Introduction
The provision of healthcare services is one of the government’s key objectives. The ability to respond to the population’s healthcare needs is crucial. The United States and Singapore have implemented distinct healthcare approaches with different levels of success. Each of the systems has specific merits and challenges that have created the results that are contextualized in this assessment. The prioritization of measures designed to improve health, eliminate disparities, and secure equity in care accounts for the differences in health outcomes between the United States and Singapore.
Comparison of Developed Nations
Chronic Disease Outcomes
The United States records a high chronic disease burden in comparison to other nations, such as Singapore. More than a quarter of all individuals in the United States have been diagnosed with diabetes, asthma, hypertension, or heart disease at some point in their lives. (Tikkanen & Abrams, 2020). According to the Centers for Disease Control and Prevention, 1 in 25 Americans is diagnosed with a serious mental condition such as major depression, schizophrenia, or bipolar disorder.
Singapore has a higher prevalence of chronic diseases than the United States. Chronic diseases such as hyperlipidemia and hypertension affected 37 and 32% of the population, respectively, in 2021 (Prudential Singapore, 2023). In Singapore, the lifetime burden of depression is 6.3% of the country’s population (Subramaniam et al., 2020). The burden of chronic illnesses in Singapore is a consequence of a growing elderly population and extended life expectancy.
Hospital-Related Care
Compared to Singapore, the United States does badly regarding hospital-linked care. For example, the United States has an infant fatality rate of 5.7 deaths per 1,000 live births and a short life expectancy at age 60 (Schneider et al., 2021). In the United States, the rate of avoidable mortality is 177 deaths per 100,000 people, while the maternal death rate is 17.4 deaths per 100,000 live births (Schneider et al., 2021). Health-related care in Singapore is superior to the U.S. context. For example, Singapore’s neonatal survival rate has steadily improved over the last ten years (Singapore Department of Statistics, 2023a). By 2022, it is anticipated that 89.4% of newborn males and 94% of newborn females will survive to age 65 (Singapore Department of Statistics, 2023a). The average mortality rate is decreasing, demonstrating the effectiveness of healthcare services.
Life Expectancy
Despite America’s costly medical care, life expectancy in the country is much shorter than Singapore’s. For example, in 2017, life expectancy at birth in the United States was 78.6 years, which was two years shorter than the OECD average (Tikkanen & Abrams, 2020). It is worth noting that life expectancy masks racial and ethnic disparities, with minorities experiencing lower rates compared to the general population. Singapore has a substantially greater life expectancy at birth, with an average of 83 years indicated for 2021 (The World Bank, 2023a). The superiority of Singapore’s health system is demonstrated in its ability to prolong its citizens’ lives.
Mortality Rate
In recent years, the United States has recorded a considerably high death rate. The crude death rate for all causes in all American states for the three-month period that ended in the third quarter of 2022 was 924.6 deaths per 100,000 (Ahmad & Cisewski, 2023). The rate for the twelve months ending in the third quarter of 2022 was 1008.6 per 100,000 (Ahmad & Cisewski, 2023). The mortality rate in Singapore is lower compared to the United States. Adult mortality was recorded at 5.9 per 1000 residents in 2022, while the infant mortality rate in the same year was 1.8 per 1000 live births (Singapore Department of Statistics, 2023b). Singapore’s health system does a better job of protecting its citizens’ lives compared to the United States based on mortality rates.
Changes in Life Expectancy Due to COVID-19
The COVID-19 pandemic has drastically impacted life expectancy in the United States. Approximately 1 million deaths occurred between February 2020 and May 2022, significantly dropping life expectancy. Expectancy at birth dropped by 3.08 years on average, by 3.02 years by age 35, and by 2.07 years by age 65, a reversal of the gains made over the past 40 years (Silva et al., 2023).
Singapore’s life expectancy figures were less negatively affected than those in the United States. Singapore’s life expectancy in 2022 was 83.0 years, down 0.2 years from 83.2 the previous year (Singapore Department of Statistics, 2023a). The country’s pre-Covid life expectancy was 83.7 years, and the overall decline after the pandemic was 0.7 years (Singapore Department of Statistics, 2023a). Singapore’s effective management of the COVID-19 pandemic resulted in fewer lives lost compared to the United States.
Economic Comparison
Gross Domestic Product
A country’s Gross Domestic Product is an indicator of its economic position. According to the World Bank, the United States GDP for 2021 was recorded at 23.32 trillion dollars (The World Bank, 2023b). The annual GDP growth rate was reported at 5.9% for 2021, and the inflation rate for 2022 was recorded at 8.0% (The World Bank, 2023b). Singapore’s GDP for 2021 is much lower than America’s and was recorded at 396.99 billion dollars, with an annual GDP growth rate of 7.6% in 2021 (The World Bank, 2023a). Unlike the United States, Singapore had a lower inflation rate in 2022, recorded at 6.1% (The World Bank, 2023a). The GDP indicators demonstrate the strength of the U.S. economy compared to Singapore.
Healthcare Expenditure Per Capita
The United States records a high per capita spending rate compared to Singapore. The U.S. per capita health spending rate is estimated at 10,000 dollars (Tikkanen & Abrams, 2020). Per-capita spending for acquiring services, such as voluntary expenditure on private health insurance, is approximately 4,092 dollars (Tikkanen & Abrams, 2020). The average U.S. resident spends 1,122 dollars in out-of-pocket healthcare expenses to cover copayments and deductibles on insurance coverage (Tikkanen & Abrams, 2020). Singapore has a much lower per capita healthcare spending rate at 6,171 dollars as of 2021 (Global Data, 2023). The highlighted rate includes expenditure on healthcare services, paramedical devices, and pharmaceutical products.
Spending Priorities
The United States spends a higher degree of its income on healthcare than Singapore. For instance, in 2018, the U.S. spent 16.9% of its GDP on healthcare, nearly double the average for OECD nations (Tikkanen & Abrams, 2020). By comparison, Singapore spent 4.47% of its GDP on healthcare, which marked an increase in government expenditure from 32-41% due to increased public subsidies designed to reduce out-of-pocket expenditure (Tikkanen et al., 2020). Unlike the United States, Singapore uses a smaller quantity of its resources to deliver quality healthcare services.
Cost Sharing
Cost sharing refers to the portion of costs covered by the insurance plan that an individual pays out of their pocket. The items covered include deductibles, copayments, and coinsurance charges. In the United States, workers with a single coverage plan with an annual deductible paid $1,763, which marked a 17% increase over the last five years (Kaiser Family Foundation, 2022). In Singapore, residents covered under Medishield Life are subject to an annual deductible of 1,095 and 2,190 U.S. dollars (Tikkanen et al., 2020). The cost-sharing rate is much lower in Singapore than in the United States.
Health Disparities
Current Status of Healthcare Disparities
There are numerous health disparities seen in the American setup. Racial discrimination has contributed immensely to the disparities in healthcare access and service delivery. For instance, the infant mortality rate for non-Hispanic blacks was recorded at 12.67 deaths per 1000 live births, which is more than double the rate for non-Hispanic whites at 5.52 deaths per 1000 live births (Ruchman et al., 2016). Such disparities mean that minority groups have limited access to essential care services. In Singapore, health disparities are limited, and a few cases result from limited income.
Holistic Admissions
The United States has applied numerous strategies to eliminate health disparities. For instance, the government is raising awareness of racial and ethnic disparities in access to care, expanding health insurance coverage, and increasing personnel in underserved communities. Singapore has implemented a raft of measures to reduce health disparities. For instance, the country’s public hospitals provide care based on the patient’s medical condition instead of their subsidy status (Tikkanen et al., 2020). Needy patients receive direct assistance when nonsubsidized drugs and services are required. The government has also adopted a system of differentiated charges based on the individual’s ability to pay (Tikkanen et al., 2020).
Divisive Concepts Legislation in APRN Education and Practice
Divisive concepts legislation refers to a set of laws under consideration by states around the United States that would significantly impair classroom freedom. The laws are intended to limit the discussion of concepts such as sexism, racism, and discrimination (National Coalition for History, 2023). Such legislation would negatively impact APRN education because students would fail to conceptualize the causes of health disparities. In addition, their ability to offer culturally sensitive care in their areas of practice would be significantly impeded. Racism has had a tremendous impact on the practice of nursing (Tobbell & D’Antonio, 2022). Divisive concept laws are likely to result in the delivery of poor-quality services in diverse populations, which may experience a rise in negative health outcomes.
Current Issues and Global Health
Medicare and Medicaid
A variety of issues are likely to impact the delivery of services under Medicaid, which is the primary program for the provision of comprehensive health services for Americans. The Consolidated Appropriations Act terminates the continuous enrollment initiative in the Medicaid program, which is likely to have a negative impact on the population (Rudowitz et al., 2023). The uninsured rate is likely to rise, and the rate of enrollment will most likely drop. Medicaid expansion is another contentious issue, with more than 2 million individuals in 11 states falling into the coverage gap because their respective states have failed to adopt expansion measures (Rudowitz et al., 2023). The United States must focus on the coordination of Medicare and Medicaid, given the fact that individuals enrolled in both programs often have higher healthcare needs (Rudowitz et al., 2023). The prioritization and continuous development of both programs are necessary to improve the vulnerable population’s access to services.
Conclusion
The United States and Singapore have adopted different models for the delivery of healthcare services. Singapore has experienced a significant degree of success, as evidenced by its higher life expectancy, lower mortality, and low expenditure compared to the United States. It is evident that Singapore’s ability to prioritize measures intended to enhance well-being, reduce inequalities, and ensure fairness in healthcare outcomes is superior to the United States.
References
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