Healthcare... The return of the Singapore model
Last week, in one of his Undercover economist columns, Tim Harford asked
If the US healthcare system is financially incontinent and the UK system is reliant on a centralised and philosophically troubling cost-benefit analysis, is there some other better way?
He answered in the affirmative, pointing to Singapore.
The aim of the country’s healthcare system is to get patients to face some of the costs of their own treatment. Healthcare is part-nationalised and subsidised in some degree. Individual citizens have a compulsory savings account to build up a nest egg for medical expenses, and there’s an insurance programme to deal with the most expensive treatments. But, broadly, the idea is that you have money in a healthcare account, and it’s up to you to decide how you want to spend it.
I think Hartford deserves credit for having undelined that part of the problem with healthcare lies in it being typically relying on third-party payment systems. The Singapore system gets praised both by conservatives (see for example John Goodman here), and by liberals (see for example Matt Yglesias here). The former emphasize the success of health savings accounts, the latter consider the system a model from a regulatory standpoint. The liberal viewpoint, which downplays the importance of medical savings accounts, appears to be dominant in more scholarly research on the subject, too.
It is interesting, however, that despite the frequent praise it elicits, the Singaporean system is never really taken as a point of reference in the debate in the West. Is it so because you cannot point to a successful Asian country as a model, if you aim to be a successful politician? Or is it because we tend to dismiss the success of small countries? Or because we tend to be suspicious of autocracies, no matter how successful, such as Lee Kuan Yew’s?