Singapores healthcare system has excellent health outcomes while spending, as of 2014, is just 5 percent of G.D.P. on health care. By comparison, a typical Western European country that year spent around 10 percent; the United States spent 17 percent.
Singaporean vision is built around personal responsibility and private spending, but also a degree of statism and paternalism that present-day American conservatism instinctively rejects.
1 .Singaporeans do not spend money voluntarily saved in health-savings accounts. Under their Medisave program, they spend money saved in mandatory health-savings accounts, to which employers contribute as well.
2. Their catastrophic insurance doesn’t come from a bevy of competing health insurance companies, but from a government-run single-payer system, MediShield. And then the government maintains a further safety net, Medifund, for patients who can’t cover their bills, while topping off Medisave accounts for poorer, older Singaporeans, and maintaining other supplemental programs as well.
The federalist health care compromise floated recently by Senators Bill Cassidy (R) and Susan Collins (R) is a little closer to Singapore than many Republican plans to date. The senators propose that states be allowed to experiment with an Obamacare alternative that would 1) auto-enroll the uninsured in catastrophic coverage and 2) directly fund health savings accounts for the working class and poor. The first isn’t MediShield (there’s no public option) and the second isn’t Medisave (no mandatory saving). But together, they’re more Singaporean than what RyanCare does and doesn’t do, and better for it.
Singapore spends just 4.7 percent of its GDP on health care (World Bank Health Data, 2014). Cost is controlled in a number of ways, perhaps foremost by the manner in which the government both fosters and controls competition—intervening when the market fails to keep costs down. Public and private hospitals exist side by side, with the public sector having the advantage of patient incentives and subsidies. Because it regulates prices for public hospital services and regulates the number of public hospitals and beds, the government is able to shape the marketplace. Within this environment, the private sector must be careful not to price itself out of the market.
At the same time, the government sets subsidy and cost-recovery targets for each hospital ward class, thereby indirectly keeping public sector hospitals from producing excess profits. Hospitals are also given annual budgets for patient subsidies, so they know in advance the levels of reimbursement they will receive for patient care.
Within their budgets, hospitals are required to break even.
Singapore currently has the second lowest infant mortality rate in the world and among the highest life expectancies from birth, according to the World Health Organization. Singapore has “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,” according to an analysis by global consulting firm Watson Wyatt. Singapore’s system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized health insurance plan, and government subsidies, as well as “actively regulating the supply and prices of healthcare services in the country” to keep costs in check; the specific features have been described as potentially a “very difficult system to replicate in many other countries.” Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the government’s programs