What Singapore Health Has to Teach the World?

Comparative healthcare is a growing area of interest for both medical and political reasons. In this guest post by Lena Paul, learn more about how healthcare operates in Singapore:

The high cost of healthcare in countries such as Australia and America has many politicians twitching. In Australia, government expenditure into health care teeters at around 9%; in America, it's just above a whopping 15%. And yet Singapore only spends about 4% and has a level of healthcare services and health in general equal to Australia and America. What gives? What could the Singapore health system have that could teach others and in doing so, help save a lot of money?

One of the big problems with the healthcare system in America and Australia is that while it's a great way to stay well, it's also growing more expensive and that means a greater burden on those who need it the most-the rapidly growing, aging population. Universal healthcare may simply become unaffordable over time and plenty of people are going to fall through the cracks.

Why are costs high? No competition! Doctors and hospitals are either overloaded with patients or they are discouraged from competing with one another which means that the prices can be higher without fear. However, this system can be tackled: change Medicare to a health saving system and allow for competition over patients without regard to their insurance status. Singapore has this system and it works insofar as spending is concerned; les than 4% of its GDP is spent on healthcare. And though the spending is less, Singapore actually rates higher in World Health Organisation rankings-6th place as opposed to America (37) and Australia (32). So how does Singapore take care of its own?

The system is a two part program. First, Singapore has a compulsory savings program (Medisave). Employees and employers contribute between 6 and 8 percent of the employee's income, split down the middle and dependent on age. These funds are used to pay for medical expenses and unlike the Australian system, people cannot run a 'negative' balance; if the medical costs are higher than what is in Medisave, the difference has to come out of the patient's wallet or through voluntary insurance such as Medishield. But accounts can also be used to pay the expenses of immediate family members. For example, if you have never needed a doctor, but your father needs regular treatments, you can pay for them in part or in full from your Medisave account. Furthermore, those who have few funds can apply for assistance through a government appointed Medifund committee.

        

It's a far from perfect system; it doesn't provide as much coverage and the poor, unemployed and chronically ill are definitely at a disadvantage. However, the Australian system (and other systems) could take the Singapore method and tweak it to provide healthcare at a lower cost than it is now. How?

Singapore Skyline (Source: Wikipedia)

The big feature to take away from the Singapore system is the ability to have a government-funded savings account system that would offer the safety net features of Medicare without any disadvantage to the poor, chronically ill and/or aged. Within this system, the government would pay a pre-determined annual amount to everyone, based on age of citizens, into a health account for each person held at the Commonwealth Health Bank. Then the account would be supplemented jointly by employer/employee contributions, say 2% of income. Then funds gathered in each account would then only be used to pay for medical services at approved prices.

Private hospitals and individual practitioners could charge more than the approved amount, but the patient would have to pay the difference from his or her own wallet or private insurance. Private insurance would also be used to cover things like sudden and catastrophic events or illnesses that would kill a health savings account such as cancer treatments.

Unlike Singapore, citizens will be allowed to run up a negative health balance to provide a safety net, but if you make above a certain threshold of money a year, a slightly higher tax rate applies until the balance is put back to normal. If you die before the negative balance is dealt with, the estate must be used to pay for it and a positive balance can be willed to someone else. And just like the Singapore system, a positive balance can be used to help another family member out.

Now, the safety net feature does mean that Australia and any other country taking on this system would still pay more, but over the long run, the percentage would drop which is always a good thing.

How does this system also benefit patients? Aside from providing affordable care to everyone, a positive health account becomes an asset which is used to reward people for taking care of their health. There would be an end to over-servicing, over-ordering of tests and general floods to doctors which would reduce pressure in waiting lists. Furthermore, there would be more competition between public and private sectors which mean the system would become more efficient.

These changes may seem radical, but with a rapidly growing and aging population and increasing pressures to pay more and more for necessary services, it's important to overhaul the system now before universal healthcare becomes a footnote in history.

Lena Paul is a medical school graduate who is an enthusiastic blogger and holds an editorial position in Prepgenie, a test prep provider that offers exam preparation courses for GAMSAT, PCAT, UKCAT and UMAT.

Open More Doors by Earning a Master of Science in Nursing Degree Online

Thought about a career in healthcare but realized medical school was not for you? Think again, but think different: a career in nursing! Check out this guest post from Susan Smith to find out more:

There are so many excellent and rewarding job opportunities in the medical profession; you don't have to be a doctor to help people. A doctor is only as good as the staff that surrounds him or her. Becoming part of the staff is not only a wise career choice, but it is a rewarding career path that provides plenty of opportunities to help people in need. A career in nursing is stable, it pays very well and it is a job that makes a difference in the lives of millions of people everyday.

Nurses are often the first people to provide care to people who are sick or injured. A nurse can form a relationship with a patient that will last a lifetime, but what is really important is this fact: a nurse is often the first person to put a smile on the face on the patient. Which nursing degree will offer the best opportunities for you, then? Well, there are several to carefully consider:

Licensed Practical Nurse - This is often the first stepping stone towards a career as a nurse; they are commonly referred to as LPNs. A LPN will be able to provide basic care to people who are sick or injured. Schooling is required and usually one year of training at a hospital is also required. A LPN can then choose to further their knowledge and career choices in the nursing field. A LPN is often supervised by a registered nurse.

Registered Nurse - A registered nurse, or RN, will have more job opportunities, but this position will require more training. RNs often have to supervise several other LPNs and certified nursing assistants.

Associate of Science in Nursing - This is the next step an LPN can take to further his or her career. By obtaining an associate’s degree, nurses will not only expand their knowledge, but they will also be able to earn a bachelor's degree with greater ease. This degree is available to both RNs and LPNs. This is a two-year degree that focuses on the more technical aspect of the nursing industry, but once again: this is just a stepping stone towards a better degree.

Bachelor of Science in Nursing - This is not the highest degree a nurse can obtain, but it is often the most sought-after by people who are pursuing a career in nursing, and it will provide the best job opportunities. Numerous current positions in the nursing industry will require a BSN (Bachelor of Science in Nursing). This is a four-year degree, but there are instances where this degree can be earned faster if the nurse already holds an associate’s degree.

Master of Science in Nursing – Also known as an MSN, for many nurses, this is the “Holy Grail” of the industry. Nurses that obtain a Master of Science in Nursing will find a huge amount of career choices. A nurse that has this type of degree can handle as much as 80% of the same work as a primary care physician. This type of degree can also grant a nurse prescription privileges. A nurse with a Master of Science in Nursing does much more than change bedpans. They have the necessary knowledge to provide primary care, examine patients and order and interpret specialized diagnostic tests and studies.

RN to MSN Online - This program allows a RN to pursue a Master of Science in Nursing online. This gives nurses more opportunities and a more flexible schedule to obtain the degree. Online classes can be taken anytime day or night.

MSN Bridge - This program allows a nurse that has a non-nursing Bachelor’s degree get started in the right direction towards earning a MSN degree. The MSN bridge course consists of many of the undergraduate courses that are needed to start graduate level courses required by a MSN.

Nurses are currently in high demand and that is not expected to change in the near future. Choosing to pursue a career in the nursing field is not only smart, but it offers gratifying and challenging experiences every single day on the job.


Susan Smith is currently furthering her education with an RN to MSN online course. She was inspired to enter nursing by her grandmother, a World War II nurse.

Physician Burnout: It's Inevitable, But Not Unavoidable

If you have given any consideration to a career in medicine, you have heard about physician burnout. But never fret: Dr. Jewell offers some advice on how to deal with the stresses of a medical career in this guest post:

Doctors are in some way or the other responsible for maintaining the balance of the yin and yang of the universe - well at least that is what they are trained to believe throughout their tenure at medical school. The practice of medicine manages to portray itself as attractive and “fun” during the first couple of years after college, but the fun aspect gradually takes a backseat and eight or 10 years down the line they get engulfed in the burnout pedantic. Experts believe that this is because of the medical training that the physicians receive (or lack of it actually) and also because how people generally define “success”. The problem is there is only one parameter to measure success - busy practice. More often than not the success of a physician is defined by his workplace pressure and his ability (or inability) to continue performing on the trapeze wire that losing balance. Here are the few reasons of physician burnout and how it can be avoided:

• The job is “stressful”: Well, how would you define that? Some of the more demanding professions such as that of a physician or a lawyer are characterized as having a heap of responsibility with very little control on the final outcome. Like it or not, the job is one of the most demanding ones and needs one to keep performing under pressure without succumbing to it. It definitely saps all energy every day, day by day.
• Physicians are taught to solve problems - not to bask in them! A typical physician encounters hundreds of physically and mentally sick patients throughout the day and he is always expected to be the problem solving machine and hardly a human being (with a whole bunch of emotions affecting performance). Here, the problem does not lie with the profession - the training provided to medical students does not adequately equip them to handle emotional pressure.
• The balance is always tipped! Throughout medical school a medical student is taught to shove aside all priorities of life and focus only on medicine and its charismatic capabilities of transforming others' lives. The problem is medical school does not last a lifetime but the training continues to dominate the students and somewhere down the line family responsibilities start qualifying as “other priorities”. Here also, it's the training mythology that is to be blamed when some elemental changes would definitely make things better.
• A physician is always expected to have leadership skills but is never taught the same. Military and medicine are two different professions their leaders are only expected to give the orders, but in the latter the so-called leaders are never made to attend even a single lecture on leadership. The dysfunctional top-down leadership system not only leaves a health care delivery team confused but also puts more stress on the “leader” himself.
• A doctor is almost always considered as a machine. A physician is supposed to be able to keep performing under pressure and never succumb to it. He is always expected to be the perfect decision maker and service provider in front of his teammates, customers and hospital governing bodies. That definitely saps emotional and mental strength.
• So much work and you still have to deal with the money part! More on healthcare system might be a blessing for patients because they can choose to remain blissfully unaware of the twisted proceedings of medical insurance companies, but the physician is never spared. He is expected to have all knowledge about all kinds of insurance companies and also be able to make sure that his cut comes to him without bothering his patient.
• There is always an uncertainty about what's going to happen next. No marketing guru can perfectly predict the career course of a physician. So, the subconscious is always worried about what plans the future has for the physician. That is definitely emotionally taxing.
• Medical practice is like a ticking bomb. Medical science has evolved tremendously over the last couple of years, but so has the legal noose that almost always is concerned only about patient benefits and rights. A physician is always silently waiting for the bad stuff to happen and that is emotionally taxing.
• Too much pressure and you eventually get hurled into a lifelong emotional trauma. That is exactly what happens with physicians. All of a sudden nothing seems to make sense and the volatile love for medicine disappears suddenly. That is the end state of a burnout.

Word of advice

Burnout is inevitable under the circumstances and in most cases physicians seem to accept it as a way of life. The good news is this can be avoided. Solution on this is quite apparent! Stick to your reason or purpose of becoming a doctor! After spending quite a lengthy span of your life in medical studies, it's obvious to get bewildered when you see the purpose behind your endeavor is lost for some reason. Now, you have to jump in and establish the connection back, for it’s a source of your motivation and endurance.

Some of the important signs of a burnout include exhaustion, questioning your own ability and cynicism. You need to make something very clear to yourself - you have a talent that can benefit your fellow men, but that does not make you a machine. You have every right to feel sick, feel stuck and feel bored. Just indulge in activities that make you happy, get help from family and stop categorizing everything related to your profession is important and everything else “other priorities”.

Dr. Jewell is a board certified Oregon plastic surgeon who has served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) in 2005-06.

Do Medical School Rankings Matter?

Every year medical students agonize over medical school rankings. Specifically, like "AHHHH! MEDICAL SCHOOL RANKINGS ARE COMING OUT SOON!" Pre-Med students are famous for being Type A "gunners" who are at high risk for obsessive compulsive disorder. An exaggeration to be sure and not true of all, but the fact remains that data about rankings in the hands of people who are geared for high achievement tend to produce more angst than relief. 

The simple fact is: one cannot boil medical education down to a single ranking! The U.S. News And World Report's Best Medical School Rankings does not even try. It actually breaks the ranks down into research and primary care lists. Oddly enough, most people focus on the research rankings, despite the fact that primary care is what medicine is all about! Taking a look at the two sets of rankings and you quickly realize that the correlation between the two is far from perfect.

As a pre-med student or medical student, which list do you follow? The simple answer is: both! You have to realize which list best applies to you. Are you more interested in research and considering an MD/PhD or similar joint degree? If so, focus on the research rankings. Do you instead prefer caring for the underserved, working internationally, or perhaps rural medicine? Then focus on the primary care rankings. Not sure yet? Try to see which schools rank highly on both. As a guide, the list below shows the top 10 medical schools in primary care with their research rankings (in parentheses); the list below it has the top 10 medical schools in research with their primary care rankings (in parentheses):

Top 10 Medical Schools Research Rankings (Primary Care Rank)

1. Harvard University (17)

2. University of Pennsylvania (7)

3. Johns Hopkins University (25) 

4. University of California - San Francisco (5)

4. Washington University - St. Louis (30)

6. Duke University (42)

6. University of Michigan (14)

6. University of Washington (1)

6. Yale (87)

10. Columbia University (62)

Top 10 Medical Schools Primary Care Rankings (Research Rank)

1. University of Washington (6)

2. University of North Carolina - Chapel Hill (20)

3. Oregon Health Sciences University (37)

4. University of Vermont (55)

5. University of California - San Francisco (4)

5. University of Colorado - Denver (27)

7. Michigan State University (-)

7. University of Pennsylvania (2)

9. University of Massachusetts - Worcester (47)

10. University of Iowa - Carver (27)

As you can see, there are some huge disparities. The only schools to make both lists are University of Washington, UCSF, and UPenn. Clearly, if you are unsure of your future career focus, you have better odds of finding out at those three schools. While the USN&WR rankings are not 100% correct, they do serve as a reasonable proxy for the actual underlying quality. Ultimately, you have to make a decision from the heart about what place is right for you. 

References:
1. U.S. News & World Report Best Medical Schools Research Rankings. http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/research-rankings. Accessed December 21, 2010