I am not qualified to give a definitive answer. But what I am qualified to do is poke around online and see who in the world is achieving the objective of health care reform explicitly laid out by President Obama – providing a way for all individuals to receive health care without fear that they are “one illness away from bankruptcy”, and reducing costs in the process.
So, who is doing the best job in the world achieving this goal?
The answer might surprise you.
In this relatively small island-nation, you can be treated to views of towering skyscrapers, mosques and temples of ancient Malay and Hindu civilizations, as well as innumerable Western-style shopping malls. Welcome to Singapore!
Singapore boasts the 6th best health care system in the world with an infant morality rate almost 1/3 of that of the U.S. (there are just 2.3 deaths per 1,000 live births in Singapore as opposed to 6.4 deaths per 1,000 live births in the U.S.). Its populace is the fourth longest-lived in the world, with an average life expectancy of 81.98 years.
And Singapore accomplishes this by spending only 3.7 percent of its GDP (only $381 per capita) on health, as opposed to America’s 15.4 percent expenditure!
What can account for Singapore being a shining example of a functional, frugal health care system? How does this system work?
In Singapore, individuals are required to set aside 6-8% of their income into what is essentially a health savings account (employers contribute to these accounts as well). This money earns interest, is tax-free, and can be withdrawn at any time to cover the health care expenses of ones’ self or family members. Unspent money accrues and rolls over from year to year. This program is called Medisave.
Citizens of Singapore may purchase additional coverage for catastrophic events with Medishield (or Medishield Plus which offers even more coverage), and their premium payments may come out of their Medisave accounts.
The government subsidizes the health care of those who cannot cover their expenses with either Medisave or Medishield through the Medifund program. For the elderly and disabled, government-subsidized ElderShield pays for health care expenses that the individual cannot cover himself.
http://www.moh.gov.sg/mohcorp/hcsystem.aspx
Here are some important points:
• Singapore’s vision as a state is “adding years of healthy life,” by focusing less on healing sickness, and in the words of the Singapore Health Ministry, more on “the more difficult but infinitely more rewarding task of preventing illness and preserving health and quality of life.”
• The people of Singapore willingly take responsibility for their own health by spending their own money to fund most of their health care costs.
• “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.”
• 75% of the populace of Singapore uses less-expensive holistic/complementary medicine at least once per year in preventing and treating illness. http://linkinghub.elsevier.com/retrieve/pii/S0965229904001189
• Complementary medicine is widely accepted by the medical community at large as an important contributor to the nation's health.
Phua Kai Hong, associate professor of health policy and management at the Lee Kuan Yew School of Public Policy at the National University of Singapore gives the following reasons for Singapore's successful health care system:
• "the creation of incentives for responsible behavior and the efficient delivery of services;
• the discouragement of overconsumption through cost-sharing;
• the regulation of hospital beds, doctors, and the use of high-cost medical technology;
• the promotion of personal responsibility;
• targeted government subsidies;
• and the injection of competition through a mix of public- and private-sector providers.’”
http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model
What can we in the United States of America learn from Singapore? Why don't we try to emulate some of the things that have worked in Singapore in our own health care reform?
Before I discuss this in a subsequent post, in my next post I will outline the health care system of a part of the world where a push to give health insurance to all is doing just that, but costs are continuing to skyrocket and hardships for middle class citizens in obtaining health care continue in full force.
Unfortunately, the latter is the system we are emulating, and it appears that almost no-one is paying attention!
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