Healthcare system is a major concern for many countries. Comparing and contrasting the quality of healthcare in the U.S. and Singapore might provide valuable insights. Regarding healthcare system, Singapore is ahead of many developed countries. Since its healthcare expenditures are lower than most high-income countries (Haseltine, 2013, p. xii), the comparison of its system with the U.S. counterpart is even more interesting.
Health Statistics and Costs
The discussion below provides information about and compares the health statistics and costs of the United States and Singapore. Health statistics include life expectancies and mortality rates, major health conditions and diseases, healthcare expenditure dollars ($) per capita, and healthcare expenditure as a percentage (%) of gross domestic product (GDP).
- United States. According to the CDC (Centers for Disease Control and Prevention, 2015), life expectancy in the U.S. is 78.8 years, while mortality rate is 821.5 per 100,000 population, with the infant mortality rate at 5.96 per 1000 live births. Major health conditions include heart disease, cancer, respiratory diseases, Alzheimer’s, and diabetes. National healthcare expenses amount to ($) 9,523 per capita, while the percentage of GDP is 17.5% (Centers for Disease Control and Prevention, 2015).
- Singapore. Life expectancy in Singapore is 84 years, while mortality rate is 55 per 1000 population (Haseltine, 2013, p. 17). Major health conditions include cancer, pneumonia, heart diseases, and respiratory diseases. National healthcare expenses amount to ($) 2,426 per capita, while the percentage of GDP is 4.7% (Singapore Statistical Data, 2012).
- Comparison of countries. Life expectancy in Singapore is higher than in the U.S. Moreover, Singapore’s adult mortality rate is significantly lower than in any other country (Haseltine, 2013, p. 37). The comparison is even more interesting when taking into account the health expenditures. The U.S. health expenses are nearly three times higher than in Singapore.
Healthcare Financing
The discussion below provides information and comparative data regarding healthcare financing. The healthcare financing systems in the U.S. and Singapore are described and compared accordingly.
- United States. According to the CDC (Centers for Disease Control and Prevention, 2015), 67% of people aged 18-64 and 53.7% of children under 18 have private insurance. The majority of younger Americans receive private insurance provided by the employer (Chua, 2006, p. 1). Public health insurance comprises Medicare program for persons over 65 and the disabled, and Medicaid for the disabled and individuals with low income. Medicare is financed by means of federal taxes and a payroll tax, while Medicaid is sponsored by the federal government and the states taxes. Due to the adoption of the Affordable Care Act, uninsured people substantially improved their health with the wider and more accessible insurance coverage (Centers for Disease Control and Prevention, 2015).
- Singapore. According to Singapore Statistical Data (2012), government expenses on healthcare account for 37.6% of total health expenditure, while private expenses account for 62.4%. According to the principle of copayment, crucial in Singapore, all citizens have the right to receive healthcare in public hospitals but no medical service is provided without charge even in public facilities. This approach ensures that over-consumption does not occur. However, government-created Medisave, MediShield, MediFund, and employers cover a substantial part of health expenditures. Therefore, government subsidies play an important role in Singapore’s healthcare system, as they partially cover insurance for the lower and middle-income individuals (Wei Lin, 2015, p. 82). Public funds are collected through the payroll taxes.
- Comparison of countries. While public healthcare expenses in both countries are predominantly covered by private funds, government subsidies play a more decisive role in Singapore, than in the U.S. Singapore’s health financing system displays a higher level of efficiency due to the principle of copayment. The role played by the U.S. government is closer to a subsidiary to the private health providers market (Shi & Singh, 2015, p. 9).
Healthcare Administration
The paragraphs below provide an overview of the government agencies in Singapore, and the U.S. The comparison between the two countries helps understand the scope of government regulation and its significance.
- United States. The hallmark of the U.S. healthcare system is the lack of a central agency (Shi & Singh, 2015, p. 9). The majority of healthcare facilities are thereby private enterprises. However, governmental agencies allocate funds for public expenses, as well as provide patients with compensation for Medicaid and Medicare treatment. Moreover, healthcare facilities are obliged to abide by the health policy regulations formulated by the state or federal governments.
- Singapore. The Ministry of Health oversees the public and private healthcare institutions. It grants renewable licenses to all medical institutions and facilities in the country. The Ministry conducts appropriate inspections and provides certain incentives for the medical providers to comply with the regulations.
- Comparison of countries. While the Ministry of Health in Singapore constitutes a central governing entity for health providers, in the U.S. the system is different. State and federal agencies control and regulate the healthcare facilities.
Human Resources
Human resources assessment is crucial for the overall evaluation of the healthcare system. Nurse-to-patient ratio, the number of physicians and beds per patient are indicators of the degree of accessibility of medical services.
- United States. According to the World Health Organization statistics (Global Health Observatory, n.d.), there are 240 physicians, 900 nurses, and 300 hospital beds per 100 000 population.
- Singapore. There are 200 physicians, 600 nurses, and 200 hospital beds per 100 000 population in Singapore.
- Comparison of countries. Human resources statistics in the two countries differ significantly regarding nurses staffing and hospital beds, while physician staffing levels are rather similar. Despite the fact that the U.S. has a slightly higher physician density, efficiency of the Singapore’s healthcare system is substantially higher.
Conclusion: Access and Equity Issues
- United States. 13, 3% of people under 65 are uninsured (Centers for Disease Control and Prevention, 2015). According to Shi and Singh (2015), the underinsured or uninsured population is mainly composed of persons with low income, low level of education, and part-time employees (p. 264).
- Singapore. Joshi and Lim (2010) identified the uninsured to be the low-income population, people with lower level of education, persons above 65 years old, and people of Malay ethnicity (p. 6). These categories of Singapore citizens are rather reluctant, or unable to obtain health insurance. Over 50% of Singapore population is reported to be underinsured (“Singapore: Majority of Singaporeans are underinsured”, 2013, par. 1)
- Comparison of countries. Despite the relatively low percentage of uninsured people in the U.S., the efficiency of the American healthcare system leaves much to be desired. It should be noted that health insurance itself does not always entail access to medical services (Shi & Singh, 2015, p. 325). The Singaporean government has gone to great lengths to ensure the efficiency of healthcare system. By employing the method of copayment, and emphasizing the importance of taking responsibility for one’s health, Singapore managed to create a highly efficient healthcare system with low expenditures.
References
Centers for Disease Control and Prevention (CDC). (2015). FastStats: How healthy are we? Web.
Chua, K. (2006). Overview of the U.S. healthcare system.
Global Health Observatory. (n.d.). United States of America Statistics Summary. Web.
Haseltine, W. A. (2013). Affordable excellence: the Singapore healthcare story. Washnigton, DC: Brookings Institution Press.
Joshi, V. D., & Lim, J. F. Y. (2010). Health insurance in Singapore: who’s not included and why?. Singapore Medical Journal, 51(5), 399-405.
Shi, L., & Singh, D. A. (2015). Essentials of the US healthcare system. Sudbury, MA: Jones & Bartlett Publishers.
Singapore Statistical Data. (2012). Web.
Singapore: Majority of Singaporeans are underinsured. (2013). Web.
Wei Lin, L. (2015). Paying for healthcare. In C. E. Lee & K. Satku (Eds.), Singapore”s Healthcare System: What 50 Years Have Achieved (pp. 75-95). Singapore: World Scientific Publishing.