS, with varied results.

Despite some complications with the execution of CCSS, it is still impressive that Costa Rica ranks 36th in overall efficiency. This is out of 191 countries as evaluated by the WHO.

Improved Healthcare Increases Medical Tourism in Costa Rica

Overall, health in Costa Rica has improved over time. As of 2017, the under-five mortality rate, logged by UNICEF, has been in continuous decline since 1990. Additionally, the percentage of children receiving all of the doses for DTP and measles are both above 90 percent. The health of mother and child are generally above average compared to the neighboring countries.

Due to the reduced cost and increased quality of healthcare, medical tourism in Costa Rica is a growing industry. Along with the boost for the economy in the medical sector, medical tourists also spend money on recreational activities. In Costa Rica, medical tourism is a new facet of tourism and is expected to expand in the future.

-Carolyn Newsome
Photo: Flickr

Living Conditions in MonacoMonaco, a small sovereign principality on the French Mediterranean coastline, is famous for its exceptional beauty, mild climate, and wealth. France surrounds Monaco on three sides and the Mediterranean Sea surrounds the other. Monaco is just 10 miles from the northern border of Italy. Monte Carlo, the state’s main district, is a popular luxury tourist destination and home to high-profile cultural staples like the Formula One Monaco Grand Prix, the Hotel de Paris and the Casino de Monte-Carlo. The principality is the second smallest independent state in the world after the Vatican and roughly the size of New York City’s Central Park. Home to about 39,000 people, Monaco is one of the richest nations in the world.

 Top 10 Facts About Living Conditions in Monaco

  1. The principality is governed by a hereditary constitutional monarchy with Albert II of the Grimaldi family, the current Prince of Monaco, at the helm. The Grimaldi family has been in power since they took over the region in 1297 and exercised absolute control until the nation’s first constitution was drafted in 1911. They celebrated 700 years of rule in 1997. Monaco’s second constitution, drafted in 1962, outlines the power of the executive, legislative and judicial branches and reinforces a shift of power from the family onto the state.
  2. Monaco does not levy personal income, capital gains, property or wealth taxes on its residents. Its business taxation policies are relatively lenient. This has turned the city-state into a tax haven for the wealthy, incentivizing the world’s richest people to buy property and establish businesses in Monaco.
  3. Because Monaco’s tax policies attract the world’s richest, the per capita income in Monaco is among the highest in the world, estimated at about $161,000 per year. Monaco has the highest concentration of millionaires and billionaires in the world.
  4. Real estate in Monaco is the most expensive in the world. In 2016, property sold for an average of $45,360 per square meter. These prices are significantly greater than in Hong Kong ($42,840) and Tokyo ($39,100), both famous for their expensive real estate.
  5. Less than a quarter of Monaco’s 38,000 residents are citizens. The vast majority of people in Monaco are wealthy foreigners. Many Monaco natives are not wealthy and must rely on government subsidies in order to afford to remain in Monaco. It is nearly impossible for foreigners to become citizens, so government subsidies are tailor-made to support Monaco natives.
  6. The unemployment rate is estimated at 2 percent, one of the lowest in the world. The Prince of Monaco guarantees every resident of Monaco a job, and the most popular industries among residents are tourism, finance and insurance. The region is also a hot-spot for research, with many residents working in the research industry.
  7. Education is mandatory for every child in Monaco and is provided for free by the Department of Education. Monaco’s literacy rate stays consistent at 99 percent. About 70 percent of Monaco’s students attend a public institution, while the rest attend one of several private schools in the region.
  8. Every worker in Monaco pays into the public healthcare system, and as a result, every contributor is reimbursed for the majority of their medical costs. Plus, with about 581 doctors per 100,000 people, Monaco has one of the highest concentrations of doctors in the world. Abundant sources of funding and doctors make healthcare in Monaco excellent, reflected in Monaco’s average life expectancy of 89.5 years.
  9. Crime in Monaco is very rare, and Monaco’s police force, consisting of 515 people, makes it the largest police force per-capita and per-area in the world. Monaco is one of the safest places in Europe and earned the nickname of “the safest square mile in Europe.”
  10. Monaco has the lowest poverty rate in the world. By attracting the world’s richest people, the state effectively eradicated poverty.

Monaco’s paradisal and business-friendly reputation attracts money from all over the world, causing its economy and residents to prosper. As a result, the living conditions in Monaco are unparalleled, and poverty is nonexistent in the state. A mix of political stability, low unemployment, low crime, high-quality health care and government assistance programs maintain Monaco’s high standard of living. As long as these aspects of Monaco endure, the phenomenal living conditions in Monaco should persist.

Jillian Baxter
Photo: Flickr

Hypertension in South Asia
The Duke Global Health Institute will begin a study this year to find cost-effective ways to fight hypertension in South Asia.

The study will enroll 2,500 people from 30 rural communities in Bangladesh, Pakistan and Sri Lanka, where heart attacks and strokes caused by hypertension, also known as high blood pressure, are major causes of death.

“High blood pressure is the leading risk factor for premature deaths globally,” the study’s lead researcher, Tazeen Jafar said. “The findings from [our study] are likely to provide a roadmap for effective blood-pressure lowering strategies that are sustainable…and have the potential for saving millions of lives and reducing human suffering in South Asia and possibly beyond.”

According to the World Health Organization, 82 percent of premature deaths caused by non-communicable diseases like hypertension occur in developing countries. That’s 28 million deaths per year, and health officials say these deaths are entirely preventable.

Jafar’s study will focus on four strategies. The first is to educate patients about the beneficial effects of diet and exercise on hypertension. In addition to regular weekly exercise, diets high in whole grains, fruits and vegetables while low in sodium, saturated fat, cholesterol and alcohol are considered to be the easiest ways to measurably reduce blood pressure.

His team will also attempt to improve referrals to specialists, train doctors to manage high blood pressure with cost-efficient medication and develop special services at clinics to serve patients with hypertension.

They will then compare their results to traditional health care systems to find out if they can effectively fight hypertension in South Asia within the economic means of patients in developing countries.

Reducing hypertension and other non-communicable diseases will be a priority for policymakers over the coming years, as they work towards achieving the sustainable development goals of the 2030 Agenda.

An economic impact study from the U.S. Institute of Medicine suggested related diseases in Brazil have caused up to $72 billion in productivity loss — a problem that persists because these diseases are passed down between generations. For countries in South Asia facing similar consequences, fighting hypertension-related deaths is more than a matter of public health, it is an economic imperative.

Ron Minard

Sources: Duke University, Mayo Clinic, WE Forum, WHO
Photo: Torange

prosthetics for the poorLIMBS International is a non-profit organization dedicated to creating affordable and durable prosthetics for the poor.

The demand for affordable prosthetics in the developing world is great and the supply is lacking. Prostheses that are affordable and sturdy enough are hard to come by.

Approximately 40 million people in the developing world are in need of prosthetics yet only five percent have any prosthetic options. Whether or not the five percent can afford the options is a whole other question.

LIMBS International works to reduce the number of amputees lacking prosthetics through innovative designs created with developing countries in mind. The organization is focused on finding cheaper and more efficient ways to produce practical prosthetics and has developed the first mass-produced, low-cost, multi-axis prosthetic knee.

The philosophy that LIMBS International uses is a holistic plan focused on education, community rehabilitation and technology development. The organization trains teachers to educate children on the needs of amputees in developing countries.

It also focuses on rebuilding the community through the Community Based Rehabilitation program to help address social, mental and emotional trauma that amputees have experienced. The technological development has an emphasis on creating low-cost, high-quality prosthetics.

Taking this further, the organization trains people to repair the prosthetic devices in their country of focus using material available in the region.

The prosthetic knee that LIMBS has built is manufactured in Bangladesh to be used in large-scale relief efforts by clinics and international organizations after natural disasters.

LIMBS International has launched a project called Project: Mobility to fit 250,000 amputees in the world with prostheses by 2024. The distribution of LIMBS International’s LIMBox to clinics that LIMBS partners with as well as to NGOs around the world will help reach that goal on time.

The organization is currently working in nine different countries: Bangladesh, Bolivia, Cambodia, Dominican Republic, El Salvador, Guatemala, India, Kenya and Mexico.

Iona Brannon

Sources: LIMBS International
Photo: Wikipedia

The Trans-Pacific Partnership (TPP) continues to face strong popular opposition, particularly among those who claim that the provisions aimed at establishing new standards for intellectual property are beneficial only to multinational corporations and associated industries. One of those is the pharmaceutical industry, which faces the prospects of increased drug prices and extended patent rights if the agreement becomes law. These revelations come from a WikiLeak’s leak of the Healthcare Annex, the TPP provision concerning access to healthcare and pharmaceutical products.

Among the provisions under scrutiny are proposals to extend patent terms on new pharmaceutical products, increased ability to enforce patent rights, increased risks and costs associated with registering generic drugs and further limits on exceptions to patent rights. The result is increased authority for multinational pharmaceutical companies, higher prices on basic goods and decreased access to basic medicine and healthcare for patients.

Dr. Deborah Gleeson, a professor of Public Health at Australia’s La Trobe University, says the Healthcare Annex does nothing to expand, or even guarantee, access to medicine for the world’s people.

“The purported aim of the [Healthcare] Annex is to facilitate ‘high-quality healthcare’ but the Annex does nothing to achieve this,” she said. “Nor does this do anything to promote ‘free trade’: rather, it tightly specifies the operation of countries’ schemes for subsidizing pharmaceuticals and medical devices with the aim of providing greater disclosure, more avenues for the pharmaceutical industry influence and greater opportunities for industry contestation of pharmaceutical decision making.”

The provision would also affect signatory countries’ control over their own healthcare programs, the result of a “consultation mechanism” that could be used to pressure countries into adopting health policies beneficial to U.S.-based pharmaceutical and medical device companies. According to Jane Kelsey, a professor of law at the University of Auckland and the second specialist consulted by WikiLeaks, this suggests that the ability of member states to subsidize medicine for their citizens will be diminished.

“That will mean fewer medicines are subsidized, or people will pay more as co-payments, or more of the health budget will go to pay for medicines instead of other activities, or the health budget will have to expand beyond the cap,” she said of New Zealand’s healthcare subsidy program.

Proponents of the Healthcare Annex argue that extended patent rights and high drug prices are necessary in order to fund pharmaceutical research and development. According to Kelsey, however, other options are available to governments worried about stimulating R&D. She notes that Pharmac, New Zealand’s medicine subsidy administrator, has been able to dramatically lower the price of drugs by subsidizing pharmaceutical companies that offer the cheapest shelf prices. Under New Zealand’s system, companies compete to provide customers the cheapest prices, and as a result of the subsidies realize increased sales for their efforts.

According to WikiLeaks, the TPP’s healthcare provision would restrict the ability of countries like New Zealand to implement such policies, and would “inhibit the adoption of similar policies in developing countries.”

The most immediate threat to medical care for the world’s poor comes in the form of decreased access to generic drugs, which often cost a fraction of the price of patented drugs. For example, generic drugs, which account for a large portion of the Mexican medicine market, have saved the poorest Mexicans $1.3 billion over the last four years. Farmacias Similares, a bargain pharmacy in downtown Mexico City, charges only $17 for a two-week supply of the generic drug bicalutamide. A patented version of the same medication under the brand name Casodex sells for $83, more than Guillermo Ocampo, a security guard with no health insurance, earns in a week.

“This medicine stops [my] cancer from growing and that keeps me alive,” said Ocampo in an interview with Global Post. “I simply couldn’t afford to pay for the patented version. I don’t know what I would do.”

The Trade Promotion Authority (TPA) passed in the House Thursday, and, if it proceeds to pass in the Senate, will strip Congress of the ability to debate or amend the version of the TPP proposed by President Obama, limiting it to an up or down vote. While the trade agreement has largely been negotiated behind closed doors, the leaked provisions indicate that access to affordable medicine among the world’s poor could be seriously threatened. “The TPP agreement is on track to become the most harmful trade pact ever for access in developing countries,” warned Doctors Without Borders in a statement in 2013. “[We urge] the U.S. government to withdraw – and all other TPP negotiating governments to reject – provisions that will harm access to medicines.”

– Zach VeShancey

Sources: The Hill, Doctors Without Borders, Telesur, Global Post, Wikileaks
Photo: Business and Human Rights Resource Center

Jhpiego is an international nonprofit health organization and an affiliate of Johns Hopkins University. Jhpiego’s programs are primarily centered on the prevention of unnecessary deaths of women and children in developing countries. The organization works on the front lines in urban slums and rural settings to design accessible and affordable healthcare solutions. Jhpiego is currently active in 40 countries, concentrated in Africa, Asia, Latin America and the Caribbean.

The organization works with healthcare professionals, influential community members and government leaders to deliver quality healthcare for those in need. It also focuses on developing sustainable strategies for communities in developing countries to manage their own well-being. Jhpiego trains local healthcare workers, improves the quality of community health systems and makes delivery of care, services or products more efficient and dependable. It focuses on developing technologies and solutions that can be used both in hospitals or in the home. The organization’s provision of affordable healthcare for women and families ensures of level of care previously unattainable by many of the recipients.

Jhpiego began as an acronym for the Johns Hopkins Program for International Education in Gynecology and Obstetrics, yet the organization has now expanded its efforts to tackle issues such as the prevention and treatment of HIV/AIDS, infection, malaria, tuberculosis and cervical cancer. Jhpiego’s science division also researches innovative technology that has the potential to help poor and vulnerable communities. The ultimate goal is sustainability—giving poor communities the tools and education they need to build a foundation of good health and continue the cycle without outside assistance or aid.

As an affiliate of a prestigious university, Jhpiego has the advantage of being well-connected. In June 2014, the United States Agency for International Development (USAID) awarded $500 million to Jhpiego to fund a program to alleviate maternal and child mortality. Jhpiego is currently using the funds to spearhead a five-year program centered around preventing child deaths due to treatable causes like diarrhea and pneumonia. By working in conjunction with other partners and nonprofits, Jhpiego seeks to create a network of aid to mothers and children in need.

Jhpiego will use the funds to provide cost-effective vaccines and antibiotics to the 24 countries with the highest numbers of child mortality. Jhpiego will also provide other medical equipment, train community medical providers and reach out to women in slums and rural areas. The USAID funds will be used to research prevention and treatments for the leading causes of death for mothers and children. Among mothers, the leading causes of mortality include uncontrolled bleeding after birth, infections and high blood pressure during pregnancy. Among newborns, asphyxia and low birth rate. And among young children, pneumonia, malaria and diarrhea.

Since 1990, the global child mortality rate has nearly been halved. Yet Jhpiego’s efforts instill hope that the number can be further lowered. Jhpiego works with NGOs and government policymakers alike to increase accessibility to quality health services. By focusing on sustainable, cost-effective health solutions, Jhpiego can help provide care for underrepresented, vulnerable populations.

– Mari LeGagnoux 

Sources: Baltimore Sun, Jhpiego
Photo: Jhpiego