In an ideal world, the UK’s National Health Service (NHS) would ensure that every person can receive medical treatment, even if they cannot afford it. In another ideal world, the US’s healthcare system would be one that allows people to access state-of-the-art healthcare whenever they need, paying as they go directly or indirectly via their insurance.

Unfortunately, both healthcare systems exist in the same, imperfect world and both are failing their people. The NHS has unbelievably long waiting times to visit both the GP and access emergency services, while healthcare services in the US are unaffordable for many residents, sometimes even with insurance. But there is a healthcare system that has taken the best of both the UK’s and US’s to allow readily available and affordable treatment options for its residents. That is Singapore’s.

Public vs. Private Healthcare

Before delving into Singapore’s healthcare system, we need to take a quick look into what defines the other two aforementioned systems. The UK’s healthcare system, also known as the NHS, is a public healthcare system, where all residents can receive necessary medical services and treatments for free. The funding for the NHS largely comes from taxation and acts as a form of “National Insurance”. The US’s healthcare system is on the opposite spectrum to the NHS, as a private healthcare system. This means that residents have to ensure their own means of funding for healthcare, either by paying from their savings or through their insurance. Economics stipulates that privatization of any industry leads to a faster pace of innovation, and this is indeed proven by the American healthcare system. It is no surprise that the two dominant COVID-19 vaccines were created largely or wholly by Pfizer and Moderna, two US-based companies. However, privatization also leads to a hunt for profits among organizations, and this is what has made healthcare in the US extremely expensive and unaffordable for many.

Countries with Public (red) and Private (white) healthcare system

Is Singapore’s healthcare system private or public?

The answer to this question is neither or both, depending on how one looks at it. The closest thing Singapore has to National Insurance is MediSave and MediShield, which will be talked about in greater detail later on. The biggest difference between the National Insurance tax in the UK and these two “schemes” is that for the former, an individual contributes to the overall National Insurance for every UK resident (with those earning more contributing more) whereas for the latter, an individual contributes to their own medical savings and insurance. But the “publicness” of Singapore’s healthcare system does not stop there. If an individual with low income cannot afford healthcare services, then there are other schemes and provisions (such as Medifund) to allow them to receive the necessary treatment at a lower cost or even for free.

Within public hospitals in Singapore, there are tiers of wards that could be associated with private hospitals. The lower tiers, which are also subsidized by the government for residents, are by no means of poor quality and would easily surpass the standards of many hospitals worldwide. The upper tiers, which include private wards, are largely unsubsidized by the government and therefore the patients pay a similar amount regardless of their citizenship status. These are often chosen by wealthier residents and expats or when it is covered for insurance.

In addition to public hospitals, Singapore also has many notable private hospitals just like the UK. They often cost significantly more than the public hospitals but have much shorter waiting times. This replicates the US in the sense that people pay for medical services directly, or indirectly via insurance, as they require with a relatively high cost but with an otherwise ease of access. It is also similar to the UK’s landscape, where there are public and private hospitals in the same community. But what sets the two countries apart is that while people in the UK go to private hospitals due to the relative inaccessibility of public healthcare, the private hospitals in Singapore are utilized by expats who would have to pay similar prices in public hospitals or the very rich who just want to get treatment as soon as possible. In other wants, excluding expats, Singaporeans tend to use private healthcare for more “want” reasons than “need” reasons than those in the UK.

MediSave and MediShield

Every working Singapore Citizen contributes about 8-10.5% of their monthly salary to their MediSave, with an additional amount also topped up by their employers. This MediSave can then be used for their medical expenses, or even for those of their family members. There is no way for a Singaporean to opt out of this, with the justification that it is designed to help them save up during their working years for their healthcare needs, especially in old age. But unlike the National Insurance in the UK, every penny of MediSave is for the individual’s own medical requirements rather than those of others. This gives a sense of responsibility among Singaporeans to stay healthy and use their MediSave wisely, unlike the UK where residents can choose to practise unhealthy behaviors willingly and then access the NHS with no financial cost.

MediShield, or MediShield Life, is a basic health insurance plan to protect Singaporeans against large hospital bills for life, regardless of age or health condition. This includes hospitalization or day surgery, outpatient treatment and long-term care. MediShield is what allows the aforementioned lower tiers of wards to be heavily subsidized. It can be paid by cash or via MediSave savings and just like MediSave, one cannot opt out of it. The premiums are age-dependent and there are typically many subsidies available for multiple income groups. If one cannot afford it, then the government will foot the bill. In other words, every Singaporean will have MediShield Life regardless. Compared to the National Insurance in UK, the premiums for MediShield Life are close to nothing at a median income level.

Guide on how MediSave and MediShield Life help finance healthcare needs of Singapore

What makes healthcare in Singapore so cheap?

Taking a look back at “The Cuban Paradox” article, another country buckling the trend was Singapore, which had a lower GDP per capita than expected compared to the life expectancy at birth. But what allows Singapore to spend comparatively less on its healthcare is multi-layered and would take an article on its own to be explained, hence this is just a quick summary. Firstly, external factors that generally lead to better health such as high education levels and a low level of homelessness are undoubtedly a factor. Secondly, the aforementioned tiered system allows residents to access treatment in accordance to their budget, and hence overspending is reduced. Underspending is also reduced, which would otherwise lead to worse health outcomes in the long-term and eventually more expensive treatment requirements. Thirdly, MediSave and MediShield allow Singaporeans to have a forced “backup plan” when needed that they may otherwise not have, reducing government spending as a whole. Lastly, Singapore has proven a private and public healthcare system can co-exist, not just between hospitals but also within public hospitals with a “private” option. They allow private and public healthcare to challenge each other, while ensuring that the needs of patients are met adequately. This has been achieved by creating a well-balanced and regularly reviewed “semi-free” market.

Cuba, Singapore and the US on Life Expectancy and GDP - Our World In Data

Preventive Healthcare in Singapore

Ending off this article is the connection back to HEA’s main agenda of preventive healthcare. For any system to allow preventive healthcare, it must not have a backlog of non-elective treatments as the resources would need to be prioritized for those first. With the NHS’s endless backlog, it is currently impossible for the UK to focus on preventive healthcare. As for the US, preventive healthcare outcomes have not been possible at the societal level due to the unaffordability of necessary treatment, let alone for elective treatment. With an ageing population, Singapore has made preventive healthcare a priority. It is also in the position to be able to work towards preventive healthcare and reduce the burden of chronic diseases due to the relative low persistency of the issues the UK and the US have to combat. With continuous effort from the government, Singapore could be the first nation to achieve a truly preventive healthcare model, where people only come in for unforeseeable emergencies or for preventive healthcare services such as annual health check-ups and the necessary early treatment.

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