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Affordable Excellence: The Singapore Health System
The United States has been struggling with its health care system for decades. Costs continue to spiral upward, while coverage of the population has decreased because of job losses and the resultant loss of health benefits, due to the Great Recession and the subsequent slow economic recovery. President Clinton's attempt to enact a national health care plan failed, and the fate of President Obama's health care plan, under attack since its inception, is uncertain.
Since achieving independence, Singapore undertook the monumental task of transforming itself to a modern, prosperous, secure city-state. Many institutions needed to be erected to reach this goal, but one that stands out and is the subject of this book was the need for a world class health care system. "Affordable Excellence" examines how Singapore succeeded in its efforts, setting up a health system that has become one of the best in the world, delivering high quality care at a fraction of the cost of most First World systems. Ranked 6th globally on performance, Singapore spends less than 4% of GDP on health care (in contrast to the U.S., for example, which spends over 17% of GDP).
How did Singapore do it? What can be learned from its achievement? What lessons can be put to use by the developing, and the most-developed, nations building new health care systems? This book provides answers. It explores the underlying social philosophy and basic approach that Singapore used to set up its system and, at the heart of the Singapore model, its system of health savings accounts and insurance programs that ensure no one would be without the means to buy quality care.
Since achieving independence, Singapore undertook the monumental task of transforming itself to a modern, prosperous, secure city-state. Many institutions needed to be erected to reach this goal, but one that stands out and is the subject of this book was the need for a world class health care system. "Affordable Excellence" examines how Singapore succeeded in its efforts, setting up a health system that has become one of the best in the world, delivering high quality care at a fraction of the cost of most First World systems. Ranked 6th globally on performance, Singapore spends less than 4% of GDP on health care (in contrast to the U.S., for example, which spends over 17% of GDP).
How did Singapore do it? What can be learned from its achievement? What lessons can be put to use by the developing, and the most-developed, nations building new health care systems? This book provides answers. It explores the underlying social philosophy and basic approach that Singapore used to set up its system and, at the heart of the Singapore model, its system of health savings accounts and insurance programs that ensure no one would be without the means to buy quality care.
120 pages, Kindle Edition
First published November 1, 2012
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Displaying 1 - 20 of 20 reviews
September 8, 2013
Affordable Excellence (2013) by William Haseltine looks at a truly remarkable story in healthcare, namely that of the Singaporean Health Care System. Singapore has the equal fourth longest life expectancy in the world and yet spends only 4% of GDP on health care, making it only the 32nd highest spender on health care. Singapore’s healthcare system is not experiencing rapidly rising costs that threaten the financial viability of the state as are most developed countries. How this is being done should be of critical importance to anyone interested in world affairs. This book covers the whole medical system in detail. It’s not a light read but is fairly short.
Singaporeans have a system called Medisave where 6.5-9% of their income is put aside into a medical savings account. This can be used for their own health care or that of their immediate family. In addition the government provides catastrophic cover.
The government and private industry then provide health services and people are able to choose what sort of service they want but much of the money comes from their own Medisave account so people care about the cost of the service they are receiving. People also have means testing for the subsidy they get for care.
The end result of all this has been a medical system that is, in many ways, world leading. It’s remarkable that no one has emulated this system unlike Singapore’s compulsory savings system that has been copied by Australia.
The book looks at the end products of the system, how the payment system works, how costs are controlled, how it’s financed, the history of the system, research done in Singapore and has a Q & A session with Singapore’s Ministry of Health.
One thing worth noting is that the quality of the graphics in the Kindle version is seriously substandard and they are very difficult to read.
The book is a dry, technical, somewhat difficult read but it does cover a really important health system. Singapore shows that high quality health care can be provided at low cost. It’s really worth reading for anyone interested in health policy.
Singaporeans have a system called Medisave where 6.5-9% of their income is put aside into a medical savings account. This can be used for their own health care or that of their immediate family. In addition the government provides catastrophic cover.
The government and private industry then provide health services and people are able to choose what sort of service they want but much of the money comes from their own Medisave account so people care about the cost of the service they are receiving. People also have means testing for the subsidy they get for care.
The end result of all this has been a medical system that is, in many ways, world leading. It’s remarkable that no one has emulated this system unlike Singapore’s compulsory savings system that has been copied by Australia.
The book looks at the end products of the system, how the payment system works, how costs are controlled, how it’s financed, the history of the system, research done in Singapore and has a Q & A session with Singapore’s Ministry of Health.
One thing worth noting is that the quality of the graphics in the Kindle version is seriously substandard and they are very difficult to read.
The book is a dry, technical, somewhat difficult read but it does cover a really important health system. Singapore shows that high quality health care can be provided at low cost. It’s really worth reading for anyone interested in health policy.
December 14, 2024
A serviceable intro to the Singapore health system and how it works. It’s more about the philosophy it comes out of than the nuts and bolts of how it’s administered. If you’ve already read the memoirs of LKY, you won’t get much more mileage out of it. This basically is a government puff piece.
I did not find it helpful in trying to think about healthcare reform in the U.S. While that is in some part due to Singapore’s politics and society being so radically different from the U.S, the book just doesn’t provide enough information to allow me to draw conclusions.
I would have been better off reading Wikipedia summaries.
I did not find it helpful in trying to think about healthcare reform in the U.S. While that is in some part due to Singapore’s politics and society being so radically different from the U.S, the book just doesn’t provide enough information to allow me to draw conclusions.
I would have been better off reading Wikipedia summaries.
November 22, 2020
Good foundation knowledge. Since it was written in 2012/13, requires an update but majority of the bits are still fairly relevant. That said, it has avoided discussion on the limitations of the system upfront. Can be misconstrued to be biased towards the healthcare system and how good it can be.
December 22, 2013
This was informative and a solid background on an interesting topic, but it could have been better executed. The book is about the Singapore health system, the envy of policy wonks, with its high quality of care and low costs for citizens. It provides a nice overview of Singapore's health system, with discussion of the government programs, their history, as well as current and future issues that it will face.
The style left a little to be desired though. It's a combination of fanboy and college-level essay. Superlatives abound, and occasionally the data is massaged so that it can be presented in the most favorable light. It's clear that a lot of the research involved reading government websites and interviews with government officials. Sentences frequently begin, "The government has created many programs to address these issues..." or "The government hopes to address this issue through the use of..." or "The government has set a goal of..." It's great that so much research was taken from first-hand sources, but the analysis could have perhaps been a bit deeper.
Even so, this was a useful primer, and it's impossible to argue with the Kindle price (free!).
The style left a little to be desired though. It's a combination of fanboy and college-level essay. Superlatives abound, and occasionally the data is massaged so that it can be presented in the most favorable light. It's clear that a lot of the research involved reading government websites and interviews with government officials. Sentences frequently begin, "The government has created many programs to address these issues..." or "The government hopes to address this issue through the use of..." or "The government has set a goal of..." It's great that so much research was taken from first-hand sources, but the analysis could have perhaps been a bit deeper.
Even so, this was a useful primer, and it's impossible to argue with the Kindle price (free!).
March 16, 2016
According to this book it is the only one available on the subject of Singapore's Healthcare system. This is sad because it is a fascinating subject which this book does not do justice. Despite the many editorial issues (repeats, including whole paragraphs, bad lay out, miserable graphs - table 3.1 and 3.1a are statistically horrendous) my main concern is with how the information is presented. I would have wished for a more pithy and succinct overview and a greater comparison to other systems (not just in various stats). I feel like the task should've been given to an intelligent journalist rather than a healthcare specialist. The information is there, but it need a lot, A LOT, of cleaning.
Review: KEY POINTS
The author needs to learn how to write for a proper audience, including decent overviews and presentation of statistics, and not as if it was a powerpoitn presentation for an undergraduate course.
Review: KEY POINTS
The author needs to learn how to write for a proper audience, including decent overviews and presentation of statistics, and not as if it was a powerpoitn presentation for an undergraduate course.
January 14, 2023
This is not a great book per se, but the idea surrounding the Singapore healthcare system is what makes it a really intriguing read. Singapore’s system has a lot of principles that could be easily applied to other countries/states/cities that would help to lower costs, increase efficiency, and improve outcomes.
August 29, 2013
Well worth reading. An accessible summary-level work on a world-class set of institutions. Recommended for economists, policy makers and health professionals.
Could have been markedly improved by increased comparative analysis, as at times it read like a Singaporean government press release.
Could have been markedly improved by increased comparative analysis, as at times it read like a Singaporean government press release.
May 31, 2017
Good enough. It's not perfect and it doesn't do everything you want but it does what it promises to do pretty well. Also, it's freaking free on Kindle, so you've nothing to lose.
I echo other reviewers in noting that the book is clearly written by a fan, with extensive citations of Singaporean ministry white papers and Lee Kuan Yew's bio. It does, at times, sound like an infomercial or PR puff piece. It would have been a much better book in the hands of a competent journalist – some "man on the street" testimonials would have been a no-brainer and much more salient than stats that "80% of Singaporeans approve of the job the government is doing". But obviously there wasn't a journalist out there willing and able to do the job or they would have written it and I give kudos to the author for attempting to shed light on a very important subject. The author has a point of view, clearly, but it never reaches the level of dogmatic praise and the author doesn't try to make sweeping generalizations or recommendations based on what works in Singapore. Instead, it comes across as the starting point to a larger conversation.
It describes the Singaporean healthcare system very well (as judged by my feeling that I could relatively intelligently discuss it with someone more knowledgeable than I) and I think the Q&A in the appendix with the government has some pretty thoughtful responses to common criticisms that Singapore's health system won't work in country X. Some more detailed comparisons with other health systems is offered, mostly on outcomes, but some additional compare and contrast segments would have been nice. That said, the author never promised this was a multi-country health system study but a primer on Singapore's system and it delivers.
I echo other reviewers in noting that the book is clearly written by a fan, with extensive citations of Singaporean ministry white papers and Lee Kuan Yew's bio. It does, at times, sound like an infomercial or PR puff piece. It would have been a much better book in the hands of a competent journalist – some "man on the street" testimonials would have been a no-brainer and much more salient than stats that "80% of Singaporeans approve of the job the government is doing". But obviously there wasn't a journalist out there willing and able to do the job or they would have written it and I give kudos to the author for attempting to shed light on a very important subject. The author has a point of view, clearly, but it never reaches the level of dogmatic praise and the author doesn't try to make sweeping generalizations or recommendations based on what works in Singapore. Instead, it comes across as the starting point to a larger conversation.
It describes the Singaporean healthcare system very well (as judged by my feeling that I could relatively intelligently discuss it with someone more knowledgeable than I) and I think the Q&A in the appendix with the government has some pretty thoughtful responses to common criticisms that Singapore's health system won't work in country X. Some more detailed comparisons with other health systems is offered, mostly on outcomes, but some additional compare and contrast segments would have been nice. That said, the author never promised this was a multi-country health system study but a primer on Singapore's system and it delivers.
August 23, 2020
Very good book explaining Singapore’s health care system in great detail. It is interesting to see their mixed approach if public/private. Reads like a white paper and I appreciated the summarized main points at the end of each chapter. More books like this should do that as the details can be a bit wonky for the layperson. Only knock on it is I would’ve liked to see some references to how things they do or don’t do compare to Western health care systems that are so much more expensive.
October 24, 2021
Very useful and illuminating book. I read it in 2021 - 8 years after its publication- but it is a fascinating overview and totally relevant.
Singapore performs well in terms of achieving world-class health outcomes and the quality of care is also high while affordability is an explicit target for the policymakers as a whole. Singapore spends less than 4% of GDP on healthcare.
The creative use of CPF means that when
Singapore performs well in terms of achieving world-class health outcomes and the quality of care is also high while affordability is an explicit target for the policymakers as a whole. Singapore spends less than 4% of GDP on healthcare.
The creative use of CPF means that when
September 29, 2020
Quite good description of Singapore healthcare system but it is good to remember that all data and facts come from government representatives. Therefore, some things are slightly idealised. Anyway, the main conclusion is that the money should follow the patient. It changes his rights and responsibilities.
November 18, 2020
Informative, direct. Illuminates how Singapore is able to have such high healthcare outcomes and community health while containing cost so effectively. Lots for US policy makers to learn.
July 23, 2016
"Perhaps when people have to spend their own money, as the Singapore system requires, they tend to be more economical in the solutions they pursue for their medical problems. In contrast, in countries with third-party reimbursement systems, neither providers nor consumers of healthcare bear the major burden of cost. Since someone else is paying - government programs, insurance companies - there is little incentive to be prudent in decisions about which and how many tests and treatments are appropriate for a given situation." - William Haseltine
I read this as a case study for the various theoretical public policy books I've read purporting to explain the causes and solutions of burgeoning health care costs in the developed world. For example, Singapore's example inspired John Goodman's call for Health Savings Accounts. The country's policies and results are encouraging evidence for reforms offered by Paul Ryan and others on the center-right spectrum: in order to keep costs reasonable without the sacrifices to quality and access seen in Europe, we should use means-tested premium support to guarantee universal health care, while relying on free market competition between suppliers as well as tax incentives motivating consumers to economize on what economist Arnold Kling calls "premium medicine."
In short, decentralize government responsibilities, deregulate health care suppliers, empower consumers.
I read this as a case study for the various theoretical public policy books I've read purporting to explain the causes and solutions of burgeoning health care costs in the developed world. For example, Singapore's example inspired John Goodman's call for Health Savings Accounts. The country's policies and results are encouraging evidence for reforms offered by Paul Ryan and others on the center-right spectrum: in order to keep costs reasonable without the sacrifices to quality and access seen in Europe, we should use means-tested premium support to guarantee universal health care, while relying on free market competition between suppliers as well as tax incentives motivating consumers to economize on what economist Arnold Kling calls "premium medicine."
In short, decentralize government responsibilities, deregulate health care suppliers, empower consumers.
April 13, 2015
I've been looking forward to reading this book for a long time, since it promised to describe a health care system far better than either the pre- or post-Obamacare American system and any of the various European arrangements. As a description, it was fine, but as a book, it fails in many ways. Specifically, Haseltine quotes what politicians say as if it's the unvarnished truth, and he sometimes sounds like he's part of the Singapore propaganda machine. (Assuming they have a propaganda machine.) He also tells us that the government limits the number of doctors to limit costs, and also that there is a widespread shortage of doctors - without mentioning the conflict.
Read if you want to know what Singapore does. Not useful for any real policy analysis.
Read if you want to know what Singapore does. Not useful for any real policy analysis.
October 7, 2020
The book does exactly as it advertises, which is to discourse how Singapore keeps healthcare costs low, while at the same time attaining stellar healthcare outcomes. In that aspect it is very informative, but nothing more. It is presented in a very pro-government manner, and there is barely any discussion regarding the cons or trade-offs of implemented measures.
In conclusion, it’s a decent read on the Singapore healthcare system, with particular attention paid to its low costs, but don’t expect facts to be presented in a balanced manner.
In conclusion, it’s a decent read on the Singapore healthcare system, with particular attention paid to its low costs, but don’t expect facts to be presented in a balanced manner.
January 22, 2015
For anyone interested in health care, this is a good read. It's not a perfect book, and some would say Singapore is in a unique position...but healthcare, and the increasing costs of it are relevant to everyone. This book presents a viewpoint and context that was new to me.
January 19, 2014
A useful resource for those who do not know much about Singapore's relatively successful healthcare system. The many typos made it quite frustrating to read at times.
November 12, 2014
FINALLY! Read for a school project, I have mixed feelings about the tone of this book but it was chock full of information. More later (maybe).
June 20, 2016
The story of the Singaporean healthcare system. Interesting and insightful to read, especially with our struggle to find the ideal system.
July 27, 2013
inspirational. makes me proud to be south east Asian.
Displaying 1 - 20 of 20 reviews