Why is Singapore so healthy

Want to eat salad but cannot understand why grass so expensive? Singaporean shares healthy eating woes

Always eat economy rice, want to eat salad but cannot understand why grass so expensive, the netizen shared. Always taobao from kopitiam because fast and convenient, forgot to eat fruits because lazy to buy and cut.

A handful of netizens responded to the post by sharing their tips and tricks for eating healthy. From easy-to-prepare meals at home to cheap eats when out. Singaporeans joined the conversation to help the netizen.

I always have caipng becuase its cheap but I always get food coma after lunches, shared one commenter. After some time, I decided to reduce my rice intake. For a while, I was spending (S)$14 every day eating salad for lunches, and it was really not sustainable for my wallet (cries). So I try to go for healthier options apart from caipng, such as sliced fish soup, beehoon or just sliced fish soup without any carbs. That helps both the food intake and the expenses, but really have to control the hunger.

Salads are probably best prepared at home, wrote another. If you can spend one weekend day doing meal prep for say half the week youll have changed up half your diet and saved money at the same time for eating well. Beware of dressings, though thats often the part that can turn salads into even higher calorie meals than pizzas or burgers.

Another shared an economic option for eating out, saying, Salad in food court is also affordable. Or I just buy veggies to make my own salad, its cheaper and doesnt take much time.

And as for saving preparation time on meals from home, a netizen suggested, Orange. No need to cut and wash. Same as banana, plus filling also.

Do you feel like you are not eating healthy in Singapore and what did you do? by inaskSingapore

What Makes Singapores Health Care So Cheap?

Singapores health care system is distinctive, and not just because of the improbability that its admired by many on the American left as well as the right.

It spends less of its economy on health care than any country that was included in our recent tournament on best health systems in the world.

And it spends far, far less than the United States does. Yet it achieves some outcomes Americans would find remarkable. Life expectancy at birth is two to three years longer than in Britain or the United States. Its infant mortality rate is among the lowest in the world, about half that of the United States, and just over half that of Britain, Australia, Canada and France. General mortality rates are impressive compared with pretty much all other countries as well.

When the World Health Organization ranked health care systems in 2000, it placed the United States 37th in quality; Singapore ranked sixth.

Americans tend to think that they have a highly privatized health system, but Singapore is arguably much more so. There, about two-thirds of health care spending is private, and about one-third is public. Its just about the opposite in the United States.

Singapores health system also has a mix of public and private health care delivery organizations. There are private and public hospitals, as well as a number of tiers of care. There are five classes: A, B1, B2+, B2 and C. A gets you a private room, your own bathroom, air-conditioning and your choice of doctor. C gets you an open ward with seven or eight other patients, a shared bathroom and whatever doctor is assigned to you.

But choosing A means you pay for it all. Choosing C means the government pays up to 80 percent of the costs.

What also sets Singapore apart, and what makes it beloved among many conservative policy analysts, is its reliance on health savings accounts. All workers are mandated to put a decent percentage of their earnings into savings for the future. Workers up to age 55 have to put 20 percent of their wages into these accounts, matched by an additional 17 percent of wages from their employer. After age 55, these percentages go down.

The money is divided among three types of accounts. Theres an Ordinary Account, to be used for housing, insurance against death and disability, or for investment or education. Theres a Special Account, for old age and investment in retirement-related financial products. And theres a Medisave Account, to be used for health care expenses and approved medical insurance.

The contribution to Medisave is about 8 percent to 10.5 percent of wages, depending on your age. It earns interest, set by the government. And it has a maximum cap, around $52,000, at which point youd divert the mandatory savings into some other account.

A second health care program is Medishield Life. This is for catastrophic illness, and while its not mandatory, almost all of the population is covered by it. Its really cheap, from $16 a month for a 29-year-old in 2019 to $68 a month for a 69-year-old, without subsidies.

Medishield Life kicks in when youve paid the deductibles for the year, and after youve paid your coinsurance. Deductibles vary by your age and the class of care you choose, and range from $1,500 to $3,000. Coinsurance ranges from 3 percent to 20 percent, varying by the size of the medical bill. Medishield Life has an annual limit of $100,000 but no lifetime limit.

Medishield Life is managed so that it covers most of a hospitalization in a Class B2 or C ward. Patients would cover the rest out of their Medisave accounts. Patients also have the option to pay for additional insurance, which would cover a higher class of care. Some plans are offered by the government, and people can use Medisave money to pay for those. Other plans are purely private, and sometimes offered by employers as benefits.

A third health care program is Medifund, which is Singapores safety net program. Only citizens are eligible; it covers only the lowest class of wards; and its available only after people have depleted their Medisave account and Medishield Life coverage. The amount of help someone could get from Medifund depends on a patients and familys income, condition, expenses and social circumstances. Decisions are made at a very local level.

A number of people hold up Singapore as an example of how conservative ideas of competition and consumer-directed spending work. Unfortunately, the story isnt so clean when you look at the data. In a 1995 paper in Health Affairs, William Hsiao looked at how health spending fared in Singapore before and after the introduction of Medisave. He found that health care spending increased after the introduction of increased cost-sharing, which is not what most proponents of such changes would expect. Michael Barr had similar thoughts in his critical inquiry into Singapores medical savings account, published in The Journal of Health Politics, Policy and Law in 2001.

But why is Singapore so cheap? Some think that its the strong use of health savings accounts and cost-sharing. People who have to use their own money usually spend less. But thats not the whole story here. Theres a lot of government regulation as well.

Through the tiered care system and its public hospitals, the government has a great deal of control over inpatient care. It allows a private system to challenge the public one, but the public system plays the dominant role in providing services.

Initially, Singapore let hospitals compete more, believing that the free market would bring down costs. But when hospitals competed, they did so by buying new technology, offering expensive services, paying more for doctors, decreasing services to lower-class wards, and focusing more on A-class wards. This led to increased spending.

In other words, Singapore discovered that, as weve seen many times before, the market sometimes fails in health care. When that happened in Singapore, government officials got more involved. They established the proportion of each type of ward hospitals had to provide, they kept them from focusing too much on profits, and they required approval to buy new, expensive technology.

Singapore heavily regulates the number of physicians, and it has some control over salaries as well. The country uses bulk purchasing power to spend less on drugs.

The most frustrating part about Singapore is that, as an example, its easily misused by those who want to see their own health care systems change. Conservatives will point to the Medisave accounts and the emphasis on individual contributions, but ignore the heavy government involvement and regulation. Liberals will point to the publics ability to hold down costs and achieve quality, but ignore the class system or the systems reliance on individual decision-making.

Singapore is also very small, and the population may be healthier in general than in some other countries. Its a little easier to run a health care system like that. It also makes the system easier to change. We should also note that some question the outcomes on quality, or feel that the government isnt as honest about the systems functioning.

There is a big doctor shortage, as well as a shortage of hospital beds. As Mr. Barr noted in a longer discussion of Singapores system, It seems to be highly likely that if one could examine the Singapore health system from the inside, one would find a fairly ordinary health system with some strong points and many weaknesses much like health systems all over the developed world. This concern about how much we can really know about Singapores true outcomes is one of the reasons it didnt fare so well in our contest.

The US healthcare structure continues to be the focus of intense debate, centered on both its effectiveness and its fairness. In the past decade or so, that conversation has only become more heated as factions square off about the degree to which the government should be involved, if at all.

Its certainly no surprise that passions run deep. But setting aside political or ideological views, at some point most of us are going to depend on the broader healthcare system. To hope for quality care at a fair price seems like a reasonable expectation. Whats more, the economic impact of healthcare policy could be staggering. According to data from the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation, global spending on health could jump to $18 trillion in 2040, up from about $8 trillion in 2013.

Given its global importance, its imperative that the key stakeholders involved in the healthcare discussion consider all options and also examine systems that have shown success in other parts of the world. One of those places is Singapore.

Why Singapore?

In 2017, the Bloomberg Global Health Index ranked Singapore as number 4 in the world, bolstered by a long life expectancy of 81 years, and low infant mortality rate of 1.5 per 1,000 live births. Another Bloomberg index of the worlds most efficient healthcare systems ranked Singapore first in 2014 and second in 2017, behind only Hong Kong. (The US came in at 50th on the 55-country list.)

What differentiates the small islands healthcare system from those in other large, developed countries? Dr. Kai Hong Phua of the Lee Kuan Yew School of Public Policy, cites three key reasons:

global spending on health could jump to $18 trillion in 2040, up from about $8 trillion in 2013.

1) The Public-Private Balance. Singapores universal health coverage system is largely overseen by the governments Ministry of Health, but also includes support from citizens and the private sector. The Singapore government has experimented with a host of different reforms which reflect evolving stages of socioeconomic development, as well as changing priorities in public healthfrom environmental measures to personal lifestyles and healthcare consumption, says Dr. Phua. The government also weighs its citizens values as a social determinant of health: there is a cultural emphasis on family support in Singapore, which brings with it a strong support network.

2) Sustainable Financing. The government adopts a diversified but integrated approach which includes:

• Tax measures that pay for accessible public health services and subsidize indigent coverage;
• Individual saving plans for acute medical care consumption, and;
• Defined coverage for medical insurance.

The latter only covers catastrophic care, which can help avoid the pitfalls of moral hazard (when consumers purchase additional unnecessary care because theyre insured) in comprehensive plans, as well as adverse selectionboth of which are typical of private insurance. Subsequently, there are cost-sharing features on both the supply and demand sides of healthcare.

3) Strong Regulatory Governance. Though it encourages free market competition and choice, the government makes substantial targeted investments in areas where market failures would make healthcare costs unaffordable. Because it controls the dominant public hospitals and supply of doctors, there is less emphasis in Singapore to protect the interests of the private sector through supplier-induced demand.

A Roadmap for the Rest of the World?

Many American observersincluding William Haseltine, in his 2013 book examining Singapores healthcaresaid the islands system might offer a glimpse of how healthcare could look in other parts of the developed world. While those observers may have focused particularly on aspects like cost-sharing or personal responsibility incentives, the key seems to be the quality of government oversight in Singapores public policy implementation. And the collective accumulation of savings for healthcare, especially in old age, may be the salvation for increasingly expensive medical systems in aging societies.

But otherslike Dr. Phuasuggest that Haseltines optimistic Singapore appraisal may be too focused on the potential solutions it can offer the US healthcare system, rather than investigate its grounding principles. Haseltine glosses over some crucial tenets of the Singapores system success: it thrives because its society embraces public health as well as disease prevention, and its health financing scheme epitomizes good governance.

Still, Haseltine notes some factors that may be transferable to other countries health systems, especially those facing large demographic shifts. Today, the emphasis is on planning for the coming demographic crises using the same cross-ministry approach that has worked so well in the past, Haseltine said in Affordable Excellence: The Singapore Healthcare Story. How can the current system be adapted to provide excellent care for the elderly at a cost the country can afford? This is the central issue for all developed economies. Those planning for the future might well look to Singapore for ideas on how to prepare for the challenges ahead.

Indeed, Dr. Phua notes the importance of adjusting the various control knobs of healthcare financing in order to achieve the proper balance in the system in the future. That is, allocating proper resources to the poor and the elderly, more robust lifelong savings to generate further resources for future aging needs, and insurance to provide greater risk pooling to cover high-cost catastrophic illnesses. This helps to avoid public cutbacks and rationing, or widening gaps between generations and the haves and have-nots.

Notably, Singaporeans believe in good governance and support stronger regulation and information-sharing within the health sector. They want to enjoy old age with greater peace of mindwith good health and medical care at affordable prices, he said.

That sounds like a model that could work for the rest of the world.

For additional insights on Singapores health policy experience, visitGlobal-Is-Asian.

This article was produced on behalf of the Lee Kuan Yew School of Public Policy by Quartz Creative and not by the Quartz editorial staff.