Skip to comments.The Singapore health system – achieving positive health outcomes with low expenditure
Posted on 03/23/2012 12:19:22 AM PDT by Cronos
John Tucci explores the current set-up.
In the 39 years since achieving independence, Singapore has developed into
one of the wealthiest countries in Asia Pacific with annual GDP (on a per capita
basis) being amongst the highest in the region. This is an impressive accomplishment
for such a small country with very limited natural resources other than its
What is equally impressive, although less well known, is that Singapore is
generally acknowledged as having one of the most successful healthcare systems
in the world, in terms of both efficiency in financing and the results achieved
in community health outcomes. This is quite an achievement compared to most
other developed countries.
Figure 1 compares the total annual health expenditure (as a percentage of
GDP in 2001) and healthy life expectancy (averaged for males and females
as at 2002) for a number of developed countries. The measure of healthy life
expectancy has been proposed by the World Health Organization as a measure
of the expected number of years to be lived without reduced functioning due
to illness or disability. As can be seen, the annual health expenditure for
Singapore is less than half that of many developed countries even though its
citizens enjoy comparable healthy life expectancy (although this is at the
lower end in the comparison).
Source: World Health Organization
Life expectancy is not the only indicator of the quality of healthcare. Singapore
also performs well in relation to other indicators, including low infant mortality
rates and acceptable waiting times for most forms of healthcare treatment (particularly
in public health care facilities).
The key to Singapores efficient health care system is the emphasis on the
individual to assume responsibility towards their own health and, importantly,
their own health expenditure. The result is a system that is predominantly
funded by private rather than public expenditure. For example, in 2002, private
health expenditure in Singapore (that is, financed by individuals or employers
on behalf of individuals) amounted to almost 67 per cent of total health expenditure
with the remaining 33 per cent financed by the Government from tax revenue.
As shown in Figure 2, this is not the norm for most developed countries (the
US aside), where health financing is predominantly from public expenditure.
Source: World Health Organization
Singapores low public health expenditure is also reflected in the low individual
tax rate environment that exists there (2 per cent to 28 per cent for individuals
and 26 per cent for companies) compared to the other countries which need to
draw higher taxation revenue to fund their public health expenditure.
The Singapore health system is based on a combination of government subsidies
(through taxation) and individual responsibility. In order to assist individuals
in meeting their component of personal medical expenses, the Government has
established the 3M framework of Medisave, Medishield and Medifund that
combine individual responsibility and is overlaid with government funding,
particularly to provide a safety net to support the health needs of low income
earners and poorer individuals.
The Government subsidises healthcare through taxation revenue,
providing funds for public hospitals and health promotion. As discussed
earlier, this amounts to approximately one third of Singapores total annual
Medifund is an endowment fund set up by the Singapore Government to
assist those in financial hardship in funding their medical needs. The scheme
is intended as a safety net for those who cannot afford the subsidised charges
for hospital or specialist out-patient treatment, after allowing for any
Medisave or Medishield funds. Qualification for Medifund provision is means
tested, based on an individuals financial circumstances at the time of application.
Medisave is a compulsory medical savings scheme with funds available to meet
a portion of future personal or immediate familys hospitalisation, day surgery
and certain outpatient expenses.
Medisave is a subset of the mandatory Government pension scheme (the Central
Provident Fund or CPF) to which a total of 33 per cent of wages is contributed
(comprising 13 per cent employer contributions and 20 per cent employee contributions)
to individual accounts to fund retirement and health related expenditure. Of
the 33 per cent contribution, around 6 per cent to 8 per cent (depending on
age) is credited to the employees Medisave account. In practice, Medisave
covers approximately 85 per cent of Singapores population.
Medishield is effectively a national insurance scheme for catastrophic illness
that is intended to cover a significant component of medical expenses from
major or prolonged illnesses that are not covered by Medisave. Medishield
operates under a scheduled reimbursement system based on days of hospitalisation
and type of surgical treatment, offset by individuals sharing costs by way
of co-payments and deductibles.
The Government has, in recent years, allowed the private insurance market
to offer similar Medishield-type policies so individuals now have a choice
of choosing between Medishield or a private alternative. Premiums for Medishield
(or private insurance alternatives) can be paid from an individuals Medisave
The Government has also recently introduced Eldershield, an extension to
the 3M system.
Eldershield is a private insurance scheme designed to help fund future medical
expenses incurred in the event of severe disability, particularly at advanced
In addition to individuals self-financing through Medisave, Medishield
and Eldershield, a significant portion of workers (and their dependents) are
covered by private health insurance. Private health insurance, which is often
funded by employers on behalf of employees, covers a diverse range of medical
expenses that are not typically reimbursed under the 3M system.
Invariably, individuals will still need to pay for part of their medical expenses
directly, even after receiving reimbursements from Medisave, Medishield or
private health insurance. These amounts generally relate to deductibles,
co-payments (under Medisave or Medishield) or for over the counter prescription
drugs not covered by private health insurance.
The key to Singapores efficient health care system is in its emphasis on
the individual to make a significant contribution towards their own healthcare
costs. With this focus, the Government has been able to maintain a relatively
low level of public expenditure on health for many years with the major burden
put on individuals and/or their employers.
The use of compulsory savings (that is, the Medisave account) has been very
successful as the main source of private funding for hospital expenses.
Another key focus of the Government has been to ensure that overall health
expenditure does not fall victim to the significant inflationary pressures
that have been evident throughout the world. This has been achieved by actively
regulating the supply and prices of healthcare services in the country.
Although the Singapore health system has been very successful, it is a very
difficult system to replicate in many other countries for several reasons:
the country over a number of years under the backdrop of political stability
enabling successive governments to introduce consistent measures relating
to individual responsibility, compulsory savings and regulatory control of
healthcare services and costs
land mass of 660 square kilometres, the planning of a healthcare infrastructure
has been somewhat easier than would be the case for larger countries.
Nonetheless, the Singapore health system is one that is certainly worth studying
by those countries who continue to be challenged by common healthcare issues
|World Health Organization website (www.who.int)||
|Singapore Ministry of Health website (www.moh.gov.sg)||
I'd guess drug abuse there for example is far lower than other western countries - do drugs there and lose you life promptly - no slow death through the health care system costing lots of money...
I'd also guess Singapore has a very stable homogeneous population as in practically zero immigration.
Another detail rarely mentioned is much of the medical technology used in other countries is developed in the United States where American citizens pay for that development and other countries get the benefit without the heavy front end investment/cost.
For those who think that this would work in America, there are a couple of things that they should notice.
1.) Fly to Singapore. Look at the people. Find a fat person, just one... THERE AREN’T ANY!
2.) You cannot even smoke outside, cigarettes are HEAVILY taxed and each package has disgusting pictures on it.
3.) Alcohol is heavily taxed to discourage its use.
4.) Public transport is safe, fast and better than driving, and the entire country is covered by the MRT (Subway system).
5.) Since Singapore is small and crowded, automobiles are heavily taxed to discourage their use, hence fewer accidents.
I will add this....the reason why medical costs in Denmark and the Scandinavian countries have been kept in check...are the same reasons.
Once you toss in unhealthy diets, ease of smoking, aggressive drinking habits, assaults and violence, teenage drivers, and 75mph speed limits...the variable for increased costs goes up. I’m shocked at how the media refuses to ever discuss this matter. If you took every rule set up in Singapore, and applied it to America....no family in the nation would have to pay more than $2k for yearly healthcare. In fact, most hospitals in America would be empty and lacking patients. This ought to make folks think.
Singapore also has a fast, cheap, effecient means of dealing with young offenders - they get caned, then released.
No long imprisonment in an expensive system which acts as a graduate school for learning crime.
The NWO elite crowd has yet to get their communist tentacles into Singapore!!!!
Nope. Singapore has a diverse, though largely Asian, population, with considerable immigration (also Asian), although they try to control it.
Hilarious. How much of what you posted would the rugged individualists of the USA put up with? The answer is none.
Let’s face it, we want it all, but we don’t want to pay for it, nor sacrifice in any manner.
——Singapore also has a fast, cheap, effecient means of dealing with young offenders - they get caned, then released.
No long imprisonment in an expensive system which acts as a graduate school for learning crime.——
Ironically, while we see caning as “cruel and unusual,” is actually far more merciful than our existing penal system, for the reason you give.
-—Another key focus of the Government has been to ensure that overall health expenditure does not fall victim to the significant inflationary pressures that have been evident throughout the world.
This has been achieved by actively regulating the supply and prices of healthcare services in the country.-—
Otherwise, the program seems fairly reasonable, although a long way from a free market.
The most difficult question regarding healthcare, now and in the future, is, What can be done for the uninsurable and the elderly? —cases of “market failure.”
In a low-tax, free market society, churches, family, and charity could fill the void. But we’re not there, so what is the best program that can be implemented now?
beheading IS bad, but caning is more public shame than anything