We’re back from Singapore!
Soaring skyscrapers, architectural wonders, spotless streets and sidewalks, it would not come as a surprise to many that Singapore (SG) is a relatively young country. Having attained independence in 1965, Singaporeans quickly set about building a country in a way to distinguish themselves from the much larger countries around them. For a population as diverse as Singaporeans, this was no mean feat. In a land mass 1/4 the size of Rhode Island, the 6 million citizens represent a diverse ethnic and religious spectrum. There are Malays, Chinese, Indians, Christians, Muslims, and Buddhists. What then ties these people together? A strong sense of national pride, or rather in the principles that have made this small island a thriving tourist destination and a financial hub of the world.
My first conversation in SG was with my taxi driver from the airport. From this, it became clear that the driving force of the country was the populations’ strong work ethic. He explained that few welfare programs exist, as the pervasive thought is that nobody should expect a handout if they do not contribute to society in the form of work. The government also employs strict rules it expects everyone to abide by, and reinforces this through the strictest punishment: corporal punishment in the form of caning is often handed out to perpetrators of vandalism. The right to protest is nonexistent, and the country has been ruled by the same party for the last 60 years, and has had 3 rulers: 2 of which are father and son.
National military service is required of all men. Rights are often curtailed in the interest of public good. For example, Singaporeans must pay a SGD 100 entry fee to casinos on the island, although foreigners are exempt from this. The logic behind this and other similar rules, are that they are all in the greater good of the country and its citizens. Other laws ensure preferential treatment of citizens: A 40% property purchase tax is levied on foreigners but not citizens, in an attempt to keep real estate prices low. As a result, 85% of Singaporeans own their home.
The population seems content with this arrangement, by and large. While sectarian tensions often simmer, this quasi-nanny state has ensured that SG is a safe (crime is virtually nonexistent), clean, and friendly place to live. That it has managed to do this without citizens demanding greater welfare programs is quite remarkable. Healthcare is a prime example of this.
The government plays a leading role in the advocacy for sustained population health. Through heavy alcohol and tobacco taxation, and other public health campaigns and initiatives, this policy is rooted in the belief that prevention provides the cheapest and most effective way of keeping people healthy (while an entrée at a restaurant can be as cheap as $2, the local beer sells for $5-$10).
70-80% of healthcare is provided by the public sector. Citizens are covered by a single universal basic coverage, although it is not free. Instead, citizens are mandated to place a certain percentage of monthly income into a Central Provident Fund (CPF) account, which is roughly equivalent to social security in the US, but also includes enrollment in the healthcare program, called MediSave. Medisave essentially acts as a savings account for each individual/family. Medisave provides subsidized healthcare to citizens, and the out of pocket expense comes out of the Medisave account. In this way, unnecessary tests, hospitalizations, and medical expenses are curtailed, while still remaining affordable. Medisave, however, can only be used in the public health system. While public hospitals and clinics provide efficient, high quality of care, certain things can be lacking. The lack of a primary care provider or family doctor is an example of this. Also, the lack of risk (and thus, resource) pooling of Medisave accounts, open the door for the possibility of an individual incurring huge expenses for an unforeseen chronic medical condition. As a result, citizens often purchase additional insurance such as catastrophic/accident or pre-cancer insurance riders.
This is not to say that the poor or needy go without healthcare if they are unable to pay. Other government programs include ElderShield (for the elderly but only up to 85), MediFund (for the poor), and Medishield (which helps offset catastrophic accident medical bills). In this respect, it is not unlike the health systems of the west. However, the admirable work ethic that pervades through the population seems to avoid people trying to take advantage of this system and allow it to be viable.
While lacking in some respects, this structure has allowed SG to run one of the most efficient health care systems in the world, with ~4% of GDP spent on health care, compared with the US’ 17%.
On February 10, 2017, 6p.m., 80 clinicians, developers, entrepreneurs, and engineers watched the kickoff, listened to an esteemed panel, including Foreign Minister Vivian Balakrishnan, who helped us understand the importance of social robotics. In particular, the main takeaway is to remember that technology needs to complement the human user, not replace or make us obsolete.
31 pain points later, 12 teams formed. Teams chose to tackle problems ranging from fall prevention to medical compliance to physical therapy, each team incorporating a Loomo Segway into their solution. Some teams hacked 48-hours straight from the first day to the last to get their prototypes ready for final presentations!
Because everyone used a robot, each team pitched the standard 3-min presentation but also had 2 min to demo their in front of the audience. Judges had an extremely difficult time deliberating the top 3, and here were the winning teams:
Bot-ler: using Loomo’s mechanical advantage to handle challenges that involve manpower in nursing homes, including pushing wheelchairs and pulling heavy items.
D.O.R.I.: inspired by the Finding Nemo character, D.O.R.I. identifies patient with facial recognition and tracks mental decline by conversing and playing memory games in order to detect and treat Alzheimer’s early on.
Nurse on Wheels: extending the nurse’s hands, ears, and eyes into the patient’s home to monitor chronic patients with hypertension, which is clinically known to give rise to many other long-term health complications.
We’re proud of all the teams for using a full-fledged robot into their healthcare hacks and coming up with real solutions specific and generalizable to the needs of elderly care in Singapore. It was a great opportunity for the MIT HackMed team to learn about Singapore and some of its healthcare challenges! Can’t wait to see the post-hack follow-up for teams in a few months!
