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Health care – another embarassing (but inspiring) Singapore comparison

  • June 10th, 2008

Annette King had good reason to be ashamed of what her DHB model has done to our hospital, even before it became clear that the rebuild would diminish capacity

Given the job frustration of our dedicated health care people, deaths of heart patients waiting for care, children with no paediatric oncologists, and losses of other specialists, this survey of Singapore’s success is another reminder of what is achievable when politicians are focussed on what works, instead of ideology.

The World Health Organization’s most recent full report on global health statistics says we spend 8.9% of our GDP on healthcare, while Singapore spends just 3.7 percent. Their health statistics are better than ours. Their infant mortality (under 5 years) is half ours (3 per thousand live births compared with our 6).

What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381 (all dollars in this article are U.S.) per capita on health—or one-seventh what the U.S. government spends. 

Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care. As the Health Ministry puts it, “Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, government subsidies help to keep basic healthcare affordable.” 

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. ”

Of course it would all be easier here if we had their levels of average income, and their sustained growth rate (on the back of no natural resources). We’ve chosen to be poor.

When I first visited Singapore, from recollection their per capita incomes were about half ours. Now they earn an average US$4500 more per capita. They spend in total on health US$ 1,140 per person, about half what we spend.



I’ve got to disagree Stephen it is absolutely not the role of the state to fund ‘preventative health campaigns’. Our own socialist government is very fond of doing so – our rather using the excuse of ‘preventative health’ to lecture us on what we should be eating! No thanks!

  • Spam
  • June 10th, 2008
  • 3:21 pm

I understand that singapore basically has individual social security accounts, that a portion of your wages go into. If you get sick / unemployed etc, then the social welfare comes out of that account. If that account runs dry, then the govt will pick-up the tab. But the fact is that you essentially pay your own way first, which has got to be good.

  • jcuknz
  • June 10th, 2008
  • 8:55 pm

The stupid ideology of black and white, private and public must never mix, stops a lot of funding from entering the health system.

For example a major operation or even a relatively minor one would seriously affect my future standard of living if I went private, but I could certainly afford to pay part of the cost, and so the health system is deprived of that extra funding becuase of ideology.

Another point about our current system is the immorality of private insurers where they adjust the premiums acording you your age. In my opinion the only moral system is for premiums to be compulsory and to be based on whole of life average needs. This tends to require it to be centrally controlled … akin the the old 1/6d in the pound that we had until a politician decided to grab it for his mob .. a National MP it was too 🙂

  • jcuknz
  • June 10th, 2008
  • 9:00 pm

It is silly to object to government funded prevention becuase it is simple ecconomics that an ounce fo prevention saves a pound of later effort [or whatever the expression is 🙂 ]

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