period to almost 11 percent of the population.8
Quality of Care
Not only does Singapore perform well in terms of achieving world-class outcomes, the quality of care as experienced by consumers is also one of the system's highest accomplishments. The Ministry of Health regularly conducts “Patient Satisfaction Surveys” to gauge the sentiments of the consumers of its health services. The seventh Patient Satisfaction Survey was done in 2010. It assessed the level of patient satisfaction, compared performance of the different healthcare institutions, and gathered feedback for service improvement. The survey found that over 75 percent of patients were satisfied with the services at the public hospitals, polyclinics, and national specialty centers. Further, almost 80 percent would recommend the services of public healthcare institutions to others9 (see Chart 2.1).
Figure 2.1
Figure 2.2
Figure 2.3
Confirming what Singapore's own self-assessments reveal, a World Health Organization report on comparative health systems issued in 2000 ranks Singapore's sixth globally in terms of overall performance. By comparison, the United States ranks 37, the United Kingdom 18, and Japan 10.10
Singapore's Healthcare Expenditure
Good healthcare is expensive, and many of the most-developed nations of the world are finding that the ever-rising costs for quality care are unsustainable. Singapore, on the other hand, has deftly managed to keep its costs low without sacrificing quality. In fact, it has achieved that exceptionally high rating from the World Health Organization while spending less per capita than any other high-income economy.
In spite of rising costs everywhere—due mainly to demographic trends, new and expensive technology, and changing disease patterns, Singapore, I am pleased to see, continues to spend less than four percent of GDP for healthcare, by far the lowest figure among all other high-income countries in the world.
The United States, by contrast, spends almost 18 percent of GDP annually—a huge price to pay that is currently causing bitter controversies and political battles as the nation debates its future approach to care.
When it comes to prices of specific procedures, one can immediately see the differences that exist in Singapore's costs vs. the United States. For example, the cost of an angioplasty in the United States is almost
Singapore's total national health expenditure as a percentage of GDP is comparable to that of the upper-middle (China–Malaysia), and lower-middle-income countries (India–Philippines), but the health outcomes achieved are on par with those delivered by the highest-income countries in the world.
Singapore's per capita expenditure was just over US
Chart 2.1
Table 2.6a
Figures on government-only expenditure for the world's healthcare systems also show Singapore as the leader in keeping costs under control. Per capita studies reveal that in 2008, the government spent over
Private expenditure in Singapore amounted to around 65 percent of the total national expense (2008). Note that this includes payments out of the government-run MediShield scheme and related insurance schemes, Medisave accounts, and other private insurance schemes or employer-provided medical benefits. The figure for the United States is 52 percent, 17 percent for the United Kingdom, and 18 percent Japan. Singapore's relatively high private expenditure is a direct result of the government's efforts to shift more of the cost burden to consumers than do most other countries. The approach is a fundamental strategy for keeping public expenditures down and curbing unnecessary usage. I would have to say that the approach is working. Later in the book, I will take a much closer look at this strategy, as well as the system's guiding principle of encouraging individuals’ responsibility for their own care.
I find it interesting that the figures for private healthcare expenditure in lower-middle-income countries are also substantial, but for a different reason. The underdeveloped public healthcare infrastructure in these countries and a general lack of faith in the system cause citizens to gravitate toward private healthcare services and to pay for their own care. In India, private expenditure was as high as 67 percent in 2008; in the Philippines it amounted to around 65 percent.
Singapore's Advantages
Along with its excellent system of medical care, Singapore has developed an infrastructure that helps support healthy living
