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?