There is no denying that medical tourism has become a big deal over the past few years. With competitive rates and attractive facilities, it comes as no surprise that Asia has become a prime location and key player in this industry. Let’s take a look at several healthcare systems across Asia, and the strengths and areas open to improvement in each.

Malaysia

The Malaysian Health Ministry implements a universal healthcare system that offers public health services to the entire population at heavily subsidised rates.

In accordance with the Fees (medical) Order 1982, the fee schedule set by the Ministry of Health (MOH) states that citizens only pay RM 1 (SGD$0.32) for a general outpatient consultation and RM 5 (SGD$1.62) for a specialist consultation at public health facilities. Inpatient and investigation charges are also subsidized, but vary depending on the ward class.

In addition to the subsidised charges, many groups are exempt from hospital charges, including senior citizens, people with disabilities, as well as organ and blood donors.

Non-citizens pay a higher fee in accordance to the Fees Act (Medical) 1951 for Foreigners, which are RM 15 (US$4.85) and RM 60 (US$19.42) respectively for general and specialist outpatient consultations.

Public facilities are not allowed to refuse services to people who cannot afford to pay, and many have left without settling their bills. As a result, the amount of unpaid bills in one year (2006) previously totalled RM 26.1 million.

There are various public facilities available and strategically located nationwide, both in urban and rural areas. These include public hospitals, health clinics and 1Malaysia clinics (K1M), which are run by qualified nurses and medical assistants to provide basic medical care for the urban poor.

The public healthcare system co-exists with a private healthcare sector, where patients pay out-of-pocket or through private health insurance schemes for consultations, medicines and other health services. In October 2016, the implementation of a Full-Paying Patient (FPP) programme was announced in an MOH circular, and many postulated that the fee structures practiced by private sectors were being emulated due to budget cuts. This has since been clarified by MOH as false, and that the RM1 and RM5 fee structure will remain.

Singapore

Unlike the public healthcare system in Malaysia, the Singaporean Health Ministry implements a system of various schemes and compulsory savings to help citizens afford medical expenses.

The national medical savings scheme is known as Medisave, where working individuals set aside 8% to 10.5% of their monthly salary into a personal account, with which savings can be used to pay for medical expenses incurred at any local hospital for the individual or his immediate family members. However, there are withdrawal limits for inpatient cases, surgeries and certain treatments such as hospice care and psychiatric treatment.

There is also a national health insurance plan for citizens and Permanent Residents known as MediShield Life, which offers payouts so that patients pay less from out-of-pocket or Medisave for hospital bills. Premiums for the insurance are payable by Medisave, which is subsidised for those in the lower-to middle-income group. Medishield Life was launched in 2015, and reports show approximately 400,000 claims were made between November 2015 until September 2016, with a total payout of over S$600 million. The scheme is also open to Singaporeans living overseas.

Similarly, the government has also introduced ElderShield, a severe disability insurance scheme for those who require long-term care.

Other schemes include the Community Health Assist Scheme (CHAS) which was introduced in 2012 to enable citizens from lower-to-middle income households and Pioneers, who are elderly citizens born before 1950, to receive subsidies from participating GP clinics.

On top of subsidies and payouts through health insurance, Medifund, an endowment fund set up by the ministry, supplements the other schemes and serves as a safety net for needy Singaporeans who face financial difficulties with healthcare bills.

Philippines

The Philippine Health Insurance Corporation (PHIC), also known as PhilHealth, is a Government Corporation attached to the Department of Health that functions to administer the National Health Insurance Programme (NHIP). NHIP is the largest insurance programme in the country established to provide coverage and benefit payments, as a measure to ensure affordable, acceptable, available and accessible health care for citizens.

For inpatient services, PhilHealth provides basic coverage through reimbursements and is provided up to a ceiling, above which patients have to cover costs. The limits vary by hospital level, public and private, severity of case, and is also specified for the type of service such as room and board, drugs and medicines, supplies, radiology, laboratory and ancillary procedures, use of the operating room, professional fees and surgical procedures.

Certain outpatient services are also covered by PhilHealth, such as for day surgeries, dialysis, chemotherapy as well as radiotherapy, and for a tuberculosis-direct observed therapy (TB-DOTS) that was introduced in 2003.

The Universal Health Care (UHC) is a reform which aims to make essential and quality health services readily available and accessible to all Filipinos, particularly to those from the lower-income group. In order to address inequity in the health system, the UHC aims to improving the level of support provided by PhilHealth, introduce fixed payments for inpatient benefits, improve coverage on non-communicable diseases for outpatient services and improve facilities of Department of Health-retained hospitals, provincial hospitals, district hospitals and rural health units.

Hong Kong

The Hospital Authority (HA) in Hong Kong acts provides citizens of Hong Kong with public hospitals and related health services such as general out-patient clinics, day hospitals and specialist clinics, which are charged as per the Gazette.

The charges are divided into public and private services, of which the former is further categorised into eligible persons and non-eligible persons.

Holders of the Hong Kong Identity Card, children under the age of 11 years who are residents in the country, as well as other persons approved by the HA’s Chief Executive are considered eligible persons, and pay HKD$45 (SGD$8.30) and HKD$100 (SGD$18.45) per attendance to general out-patient service and specialist out-patient services respectively.

Those who do not fall under the category of eligible persons, however, pay up to HKD$385 (SGD$71.03) per attendance for general outpatient services and HKD$1,110 (SGD$204.80) for specialist outpatient services.

Charges for health services at private sectors do not differ between eligible or non eligible persons, and are more expensive, depending on the service. An outpatient consultation may cost up to HKD$2,160 (SGD$398.53) per initial consultation, of which subsequent follow-ups may amount up to HKD$1,420 (SGD$262) per session.

To discourage late or non-payments of medical fees, administrative charges are imposed to and this is applicable to all outstanding medical charges.

India

In India, there is a huge divide between rural and urban populations in access to healthcare. Approximately 70 percent of the population in rural areas have limited access to health facilities.

Most healthcare expenses are paid out of pocket, but many citizens from the lower income group are unable to afford medical bills, and are also unable to pay for coverage by health insurance. In order to address this, the government has implemented National Health Insurance Schemes to address health coverage for Below Poverty Line (BPL) families.

The National Urban Health Mission (NUHM) was started to meet the needs of the urban poor in healthcare, by making essential primary healthcare services available and reducing out of pocket payments for medical expenses.

The Rasthriya Arogya Nidhi (RAN) was also set up by the Ministry of Health & Family Welfare to provide financial assistance for patients who fall below the poverty line and are suffering from major life threatening diseases in order to help them receive medical treatment.

All elderly residents above the age of 60 are also eligible under the National Programme for Health Care of the Elderly (NPHCE), allowing them to receive free, specialised health care from facilities through the State health delivery system.

In order to provide citizens with comprehensive health security nationwide without exclusion or discrimination, India is aiming to achieve Universal Health Coverage, with a vision for a National Health Package to guarantee access to essential healthcare by the year 2020. MIMS

Read more:
The Medical Tourism Boom in Asia
5 difficulties Singaporean doctors face in tackling medical tourism
Top 10 countries with the best healthcare system

Sources:
Malaysia
https://kpkesihatan.com/2016/11/14/kenyataan-akhbar-kpk-14-november-2016-pengemaskinian-caj-rawatan-hospital-kkm-hanya-untuk-caj-pesakit-dalam-kelas-1-dan-2/
http://www.wpro.who.int/asia_pacific_observatory/hits/series/Malaysia_Health_Systems_Review2013.pdf
http://www.1malaysia.com.my/en/products/klinik-1malaysia-1malaysia-clinic
http://www.moh.gov.my/english.php/pages/view/151
http://www.moh.gov.my/english.php/pages/view/153

Singapore
https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/medisave.html#6
https://www.moh.gov.sg/content/moh_web/medishield-life/about-medishield-life/what-is-medishield-life.html
https://www.moh.gov.sg/content/moh_web/eldershield/about-eldershield.html
https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medifund.html
https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/
Community_Health_Assist_Scheme.html

Philippines
http://www.doh.gov.ph/milestones
https://www.philhealth.gov.ph/about_us/mandate.html
http://www.wpro.who.int/asia_pacific_observatory/Philippines_Health_System_Review.pdf
http://www.doh.gov.ph/universal-health-care

Hong Kong
http://www.ha.org.hk/haho/ho/cs/v3/serviceguide_feenchg-en.htm#1
http://www.ha.org.hk/visitor/ha_visitor_index.asp?Parent_ID=10044&Content_ID=10045&Ver=HTML
http://www.gov.hk/en/residents/health/hosp/overview.htm

India
http://mohfw.nic.in/showfile.php?lid=3085
http://mohfw.nic.in/index1.php?lang=1&level=2&sublinkid=2183&lid=1879
http://iussp.org/sites/default/files/event_call_for_papers/T.V%20Sekher-IUSSP%20pdf.pdf
http://www.forbesindia.com/blog/health/5-things-to-know-about-the-indias-healthcare-system/
http://nrhm.gov.in/nhm/nuhm.html
http://www.nhp.gov.in/national-health-insurance-schemes_pg
http://www.nhp.gov.in/universal-health-coverage_pg