more on Singapore healthcare

Further to yesterday’s post, Professors Frakt and Carroll have written a short review of the literature. Read it – and some of the literature they cite – after reading Haseltine’s book.

We have already written many posts about Singapore’s health system (there’s a a tag for that), which is built around medical savings accounts (it’s Medisave program), though encompasses so much more. Unsurprisingly, we’re far from the first to comment on the system. But, contrary to what some have suggested, we’re not just interested in scoring political points. We want to know what data and evidence have to say about Singapore. This post summarizes a few points from some of the relevant literature from peer-reviewed journals.

Scholarly literature on Singapore’s health system goes back at least as far as the 1995 Health Affairs paper by William Hsiao.  (His paper is ungated. Ungated versions of those linked below may also exist. Use Google Scholar.) He described the country’s health spending trajectory just before and after Medisave was introduced … [and shows that] health care spending increased after the introduction of increased cost-sharing, which is not what most proponents of such changes would expect. …. But this was not a randomized controlled trial, and causality is, of course, not proven. ….

The bottom line is that Singapore isn’t simply “cost-sharing”, “free market”, “competition”, and a “lack of government involvement”. If you endorse Singapore’s health care system, you’re buying into many things, and some truths, that libertarians and conservatives claim to dislike. We acknowledge that more cost sharing can reduce spending. But if that’s the only thing you endorse, then you’re not talking about Singapore.

Austin Frakt and Aaron Carroll, “Singapore’s health system: commentary from the literature“, The incidental Economist, 28 August 2013.

Health economost Austin Frakt (Boston University) is the creator and primary author of The Incidental Economist. Co-author Aaron Carroll is Professor of Pediatrics at Indiana University School of Medicine.

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