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The city-state of Singapore may have a fix for America’s healthcare woes

The Singapore Model
By Rowan Callick
Tuesday, May 27, 2008
The city-state of Singapore may have a fix for America’s healthcare woes.

The city-state of Singapore may have a fix for America’s healthcare woes.
Americans have grown used to buying every kind of product from overseas. So why not “buy” foreign ideas or social institutions? Why, for instance, hasn’t the United States adopted the same healthcare system as Europe, Canada, and nearly all the rest of the developed world?

While the United States is portrayed as the outlier, the truth is that another developed nation has eschewed the European government-payer model—with a great deal of success. That nation is Singapore, a city-state with a population of just 4.6 million but a lot to teach America.

Singaporeans are considerably healthier than Americans, yet pay, per person, about one-fifth of what Americans pay for their healthcare. A major reason is that Singapore’s system does not focus on the question that seems to preoccupy both Europe and America: who pays? Ultimately, whoever signs the checks, the money comes out of the pockets of individuals. Singapore takes a different tack.

The country, a genteel and still sleepy colonial port when it became independent in 1965, was whipped into industrial shape by its founder, Lee Kuan Yew. Its detractors, opposed to his draconian style, dismissed it as a place where you could get fined for chewing gum, littering, smoking in taxis or elevators, almost anything.

But in this election year, as Americans agonize yet again over their health service, Singapore’s system has emerged as an impressive model that is a major attraction for increasing numbers of permanent Western expatriates.

“Singaporeans are considerably healthier than Americans,
yet pay, per person, about one-fifth of what
Americans pay for their healthcare.”

Here are some comparisons: Life expectancy at birth in the United States is 78 years; in Singapore, 82 years. The U.S. infant mortality rate is 6.4 deaths per 1,000 live births; in Singapore, just 2.3 deaths per 1,000. But the United States has far more caregivers: 2.6 physicians per 1,000 people, compared with 1.4 physicians in Singapore. The United States has 9.4 nurses per 1,000 people; Singapore, 4.2. And it has six times as many dentists as Singapore and three times as many pharmacists.

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