Singapore’s health care system
Via Chris in the comments, this intriguing look at the Singapore health-care system:
Here are some comparisons: Life expectancy at birth in the United States is 78 years; in Singapore, 82 years. The U.S. infant mortality rate is 6.4 deaths per 1,000 live births; in Singapore, just 2.3 deaths per 1,000. But the United States has far more caregivers: 2.6 physicians per 1,000 people, compared with 1.4 physicians in Singapore. The United States has 9.4 nurses per 1,000 people; Singapore, 4.2. And it has six times as many dentists as Singapore and three times as many pharmacists.
The World Health Organization’s most recent full report on global health statistics says the United States spends 15.4 percent of its GDP on healthcare, while Singapore spends just 3.7 percent.
What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381 (all dollars in this article are U.S.) per capita on health—or one-seventh what the U.S. government spends.
Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care. As the Health Ministry puts it, “Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, government subsidies help to keep basic healthcare affordable.”
The reason the system works so well is that it puts decisions in the hands of patients and doctors rather than of government bureaucrats and insurers. The state’s role is to provide a safety net for the few people unable to save enough to pay their way, to subsidize public hospitals, and to fund preventative health campaigns.
The low proportion of government spending on health in Singapore helps the country maintain regular budget surpluses while reducing taxes. The top personal income tax rate is now 20 percent, and the corporate tax rate is 18 percent (both roughly half the U.S. rates), while the value-added tax, at 7 percent, is roughly one-third the level of the typical European country.
Of course, once again I’m left thinking – What a truly elegant solution! But this would never work in the United States! Am I wrong? Could something like this be implemented or would it just devolve into special interest shenanigans? Do Americans have the saving ethic necessary? Can such an amalgam of individual choice and state-subsidies work here?
There is a difference though between taking personal responsibility, focusing on maintaining health (a good practice) and ““Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service.”
This ends up a system where only the socioeconomically advantaged have access to state of the art health care. The standard is set low by those who pay, either the government or the insurance companies, ensuring the cost will be low.
If you have friends in Singapore, ask them. They will tell you.Report
I’m Singaporean and one of my daughters have biliary atresia, a congenital liver diesease. She’s gone through her Kasai operation at age two months, and was put on the list for liver transplant at age 1. However, her condition stabilised and she was off the liver transplant list and is now, aged nine, on regular follow up visits with the liver specialist at a restructured hospital in Singapore. And all through my experience, my daughter has received extremely competent care (with major surgery, HIDA scans, MRIs and ultrasound scans) in the two hospitals that have treated my daughter — and I have not been paying the so called high price that Livy may imply that I will need to pay. When my daughter was put on the liver transplant list, my first worry was the cost. I was worried that I would not be able to afford to pay for the transplant opertion, but the doctors and hospital was quick to assure me that when the time comes, and a liver becomes available, my daughter would have the transplant regardless of whether I could pay or not. I believe that this cannot be taken as an indication of the notion that “only the socioeconomically advantaged have access to state of the art health care”. For Singaporeans to make a statement that only the rich can afford state of the art health care is an irresponsible statement to make… and I have a feeling that these same people are the ones who expect that the government or someone else should bear all their medical costs. Singaporeans by and large love to complain — it is a national past time. But when they really sit down and make dollar for dollar comparisons, and service to service comparisons, they find that home is where you still get a comparatively better “bargain”. For those who cannot afford any crucial health care, there are so many organisations here who can help them. Medifund helped me with my daughter’s medical bills when I was not working full-time. Even though it is a case-by-case basis, people I know who need help have always been given the financial assistance they require.Report
Livy…
I’m Singaporean… and i can tell you for a fact that we’re having it good here where quality healthcare coverage (facilities,service, affordability etc) is concerned for all income level groups. Its a system Singaporeans are really thankful for.
Healthcare, Education, General Public Safety & Security are some things on the whole we got right.
I have my grudges and i do get pissed off about the way the govt runs certain things BUT i gotta admit, at least they got the basic fundamentals for what makes a stable and safe country correct.
I believe Singaporeans share this following view. We pay taxes, the govt better be on their heels to provide what we expect from them especially on the issues of health, security and economy.Report
Singapore is 100% urban and has a population density of 6723 people/sq km versus 31 in the United States (source: cia.gov). We will never have these efficiencies of population density and concentration of resources (which are briefly acknowledged in the original article) that make their system possible.
But then there is the principle of “the regulation of hospital beds, doctors, and the use of high-cost medical technology” cited as one of the reasons the system works dropped in the middle of a delightful list of self-restraint. Isn’t invasive government regulation of medical care one of the great fears people have about universal health care?Report
Well Ian…
If you got friends who work in Singapore. You should ask them about the healthcare system here and what they feel about it.
There are different versions of UHC applied worldwide in different countries. Funny thing about the USA is that they keep using Canada and UK as the focal point in case studies to debate on. Why not use Singapore or Japan or some other top ranking countries with successful healthcare system as a benchmark to what they wanna achieve as well?
Yup, you can’t just use us as a cut n paste template but if you have to know…. we didn’t do that as well. Basically, we took the best bits and pieces on what works well in other countries, study it, customised to our needs and adapt it into our system.
But for it all to be successful. America gotta sit down and ask themselves…. what does healthcare mean to their citizens…is it to an extent, a civil right or a privilledge? Americans generally talk about govt control and power but it seems to look more like the govt are just mere puppets to the private institutions and the lobbyist. Clearly, America is being run by CEOs and if its for a profit…theres gotta be exploitation. Come to think of it, its not healthcare in America that is a problem. Its the foundation of its political process that is shaky. How can things be done properly in the interest of its people? Ah rats… thats a another debate altogether….
So yeah thats pretty much what i have to say for now….Report
Singapore has a younger population than the U.S. Has that been factored into the analysis?Report