Tuesday, April 23, 2013

Thoughts on Singapore Health System

 Even in a society as tightly controlled as Singapore’s, the market creates certain forces which perhaps in the long run may lead to democracy.
 Peter L. Berger (born 1929), American sociologist who specializes in the structure of societies.
I recently briefly  chatted with Paul Grundy, global director of IBM global health, who had just returned from Singapore, where he had once lived for 3 years.  We did not discuss Singapore’s health system, but subsequently I ran across this description of the system.

 “The Singapore Health Care system costs in Singapore costs less than 25% of that in the USA and results are better. In Singapore everyone has 6-8% deducted from your income for a Medicate account that is used for hospitalized medical expenses. The government subsidizes the health care system but the system is based significantly on the consumers paying (from their Medicate account or cash) and therefore making economic decisions.”
 “The medical system in Singapore has been designed with much more attention to costs than the USA system. Hip replacement costs US $43, 00 in the USA and US, $12,000 in Singapore. A heart bypass costs US $127,000 in the USA versus US $22,500 in Singapore.”
 “The quality of Singapore health care is at the highest level worldwide. There is health insurance available in Singapore though many rely just on the Medisave accounts. Catastrophic  health care coverage is widely used.”
This got me to thinking:

How do Singaporeans do it? 

Apparently they rely on a national  public system where most get their care.   But  authorities allow patients to use the private system as much as they wish and practitioners to charge what  they wish as long as consumers use their own money out-of-pocket and out of their medical savings accounts.   The Singaporeans have three interdigitating systems: Medischield, Medisavings, and Mediservices, -the interrelationships which I do not fully understand.
 But as understand it, the responsibility and decision making rests with consumers.    It sounds as if  Singapore has a universal version or our health savings accounts, except we restrict consumers from setting aside more than $2500 in any given year   The average citizen of Singapore now makes $50, 000 a year, which means they can stash away $3000 to $4000 yearly, and if cumulative savings are not enough, catastrophic coverage kicks in. 
 Comparisons between countries with different cultures, especially a Pacific Island or 5 million or so. predominately ethically Chinese , to  a continental nation of 315 million, is a dicey proposition, but there are perhaps lessons to be learned.
 As I was pondering the comparisons,  I ran across the review of a book by Lee Kwan Yew, “The Grand Master’s Insight on China, the United  States,  and  the World. “ Yew, now 89, was Singapore’s  leader from 1959 to last year, when he stepped down and during his reign  per capital income in Singapore rose from $400 to $50,000.  
 Yew’ s advice  to America, whom he considers a staunch ally. Keep your culture. You are creative, inventive, and original.  You have a capacity for renewal and revival.   Retain your openness.  Invite people from abroad to work with you and for you. Keep your “can do” spirit.  Realize risk and failure go together.  Do not go the way of Europe with its entitlement mentality and massive welfare states.  Be entrepreneurial.   Don’t  let the mass media, and  preoccupation with guns, violence, and social inequality  lead you astray. Control your debt,. Exploit your human capital, emphasize your assets, not your liabilities, and control your debt.
Tweet:  Singapore, an island of 5 million, has a health system that offers universal coverage that costs less than 25% of the US per capita.



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