Singapore
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EnactedMinistry of Health formed in 1965.Number of People CoveredAll Singaporeans.Estimated CostApproximately 4 percent of GDP.
Payment Scheme Government pays for 80% of public hospital care and 20% of public primary care, using funding drawn from taxes. Individuals contribute via copayments and approved withdrawals from mandatory HSAs. Private and public health care systems and coverage co-exist.
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Plan in Brief
- The public system guarantees health care to all.
- A combination of "community support and individual responsibility."
- Individuals and their employers contribute almost two-thirds of funding, much higher than in other developed countries.
- Health Savings Accounts are mandatory.
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Impact on Federal Government
- Pays for 80% of public hospital care and 20% of primary care.
- Regulates hospitals, clinics, laboratories, and nursing homes and is responsible for public health and safety.
- Regulates prices for public health care services.
Impact on States
Impact on Insurers
- Can offer private insurance as well as catastrophic care insurance.
Impact on Providers
- Must publish price lists to allow consumers to make informed choices.
- The Healthcare Quality Improvement Fund was established in 2005 to promote improved quality and safety of care.
Impact on Employers
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Must contribute to mandatory HSAs.
- Often purchase private insurance for employees.
Impact on Individuals
- Contribute to expenses via copayments and approved withdrawals from mandatory HSAs.
- Can choose levels of care (e.g., a range of in-hospital accommodations).
- Means-based catastrophic care spending caps are in place.
| Proponents/Opponents
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Proponents say that Singapore’s mandatory HSAs and emphasis on individual responsibility are the keys to the remarkable combination of low public financial contribution and high health care outcomes.
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Critics contend that emulating the Singaporean approach in a larger nation with a different government and socioeconomic structure is no guarantee of success. They say too that quality of life measures may not be uniform across countries.
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Key Targets for InvestmentPreventive health care.
Chronic disease management.
Mental health programs.
Notable Features
- Singapore is regarded as having one of the most efficient and effective public health systems among developed countries; it has markedly lower expenditures but comparable healthy life expectancy.
- Public health care facilities are organized into two clusters to foster competitive innovation between the two clusters but gain comprehensive care and economies of scale within each cluster. They are run as private companies but also as government-owned nonprofit organizations.
- The health care system is based primarily on Western medicine, but traditional Chinese medicine is supported and regulated.
Experts' Comments
"The spirit is closer to the value model than most other economies. If you look at Germany or UK, you actually see them behind. They have some great doctors and some great institutions but philosophically Singapore is probably one of the most progressive countries in moving towards a value model. The US (has) a huge distance to go. US has high quality - the best in US is the best but the average is not good enough and we don't get good value for 17 percent of GDP (spent on healthcare)."
--Michael Porter,
Professor,
Harvard Business School, Adviser, Asia Competitiveness Institute, quoted in Channel NewsAsia
"The concept is simple, that healthcare everybody must look at values. So from a patient's point of view, what is value? Value means I want to get well. I'm sick, I want to get well. Are you able to bring me back to my healthy state at the lowest possible cost?"
-- Khaw Boon Wan,
Health Minister, Singapore,
quoted in Channel NewsAsia
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