William Haseltine has a new book out on the Singapore health care system. This summary is from Brookings:
- Singapore is 6th in the world in healthcare, but has 25% of the spending the U.S. has.
- Tertiary care is 80% public, while primary care is 80% private.
- Price transparency: Singapore has a law mandating that public and private caregivers post their prices.
- Singapore encourages competition among the public hospitals, but has certain regulations in place. The regulations were put in place after Singapore found that hospitals were spending a lot of money competing for higher class business by providing higher quality care. Average prices across the country increased. Some regulations include quotas requiring that they provide various qualities of care with various prices.
- Mandatory 401(k) and people use their savings to pay for whatever they need. Healthcare included. (My comment: Singapore has had mandatory medisave accounts since 1984.)
It really looks like Singapore knows what it is doing. The U.S. could learn from that country and many others out there about how to run a proper healthcare system.
While it sounds like they have a great system as far as public ones go, I am still opposed to the idea of the government running health care at all.
Privatize healthcare would be the best way to go. You are right to say that government is the worst option for handling our healthcare.
“Singapore is 6th in the world in healthcare, but has 25% of the spending the U.S. has.”
– I think this is another example of the shear size of the US Healthcare System.
Tertiary care is 80% public, while primary care is 80% private.
-Very interesting stats
This is a much better model, where individuals are expected to set aside funds over their lifetime to finance their own medical care. Moreover, they can choose how much care they are willing to pay for. Instead of discussions like this, the United States created Medicare, Medicaid and encouraged employer-sponsored health insurance.
My fear is that the politics of health care are too divisive and the United States cannot have a serious discussion on health financing like this.
Agreed. There are so many strong opinions in this country that we end up with a terrible system. Too many cooks in the kitchen.
I am opposed to the idea of employer-sponsored health insurance run the way we adopted it to be in this country, along with the way government-run insurance works and insurance companies distort prices. Perhaps we should be bold enough to follow something similar to Singapore’s model…however, I don’t know why but I sense there’d be much opposition to this.
I wonder how people from very low-income households can afford quality health care in Singapore. In other words, I wonder how much of government aid is available for these purposes.
“Tertiary care is 80% public, while primary care is 80% private.”
This spreads the risk of really high-cost care across the whole population.
U.S. statistics suggest that between 25% and 33% of medical insurance spending is for high-cost care. So it appears that the Singapore strategy, if adopted here, could effectively pool that same proportion of total medical spending, reducing insurance spending by the same amount.
Thus in one stroke that could guarantee to all citizens that their catastrophic expenses would be paid from public funds; while at the same time, it could make medical insurance much more affordable and permit people reasonable choices about how much insurance they might want to buy for themselves.
It would have the further advantage of avoiding the controlling, baffling, and intolerably expensive governmental superstructure of anything like “Obamacare.”
I think Singapore has a pretty good strategy, eh?
“The regulations were put in place after Singapore found that hospitals were spending a lot of money competing for higher class business by providing higher quality care. Average prices across the country increased. Some regulations include quotas requiring that they provide various qualities of care with various prices.”
There is still significant government intervention.
Conceptually it has some merit to make this comparison, but the reality of trying to make a comparison between 300 million people and 5 million people has little value.
Explain.
Not sure where to begin:
Singapore has one culture, virtually everyone is bilingual and many speak three and four languages, all males must serve in the military which may explain why they are in better shape. And it’s easier to “control” or change behavior with 5 million people.
The U.S. has as many cultures as the entire world. Since men don’t serve in the military we have far more “slugs” than Singapore to take care of.
Oh and I’ve learned also that Singapore has had means-testing since 09 so if you go to one of the 10 government hospitals (they have 13 private hospitals) and you’re unemployed you have to mortgage your house for payment. The government recoups 20-100% of their expenses from user fees.
They have some good ideas. There is no question about that. It’s just that you can’t take a one-culture population the size of Minnesota or Maryland and compare them to the entire U.S. There are just too many variables.
“It’s just that you can’t take a one-culture population the size of Minnesota or Maryland and compare them to the entire U.S. There are just too many variables.”
Thanks – – but I think you are assuming as true what you want to believe is true.
Nothing you’ve said is more than speculation. Maybe you have better arguments. If so, now would be a good time to share them.
23 hospitals in the entire nation? America has 5,000 hospitals. This indeed seems to limit the applicability of Singapore to the USA’s challenges.
Also I was not aware that behind the scenes, the govt of Singapore turns to user fees and estate recovery.
No. 1, that probably raises their system cost well above 35% of GDP.
But more importanty, it backs up my contention that all modern hospital systems rely on some form of coercion.
In the single payer countries, the coercion is through taxes and not hidden for a moment.
In the American-type system, and now Singapore’s also, the coercion is from bill collectors, and in the fear that prompts people to buy health insurance. Granted, this coercion hits fewer people than taxes, but it hits them much harder.
When we oppose the ACA, we should not delude ourselves that we are opposing all coercion.
Bob: Perhaps Stella will listen to your argument as my true statements have been labelled as “speculation.”
Perhaps.
“23 hospitals in the entire nation? America has 5,000 hospitals. This indeed seems to limit the applicability of Singapore to the USA’s challenges.”
If you look at hospital bed capacity, the difference between the two countries is much less than you make it seem. The number of hospital beds per 1,000 population is about 2.0 in Singapore which is roughly 2/3 of U.S. capacity.
Additionally, Singapore is taking action to expand its hospital capacity.
http://www.sgh.com.sg/about-us/newsroom/News-Articles-Reports/Pages/Shortageofhospitalbeds,sosomeopsdelayed.aspx
Hospital bed shortages plague health systems in other places.
UK:
http://www.bbc.co.uk/news/uk-england-21874523
Canada:
http://www.thestar.com/life/health_wellness/2011/07/21/ontario_facing_serious_shortage_of_hospital_beds_report_warns.html
Even (horrors!) Sweden:
http://www.thelocal.se/discuss/index.php?showtopic=58721
An important question is therefore whether there is any reason to believe hospital bed shortages could not happen here, were the government responsible for hospital bed capacity in the U.S?
Agreed.
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