Mari Edlin
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With the Academy for International Health Studies, 30 executive delegates and I recently visited Singapore to study its healthcare
system.
Singapore is somewhat of an anomaly. The 438-square-mile island, which houses 4.5 million people, is considered a city, an
island state, a country and even a brand, emboldened by public/private partnerships, which shape its healthcare, economy and
tourism. The result is one of the cleanest and most efficiently run countries in the world—despite its wall-to-wall shopping
malls and restaurants.
From the outside, Singaporeans might seem a bit politically and socially repressed—with the same ruling party since 1959—but
the status quo is a small price to pay for adopting a "brand" that provides almost seamless healthcare as well as housing,
employment and a good education. The country spends as little as 3.7% of GDP on healthcare, yet still insures all of its residents.
Phua Kai Hong, professor at the Lee Kuan Yew School of Public Policy, National University of Singapore, put it well when he
said the key to the success of Singapore's healthcare system, is that "there's no free lunch." He also says that Singapore's
system represents the last bastion of family caring. At the heart of the healthcare system is individual responsibility, driven home by Medisave, the compulsory national health
savings account. As many as 85% of Singaporean families obtain their care through the fund, which is tax-free, earns interest
and becomes part of one's estate after death. However, they are not exempt from out-of-pocket deductibles and copayments.
In addition to Medisave, the three-pronged financing scheme includes Medishield, offered by the government and through private
plans, which provides catastrophic insurance and can be funded by Medisave. Medifund is a government-endowed safety net for
the needy.
Although only 8% of the population is older than 65, the government recently added Eldershield, a private insurance system
for long-term care. The country still has much to do to meet the needs of older citizens.
While the private sector delivers 80% of primary care, publicly owned facilities provide 80% of hospital care and even offer
choice. Consumers can pay for better hospital accommodations: one- or two-bed rooms with air conditioning, for example. Patients
are responsible for the full cost of their stay in the more expensive rooms, while the government subsidizes part of the lesser
hospital accommodations. Medisave can also be used to fund it.
Unfortunately, Singapore had declared a high-level alert for the H1N1 virus during our mission, prohibiting us from visiting
any of the hospitals.
FRIENDLY COMPETITION
The public healthcare system, headed by the Ministry of Health and managed by several healthcare clusters—predominantly Singapore
Health Services and the National Healthcare Group—offer a gamut of specialties and services. Run like private companies, the
organizations face off in friendly competition to improve care and keep it affordable.
Medical travel and Singapore's Biopolis, a high-tech, biomedical park, are two other kingpins. The director of marketing for
Raffles Hospital told us medical travel to Singapore had grown 43% between 2004 and 2006.
Mari Edlin is a frequent contributor to MANAGED HEALTHCARE EXECUTIVE. She is based in Sonoma, Calif.
