STATEMENT BY MR LEE BOON BENG, DELEGATE TO THE 67TH SESSION OF THE UNITED NATIONS GENERAL ASSEMBLY ON AGENDA ITEM 123: GLOBAL HEALTH AND FOREIGN POLICY, 12 DECEMBER 2012

Mr President,

                   Singapore welcomes the draft resolution on “Moving Towards Universal Health Coverage” and thanks the “Foreign Policy and Global Health” Group for their excellent work on the resolution.  Singapore further welcomes the note by the Secretary-General on “Global Health and Foreign Policy” which analyses the challenges states face in achieving universal health coverage.

2                 The issue of universal health coverage has gained increasing traction with the international community in recent years.  All countries – both developed and developing – agree that universal health coverage brings benefits to society and the economy.  Within multilateral settings, the World Health Organisation has been active in promoting universal health coverage.  In this context, the tabling of the resolution “Moving Towards Universal Health Coverage” at the 67^th UNGA is a timely endeavour.

3                 However, the path to achieving universal health coverage is complex and there is no universal formula.  Instead, member states should adopt different solutions to cater to their unique circumstances.  Just as every sovereign state embarks on its own path of development, every sovereign state should tailor its own approach to achieving universal health coverage.

4                 We would like to highlight here that universal health coverage needs not only to be accessible and effective, but also sustainable.  To be successful, such health coverage needs to satisfy the following features.  First, it should provide universal healthcare coverage, ensuring that the sick and poor are not denied good quality healthcare because of their inability to pay.   Second, it is affordable to both present and future generations.  Third, it encourages patients and doctors to choose effective healthcare that is appropriate to their needs.

5                 In Singapore’s case, we have tried progressively to put in place a sustainable health financing system over the years.   We are acutely aware of the dangers of borrowing against our children’s future to finance our present needs.  In this regard, Singapore introduced Medical Savings Accounts (Medisave) in the 1980s – not to replace – but to ensure the long-term sustainability of universally-available government subsidies in our public hospitals.  With a rapidly ageing society, we have anticipated that our future generations will face an increasingly heavy burden in financing such universal health coverage.  In setting up Medisave, we ensure that those who can afford it set aside sufficient resources for themselves, freeing up subsidies to those who most deserve it.  

6                 Singapore’s health financing system is also designed to encourage patients and doctors to make the appropriate treatment choices, with supply-side cost-containment, as well as demand-side cost-sharing in the form of user fees and patient co-payments.  Government subsidies for public hospitals are given out based on diagnosis-related groups rather than a fee-for-service model.  This has reduced over-servicing and increased hospital efficiency.  Our national health insurance scheme, MediShield, is designed with deductibles and co-payments.  Such patient cost-sharing features instil individual responsibility when making healthcare decisions, and prevent flagrant abuse.  The Singapore Government has also worked to ensure that co-payments should not be overly large such that it creates a financial burden on the patient and his family.

7                 By and large, Singapore has achieved reasonably good outcomes on providing universal health coverage to our citizens while ensuring a sustainable financing system.  Nevertheless, our system is not perfect and will continue to evolve as our healthcare needs change over time. 

Mr President,

8                 I offer these examples not to highlight Singapore’s modest achievements but to point to the challenges of achieving sustainable and effective universal health coverage.  More importantly, I wish to illustrate the broader point that each country needs to design its own path to achieve this goal.   There is no one-size-fit-all healthcare financing system – whether it is tax-financed, based on social insurance, or a medical-savings funded model.   There are strengths and weaknesses in each system.  What is critical is that we can objectively judge each system on its merits, adopt features that work and refine them to meet with the evolving environment. 

9                 Thank you, Mr President.

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