Health care systems in transition II. Singapore, Part I. An overview of health care systems in Singapore

Health Analytics, Economics and Medicine toward a 21<sup>st</sup> Century Health Care System

“…According to WHO, Singapore ranks sixth in the world's healthcare systems [33]. As a city state in just 50 years since its independence in 1965, Singapore has transformed from a low income country to one of the highest per capita incomes and health outcomes in the world [34] [35]. A major move soon after it became an independent country was to develop a network of satellite outpatient dispensaries and maternal and child health clinics in order to bring primary care services closer to the people [35]; these outpatient clinics have since been consolidated into modern polyclinics.…”

“…Community hospitals and private nursing homes provide home nursing and rehabilitative care services [35]. To finance healthcare, the Singapore government placed "the emphasis on individual responsibility supported by an enabling state", adopting the policy that nothing, not even medical services, should be provided free [34]. This principle of copayment is a central feature of Singapore's approach to cost containment.…”

“…Singaporeans make mandatory monthly contributions to their Medisave account, thus building savings for their health care needs. Medisave is a savings and not a risk-pooling scheme [34]. Medishield, a voluntary insurance scheme to cover basic, low-cost catastrophic illness, was introduced in 1990.…”

“…In addition, since the inception of Medifund in 1993, a state-funded safety-net covering the health costs of those without the means to pay, has given financial assistance to the 99% of those who turned to the fund for assistance. "No Singaporean would be denied the treatment he needs because of lack of funds" [34]. The country's health care system also emphasizes on health promotion and disease prevention.…”

“…In addition, preventive health strategies are tailored to suit the needs of special groups including children and the workforce. As pointed out in [34], the government favors a largely free market as the most efficient allocator of scarce resources, but also uses incentives to encourage demanding responsibility and discourage supply-side waste as an intervention if needed. Its cost sharing and savings scheme encourages "consumer prudence", and the private services and the granting of greater autonomy to public institutions "reduces state-funded health spending and frees up tax-based resources to meet health promotional and preventive activities that benefit the public good as well as other national priorities".…”