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Various evaluation studies of the EHCVS showed that the overall design and the lack of
specificity of the EHCVS are core areas for improvement (Box 4.3). Therefore, along with the
findings from the interview with key stakeholders (Chapter 4.1), it is important that the
Scheme clearly defines the service scope. In line with the concepts of strategic purchasing
centred on the purchasing of specified services, the Scheme should align with a more
well-defined structure that targets specific healthcare services, notably
preventive care, and chronic disease management (Yam et al., 2019; Yeoh et al.,
2020).

The lessons learned from the implementation of the EHCVS formed an important
cornerstone of question-setting for our telephone survey, which sought to identify
improvements to be made for enhancing the effectiveness of similar
schemes. For instance, in designing a more effective voucher Scheme, clearly defining the
scope of services to be offered and identifying the accessible price, also known as
willingness-to-pay (WTP), based on prospective users’ healthcare needs are
imperative to bridging the gap between intention to use health services and actual uptake
(Box 4.4).

Box 4.3

Key findings from evaluation studies of the EHCVS

There is increased utilisation of private sector services, but purchased
services were generally more associated with acute care rather
than disease prevention or chronic disease management
(Yam et al., 2019).

There is an unintended increase in dual utilisation of public
and private healthcare services, indicating the likelihood that service
duplication remains, which would greatly challenge overall health system
performance and sustainability (Yam et al., 2019).
Non-targeted services of the EHCVS, inadequate knowledge
about the EHCVS, higher cost, and low trust towards private
healthcare services compared to public services were key
contributors to the observed underutilisation of vouchers for disease
prevention and management, and for the failure to reallocate care demand
from the public to private sector (Lai et al., 2018).

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