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05/05/2017

Singapore: A More Conservative Healthcare Model

Singapore has a health system widely considered by many conservatives as vastly superior to that of America’s.  So what makes this healthcare system different than America’s, and how did the government of Singapore get this system to work?  These questions should become clear at the end of this post.

Singapore’s healthcare system is vastly different from our own.  The first major difference is that it is far more regulated than America’s current system.  To say that the government has some control over the market at all levels of healthcare is an understatement.  The Ministry of Health has the ability to set provider service fees, cost control, service planning and a list of other regulatory machinations to control the quality of services rendered at hospitals and other institutions.  The system focuses on utilizing a number of different stop gap measures to help the poor, sick and the elderly such as MediSave, MediShield and Medifund.  While many similar systems exist in the American healthcare system, the fact that the government can also control costs and financing has little to no equal in the American healthcare system.  U.S. Medicare and Medicaid do have measures that allow the federal government to set the maximum amount that they will spend on patients.  This owes itself to some cost control as all hospitals have to take these patients.  However, the existence of insurance companies throws off this rate control by giving more basic healthcare practices the ability to deny Medicaid and Medicare recipients and take patience with private insurance companies that pay more money.  In Singapore, most hospitals in Singapore are connected to the government via heavy subsidizing and have not choice but to conform to the rules of the government.

The 1993 White Paper generated by the government of Singapore gave a set of criteria upon which the government would aim to give Singaporeans excellent healthcare.  In it five major fundamentals were stated: promoting good health, personal responsibility over reliance on welfare or medical insurance, providing good and affordable basic medical services to all Singaporeans, reliance on free market competition to raise efficiency and finally intervention whenever necessary to keep healthcare costs down.  That brings us to the second question - why do some conservatives think the system better than America’s? 

Singapore’s system is intrinsically based on many more conservative views of healthcare.  Pushing concepts such as free-market driven decision making, Singapore’s healthcare system has a radically different view of how healthcare should work from the perspective of most single-payer enthusiasts.  For all of the control on healthcare, the main purpose of the government in Singapore’s model is aimed at addressing specific issues.  Controlling worst case possible actions in the market place and ensuring everyone can get treated for diseases.  From there, the people are allowed to make decisions about which general practitioner they see, the hospital they go to and the treatment they receive.  The ensuing freedom seems like a factor that would resonate greatly with the average American voter and the idea of a healthcare system based on personal responsibility is something that many American’s would find attractive.  The system also thusly prevents moral hazard from occurring via pushing health insurance as a last resort, not a primary form of payment.   In doing this, the system all but removes insurance companies as middlemen in the healthcare of patients.  Since patients are spending their own money, no one can force them to spend it on a medication they do not want or a treatment regimen they do not like.  The importance of government control is thus ensuring that no treatment system is, for lack of a better term, a scam.  So then how does the government know that the healthcare system is working properly?  For years, the American healthcare system has been based on the concept that insurance would pay for healthcare.   This notion was further entrenched by the Affordable Care Act’s measures pushing insurance companies to spend more to keep American’s healthy.  Many conservatives take pride in freedom   In order to change America’s healthcare to a more conservative   model, the Republican party would need to write how the new system would work.  In doing so, they would also need to create an entire framework of mechanisms to slowly transform healthcare from its current system to the entirely new one.  The problem right now

One thing that has become abundantly clear is that the free market economy, much like nature, does not care whether you live or die.  That being the case, it is in everyone’s best interest to ensure proper government regulation in the healthcare system.  Singapore has pushed a system that has a large amount of government regulation in it.  The tantalizing portions of this system, however, are that it pushes people to be more responsible, reduces third party interventions into an individual’s healthcare, and yields overall more efficient healthcare.  Personally, I feel that there are many aspects of Singapore’s healthcare system that could be imported into America.  There is a good case for changing the face of healthcare to be more similar to Singapore’s model.  The problem is that in changing America’s healthcare model a voluminous bill would have to be created in order to work stop-gap measures keeping individual from dying during the interim.

Kunle Adejare, PharmD, 19

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