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Affordable Excellence

Affordable Excellence: The Singapore Health System

William A. Haseltine
Copyright Date: 2013
Pages: 182
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  • Book Info
    Affordable Excellence
    Book Description:

    This is the story of the Singapore healthcare system: how it works, how it is financed, its history, where it is going, and what lessons it may hold for national health systems around the world. Singapore ranks sixth in the world in healthcare outcomes, yet spends proportionally less on healthcare than any other high-income country. This is the first book to set out a comprehensive system-level description of healthcare in Singapore, with a view to understanding what can be learned from its unique system design and development path.

    The lessons from Singapore will be of interest to those currently planning the future of healthcare in emerging economies, as well as those engaged in the urgent debates on healthcare in the wealthier countries faced with serious long-term challenges in healthcare financing. Policymakers, legislators, public health officials responsible for healthcare systems planning, finance and operations, as well as those working on healthcare issues in universities and think tanks should understand how the Singapore system works to achieve affordable excellence.

    eISBN: 978-0-8157-2526-8
    Subjects: Health Sciences, Political Science

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-v)
  3. List of Illustrations
    (pp. vi-viii)
  4. Acknowledgments
    (pp. ix-xi)
    William A. Haseltine
  5. Introduction
    (pp. xii-xiv)

    Why this book?Affordable Excellencetells the story of the Singapore healthcare system, how it works, how it is financed, its history, and where it is going.

    Today Singapore ranks sixth in the world in healthcare outcomes well ahead of many developed countries, including the United States. The results are all the more significant as Singapore spends less on healthcare than any other high-income country, both as measured by fraction of the Gross Domestic Product spent on health and by costs per person. Singapore achieves these results at less than one-fourth the cost of healthcare in the United States and...

  6. CHAPTER 1 The Singapore Healthcare System: An Overview
    (pp. 1-15)

    Singapore has achieved extraordinary results both in the high quality of its healthcare system and in controlling the cost of care. In per capita terms and as a percentage of Gross Domestic Product (GDP), its healthcare expenditures are the lowest of all the high-income countries in the world.

    How did this happen? How has Singapore been able to achieve these kinds of results?

    The answers are bigger than just the process of putting a healthcare system together. There are larger factors that have to do with the spirit and philosophy of Singapore itself, the way it is governed, how the...

  7. CHAPTER 2 High Quality, Low Cost
    (pp. 16-37)

    Lee Kuan Yew wanted Singapore to achieve excellence—“first world standards” as he put it in his memoirs. Only then, he believed, would his young country survive and thrive. There is no doubt in my mind that the standards he desired for his city-state have indeed been met, and healthcare is one good example. Singapore now has a First-World healthcare system, rated sixth in the world by the World Health Organization and ahead of most high-income economies.¹ By most common measures, the nation has achieved noteworthy outcomes in all areas of healthcare. It has increased the life expectancy of its...

  8. CHAPTER 3 Helping Patients Pay
    (pp. 38-63)

    The success of healthcare in Singapore today is largely due to the government’s creative use of the Central Provident Fund. The CPF’s medical savings component, called Medisave, makes it possible for Singaporeans to pay for much of their own medical care. Medisave is, in essence, a compulsory savings account. The government sets contribution rates for workers and their employers as a percentage of wages. Once in their accounts, the money may be used to pay for personal and family healthcare—always along carefully-established guidelines.

    As mentioned in Chapter 1, the Central Provident Fund was first introduced under British colonial rule...

  9. CHAPTER 4 Controlling Costs
    (pp. 64-82)

    Once a healthcare system is built, it is much more difficult to reduce fixed costs, and when those costs spiral out of control, national budgets are strained. When nations can no longer support the system they have produced, they may need to resort to unwelcome alternatives that can include long delays for appointments, testing, and treatment; rationing; limitations of service; and even denial of service.

    Singapore has mostly avoided these problems. It has had the advantage of being able to build its system almost from the start, and of having a far-thinking government that carefully planned for healthcare, implemented its...

  10. CHAPTER 5 Financing
    (pp. 83-92)

    The Government of Singapore contributes billions of dollars to building and maintaining the country’s healthcare system and subsidizing a major portion of the cost of patient care, based on the individual’s ability to pay. As discussed earlier, the country does all this and achieves world-class outcomes while spending far less than most developed nations.

    One of the many factors that contribute to Singapore’s healthcare budgets remaining within reasonable bounds is that consumers of care are asked to pay their share for services. Private expenditure on healthcare amounts to over 65 percent of the total national expense of healthcare.

    At the...

  11. CHAPTER 6 Design and Infrastructure
    (pp. 93-105)

    Primary care, where ill patients make first contact with care professionals, is largely issued by private rather than public care providers. There are approximately 2,000 private general practitioners in Singapore, located mainly in housing estates, and they deliver 80 percent of primary care.¹ Several private general practitioner chains serve the public, including Raffles Medical (with more than 70 clinics), Parkway Shenton (over 40 clinics), and Frontier Healthcare Group (with nine clinics). The idea behind allowing the private sector to handle much of this care stems from the philosophy that people must take responsibility for their own health. It follows that...

  12. CHAPTER 7 Investing in the Future through Medical Education and Research
    (pp. 106-127)

    Education, research, innovation, and continual improvement are fundamental to the success of the Singapore healthcare system. The government has two broad goals in mind as it directs investment into healthcare knowledge and medical research. One is to better serve the people of Singapore, making certain the healthcare system is staffed with highly-competent, highly-trained doctors, nurses, and other medical personnel, and that the system is as effective and efficient as it can possibly be by incorporating relevant new technologies and research findings in the delivery of care. The other is to make economic progress in Singapore by developing the country into...

  13. CHAPTER 8 Facing the Future
    (pp. 128-142)

    In many developed countries, the proportion of elderly people in country populations is increasing rapidly. This trend is also true in Singapore, which has for years been experiencing a birth rate substantially below replacement. At the same time that fertility rates have declined, life expectancy has increased—due to the high quality of healthcare and rising standards of living. It is estimated that by 2030, 20 percent of the population will be over 65.¹ The growing proportion of elderly people will have a large impact on the entire society—individuals, families, communities, businesses, and the government.

    With its rapidly growing...

  14. Appendix
    (pp. 143-147)
  15. Notes
    (pp. 148-161)
  16. Bibliography
    (pp. 162-173)
  17. Index
    (pp. 174-182)
  18. Back Matter
    (pp. 183-183)