Blue Paper on the National Health Plan is published

On 2 February 1983, the government published the National Health Plan, a 20-year plan to overhaul Singapore’s health system.^[1]

At the time, Singaporeans were generally in good health, but the nation’s health bill had risen four-fold over the past decade, from S$59 million in 1971 to S$257 million in 1981.^[2]

Hence, the plan set out the government’s strategy to maintain a high standard of health care within Singapore’s limited resources as well as meet rising demand from an increasingly health-conscious, affluent and ageing population.^[3]

One of the plan’s main thrusts was to build a new partnership between the public and private sectors, with the government playing the role of a coordinator to ensure better distribution of health services. Private doctors and hospitals were asked to assume greater responsibility in providing curative care at reasonable fees.^[4]

The first part of the plan, which was published on 2 February 1983, included the following proposals:^[5]

• Building community hospitals in Housing and Development Board (HDB) new towns as a more affordable alternative for patients who only needed basic treatment rather than highly specialised care;
• Establishing modern polyclinics in every major HDB new town;
• Extending the opening hours of outpatient clinics into the evening to reduce the number of non-emergency cases at accident and emergency departments in hospitals;
• Introducing a means-test for admission to Class C wards; and
• Converting more Class C beds to Class A and B beds, which were preferred by the public.

The second part of the plan, which was published the following day, proposed a compulsory national contribution scheme called Medisave. This was a monthly deduction from employees’ Central Provident Fund (CPF) to ensure that they would be able to pay for their own hospitalisation expenses.^[6]

The purpose of Medisave was not as an insurance scheme but rather to meet the basic hospitalisation needs of the average Singaporean worker and his family. It was worked out based on  government Class C ward charges charges.^[7]

Under the plan, the government planned to eventually raise the CPF contribution rate to 50 percent of wages. Of this 50 percent, 6 percent of wages would be channelled to Medisave.^[8]

Unlike other CPF accounts, an individual would not be able to withdraw his Medisave savings upon reaching the age of 55. However, it could be used to pay for hospital bills incurred by the individual or his/her immediate family in a government or approved private hospital.^[9]

The National Health Plan was published as a Blue Paper, which meant that members of the public could share their views and suggestions about the plan before it was implemented.^[10]

Many groups and individuals who responded agreed with the plan’s axiom, “Prevention is better than cure.” However, one frequent criticism was that the plan seemed to overlook the fact that people did not always have control over whether they fell sick or got injured.^[11]

For instance, the Singapore Association of Social Workers felt that Medisave coverage should include outpatient treatment and long-term hospitalisation for the chronic sick.^[12] The Singapore Medical Association (SMA) commented that while Medisave was an ingenious way of helping the majority of the population look after their own healthcare needs, it did not provide for the sick minority, the indigent and the handicapped.^[13] The SMA suggested that Medisave be accompanied by a national insurance system as a safety net.^[14]

Following a two-day debate in August 1983,  parliament gave its support for the Medisave scheme, with two exceptions: then Member of Parliament for Rochor Toh Chin Chye abstained from voting, while J. B. Jeyaretnam, Member of Parliament for Anson, voted against the scheme.^[15]

Toh, who was formerly the minister for health, argued that health care was primarily the government’s responsibility. It was therefore the government’s duty to find ways of using taxpayers’ money to fulfil its different objectives, rather than taking out savings from CPF.^[16]

The Medisave scheme was launched on 1 April 1984. In the scheme’s first year, the CPF Board collected S$786 million – more than double the running cost of the public health system that year. Only 3.5 percent of the total collected amount was paid out in claims, although the figure was envisaged to rise over time due to the ageing population.^[17]

References
1. Tan, B. (1983, February 3). Govt's new 20-year health plan. The Straits Times, p. 1. Retrieved from NewspaperSG.
2. The Straits Times, 3 Feb 1983, p. 1.
3. The Straits Times, 3 Feb 1983, p. 1.
4. The Straits Times, 3 Feb 1983, p. 1.
5. The Straits Times, 3 Feb 1983, p. 1.; Lee, Y.M. (1983, February 3). Health Plan for public review. The Business Times, p. 7.; Here's to health. (1983, August 30). The Straits Times, p. 14. Retrieved from NewspaperSG.
6. The Straits Times, 3 Feb 1983, p. 1.; Medisave debate. (1983, August 16). The Straits Times, p. 1.; Tan, B. (1983, February 4). How Medisave will work… The Straits Times, p.1. Retrieved from NewspaperSG.
7. Thomas, M., & Liau, J. (1983, February 4). The National Health Plan and you. Singapore Monitor, p. 18.; Workers may also use savings for outpatient treatments. (1983, June 18). The Straits Times, p. 11. Retrieved from NewspaperSG.
8. The Straits Times, 4 Feb 1983, p. 1.
9. The Straits Times, 4 Feb 1983, p. 1.
10. What do you have to say? (1983, February 3). The Straits Times, p. 1. Retrieved from NewspaperSG.
11. Many agree on the need for prevention.... (1983, August 30). The Straits Times, p. 15. Retrieved from NewspaperSG.
12. Social workers give their views on the health plan. (1983, July 8). The Straits Times, p. 10.; Debate was tamer than expected. (1983, September 1). The Straits Times, p. 1. Retrieved from NewspaperSG.
13. Koh, N. (1983, April 27). What the doctors say.... The Straits Times, p. 1. Retrieved from NewspaperSG.
14. Now that doctors have spoken.... (1983, May 1). The Straits Times, p. 18.; The Straits Times says… No question about it… (1983, April 29). The Straits Times, p. 18. Retrieved from NewspaperSG.
15. Debate was tamer than expected. (1983, September 1). The Straits Times, p. 1. Retrieved from NewspaperSG.
16. Former health minister attacks scheme. (1983, August 31). The Straits Times, p. 11. Retrieved from NewspaperSG.
17. Yong, P. A. (1985, June 1). $786 million collected in scheme's first year. Singapore Monitor, p. 4. Retrieved from NewspaperSG.