Why Singapore's health-care system works Think | Updated today at 01:28 AM By Gillian Tett
A decade ago, I had an experience that left me profoundly grateful to Singapore's health-care system. During a work trip to the island state, I was suddenly taken ill and succumbed to a rare variety of meningitis.
In many countries, I would have died, but two extraordinary things occurred.
First, a colleague had a strange premonition that something was wrong and came to my hotel room, where she found me sliding into a coma.
Second, the colleague then had me rushed to a local hospital, where Singaporean doctors identified the problem with astonishing efficiency and then took a bold medical gamble to save my life. (Essentially, they injected every type of antibiotic they possessed directly into my heart because they did not have any tailored way of treating the rare strain of meningitis I had.)
When that gamble pulled me out of the coma, the staff set me on the path to rehabilitation, with further efficiency and grace.
A few months later, I stumbled on some paperwork between the hospital and my insurance group and noticed that the bill for the intervention was not that large.
"If this had happened in America, it would be many times that size," a colleague later grimly remarked in New York. To which I retorted that if the incident had happened in America, I might not have survived at all since litigation risk might have deterred the doctors from engaging in that antibiotic gamble.
Was this just a piece of random good luck? Yes, in part. But that may not tell the whole tale. Recently I have been flicking through a fascinating e-book, Affordable Excellence, that a scientist friend, Professor William Haseltine, has written about Singaporean medicine for the Brookings Institution. And this leaves me convinced that I have even more reasons to say "thank you" to Singapore than I realised at the time.
Professor Haseltine believes that Singapore's health-care system is not just low-cost but also very effective in terms of saving lives; so much so, in fact, that this might offer lessons to the US, which is embarking on health reform.
The statistics are striking. At present, the US spends about 18 per cent of its gross domestic product on health care, more than any other Western nation. But while this produces fantastic results in some niches (such as cancer treatment), the metrics for infant mortality, adult deaths, life expectancy and other health issues are worse.
Singapore's health-care costs, by contrast, are just about 4 per cent of its GDP; and while the system is based on insurance programmes, premiums per capita are just 2 per cent of those paid by Americans. But on issues such as life expectancy, infant mortality, premature adult death and emergency care, Singapore produces much better outcomes than the US.
Why? One reason, Prof Haseltine suggests, is that Singapore created a health-care system from scratch a few decades ago and was able to adopt a rational plan that focuses on the total health experience of the population. America, by contrast, is marred by competing, wasteful silos.
But another weapon for lowering costs in Singapore is consumer pressure: Hospitals are forced to publish prices for medical procedures and outcomes so that consumers can compare them. Patients are also forced to co-pay for treatment, alongside insurance groups, to create incentives to scrutinise their bill.
Now, it would be impossible to replicate some of this in a vast, fragmented system such as the US'. After all, most Americans hate the idea of state meddling, but there is one aspect of Prof Haseltine's report that is relevant: accountability. If Americans could compare the price of treatments as easily as they can in Singapore, that might lower treatment prices - doubly so if the use of co-payments was as widespread among the rich as among the poor.
The good news is that the US is moving that way since there is growing support within the medical world for co-payments and price transparency. But the bad news is that any changes are slow and patchy because the system is so fragmented. For the foreseeable future, in other words, those statistics from Singapore are likely to keep putting the US and other nations to shame.
It is a sobering thought, given that behind those statistics stand millions of human stories, many of which were not as blessed with as much good fortune as mine.
Financial Times