Singapore is often held up as a shining example of what a health care system could be: it has much lower spending than the United States — about $2,000 per person in 2009 compared to the U.S.'s $7,000 — and better outcomes. In a frequently-cited World Health Organization study, Singapore ranked sixth among international health systems. The U.S. ranked 37th.
What makes Singapore's system tick? Aaron Carroll, director of the Center for Health Policy and Professionalism Research at Indiana University School of Medicine and blogger at The Incidental Economist, lays it out in his latest episode of Healthcare Triage.
Singapore relies on some principles embraced by conservative health policy scholars — notably, savings accounts for paying out medical expenses. These are a popular health reform tactic with the GOP; the belief is that these accounts, paired with high deductibles, will make consumers more cost-conscious and smarter about how they spend money on medical care. Health savings accounts have been embedded in Medicaid expansions in certain conservative-led states.
But that's not the whole story. Unlike in the United States, Singapore mandates that people deposit money in their health savings account: from 7 to 9.5 percent of income, depending on age. (Other mandatory and optional savings accounts consume additional income.)
Singapore's system is also heavily regulated by the public sector. Though only one-third of the country's health spending is public, the government takes a strong role to keep prices low.
None of this is to say that Singapore's system is something that the United States could easily emulate — and it's wise to be wary of people who suggest otherwise, regardless of ideology.
"The most frustrating part about Singapore is that it's easily misused by those who want to see their own health care systems change," Carroll says. "More conservative types will point to the Medisave accounts and the stress on individual contributions, but ignore the heavy government involvement and regulation. More liberal types will point to the public's ability to hold down costs and achieve quality, but ignore the class system or the system's reliance on individual decision-making."