How to Control Health Care Costs: Lessons from Abroad

On June 13, Brookings hosted Dr. William A. Haseltine, author of Affordable Excellence: The Singapore Health Care System (Brookings Press, 2013), for a discussion on how to control health care costs, examining successful methods used in Singapore.

[@konarocky]

One thing to keep in mind is that most causes of health outcomes has nothing to do with medical care. Top two examples are lifestyle choices and genetics. So comparing the US to any other country is comparing apples to oranges. Compare German Americans to Germans. Swedish Americans to Swedes. Japanese Americans to Japanese and so on.

[@ZameerHJ]

Good talk. But he made a mistake regarding the third Singapore medical school. The school was set up as a collaboration between Nanyang Technological University (NTU) and Imperial College London. He said it was collaboration with MIT, which is incorrect. There is a university called Singapore University of Technology and Design (SUTD), which was set up in collaboration with MIT, but it's focus is purely on technology and design.

[@origill1098]

A very interesting discussion. ThanQ

[@powerlinkers]

Hahaha.... 8 years have passed, nothing has changed in USA......

[@rickbruner]

He has some very good insights and I appreciate his thorough analysis of the Singaporian system. However, his negative stats about child mortality in the U.S. are way off. Does he know that the U.S. counts preemies that may live a week and then die in our infant mortality stats, whereas many other countries arent' able to keep these infants alive before they emerge from the womb and then don't count the stillborn as a death? Also, according to the U.S. Department of Health and Human Services, the U.S. infant mortality rate (1-4 year olds) has gone from 1419 deaths per 100,000 population in 1907 to 29 deaths in 2007. That's a 4,800% improvement! The number of deaths gets less every year. Look at the trend line. Not even a blip upward. We are doing fine.

[@bighands69]

Cuba that gets put up as the world's greatest healthcare system does not count babies who die in the first 12 hours as infant mortality meaning they do not consider the child to be a person. And for all we know they are still fixing their figures beyond this.

[@powerlinkers]

How this is different from Singapore?

[@Dacos127]

This guy obviously doesn't understand how things work in the U.S. We already have Medicare/Medicaid tax out of every paycheck, HSAs and people will claim massive discrimination if you establish a tiered subsidy healthcare system. We also have a much greater mix of population than Singapore from a genetic perspective so health approaches will be more difficult to standardize than that country.

[@maxabramson4781]

I agree with your main point, but not two smaller issues. Singapore is at least as 'diverse' as the U.S.--not that our generation gives a rip about someone's appearance or background. Consumers in Singapore can choose which of the five tiers that they want to join, depending on how much they're willing and able to pay. The bottom tier still gives you that great survival rate, but you may spend your time recovering from surgery in a ward with six or eight people.

[@teerificbitch]

What would a genetic perspective imply??? Singapore is a multiracial and multicultural country with ethnic Chinese (76.2% of the citizen population), Malays (15.0%), and ethnic Indians (7.4%). There are an additional 2.14 million EXPATs from all over the world living in Singapore which is ~35% of their TOTAL population. So the diversity is very high. I don't know of any country with 35% expat population, on top of a multilingual society. Furthermore, a "tiered subsidy healthcare system" is not as you described. Singapore's tiering system is based on the Individual's CHOICE. Tier A means you forgo ALL subsidies and get the best luxury healthcare, while all other tiers have subsidies, all the way down to the lowest tier where 80% of your bills are SUBSIDISED. In fact, Singapore's healthcare system also has a very popular insurance scheme where people pay a very low double-digit monthly figure, to insure themselves at a CAP cost of $2,000 per year on medical bills. Meaning that the individual pays for everything (after subsidies) to the cap of $2,000, and if treatment surpasses $2,000, EVERYTHING is paid for by the insurance/state. So cancer, major operations, and the stuff that bankrupt you are essentially mitigated.