Singaporeans Do It Better: Why their Healthcare is the Best in the World
Emily Dow
Since officially leaving Malaysia and declaring independence on 9th August 1965, Singapore has managed to transform from a low-income to high-income country relatively seamlessly. The main source of this growth has been industrialisation which boosted Singapore’s economic potential; since 1965 Singapore’s GDP per capita has increased 115-fold, from $516 (2021 USD) to a high of $59,797 in 2020. Rankings by the International Monetary Fund show Singapore holds the 8th largest GDP per capita figure globally, a place it has remained consistent with. There are a multitude of reasons as to why Singapore is really ‘that good’. Their education system, large business growth opportunities, developed banking system, and their advantageous climate and environment are all lucrative qualities which draw immigrants and firms alike. But their healthcare system above all, is a unique, excellent feature and driver of their ever-strengthening economic profile.
The healthcare system operates through a mixed financing system which is unlike their equally economically developed competitors. The United Kingdom, for example, has a National Health Service that provides for the entire population, with an optional private healthcare sector. The problem in the U.K., however, is that the NHS provides – to the largest parts of the population – all the healthcare needs they could ever desire. As of 2018, less than 6% of U.K. households had private healthcare due to its cost and often more restricted services compared to the NHS. This places almost all the healthcare burdens on the public sector of the U.K. Although a defining feature of the U.K. and the political profile they have formed, perhaps a more progressive system, like Singapore’s, would prove beneficial. The United States, on the contrary, is largely privatised with a smaller public healthcare system having less access to the widest range of services. In 2018, two-thirds of Americans’ main source of coverage was private. However, the U.S. faces the opposite problem to the U.K., with 8.5% of their population completely uninsured in 2019. So how have Singapore managed to have – debatably – a ‘better’ healthcare system than the U.K. (with public healthcare spending being over 10% of GDP) and the US (a massive 17% of GDP is spent on healthcare), while keeping the cost 5% below their GDP?
Singapore’s relatively minimal healthcare spending may look concerning on paper. In the rankings, their neighbours are poor, developing countries such as Sudan, Chad, and Ghana. Certainly, a poor-quality system is not the reason for their low expenditure, in fact, Bloomberg ranks them second for healthcare efficiency, only behind Hong Kong. When constructing their healthcare system, Singapore decided to place accountability with their citizens while guaranteeing them some form of healthcare, but nothing was explicitly ‘free’. The government has a savings plan which ensures individuals deposit a large portion (in 2016, employers contributed 20% and employees 17%) of their income into three types of savings accounts, one being MediSave. This account is used exclusively for healthcare bills, reassuring the government that their citizens will feel accountable for their own care. As citizens grow older, a larger percentage of what an individual saves is allocated to the MediSave account as opposed to the other two accounts. However, Singapore has since employed some security measures, too. This includes MediSheild Life, an insurance-like structure to protect citizens from financial difficulty in extreme cases, such as chronic illness, and Medifund which protects the lower-income spectrum of the population. Their low spending, therefore, can be explained by the simple, yet effective, blended model of public and private healthcare, which succeeds in covering all citizens, and all citizens cover themselves.
Perhaps the more impressive aspect of the Singaporean system which is not noted in much literature is their Health Promotion Board. This is a board which focuses solely on disease prevention and promoting healthy living. However, this description does not get nearly the recognition it deserves. Most governments have health campaigns, particularly in light of COVID-19, but Singapore knows their citizens and knows what will receive positive reactions. Just as many countries implement KYC (Know Your Customer/Client) standards with financial services, so too the Singapore government employs a similar ideology when communicating with their population. Instead of ending their pledge to citizens to stay healthy through a sugar tax or passive advertising campaign, the HPB integrated themselves into society through consumer goods. In 2019, they partnered with Fitbit, an activity and fitness tracker allowing citizens – subject to facile sign-up requirements – to acquire and use the popular gadget, promoting healthy and active lifestyles. This is different to any other government (and is claimed to be the first partnering of wearables and a national public health program). Instead of forcing citizens to accept a government campaign like an adult convincing a child to eat a tomato, the Singaporean government successfully implemented their health and activity objectives by disguising their citizen nudging through partnerships with popular consumer goods. By engineering effective consumer campaigns to halt future sickness instead of future budget burdening, their society is the nucleus of the Singaporean healthcare strategy.
A fundamental key is that Singapore prevents their citizens from actually needing the healthcare system, rather than tackling the problem when society becomes unwell, dragging with it high emergency room waiting times and piling demand for general doctor appointments. Their healthcare system’s approach may seem counterintuitive by trying to deter use and consumption, but for a public service this is advantageous in many ways. The life expectancy in Singapore is just under 84 years, yet countries such as the U.K. sit marginally above 81 years, with the U.S. even lower at below 79 years. And they’re economically developed countries! The global life expectancy is over a decade less than Singapore’s, standing at just over 73 years. Simply, Singapore ultimately has a healthier, more enduring population. This is backed up by more in-depth research by The World Population Review, revealing Singapore has the lowest mortality rate when assessing deaths from heart or respiratory diseases. The pre-emption of illness by encouraging, from a young age, a healthy lifestyle produces these results rather than the approach of many governments which is to only interfere once one shows a health issue.
Ultimately, Singapore has tapped into the sweet spot where citizens feel a responsibility to provide for themselves and trust the government to support them in achieving this. The three-tiered system is vital to creating the connection between the government and its population, identifying it as the reason for their fine-tuned, successful healthcare system, envied by other nations globally.
https://worldpopulationreview.com/countries/life-expectancy
https://www.statista.com/statistics/829978/households-with-private-medical-insurance-united-kingdom/
https://www.commonwealthfund.org
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https://www.singstat.gov.sg/-/media/files/publications/population/lifetable19-20.pdf
https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=SG
https://www.imf.org/external/datamapper/NGDPDPC@WEO/OEMDC/ADVEC/WEOWORLD