Annette King had good reason to be ashamed of what her DHB model has done to our hospital, even before it became clear that the rebuild would diminish capacity

Given the job frustration of our dedicated health care people, deaths of heart patients waiting for care, children with no paediatric oncologists, and losses of other specialists, this survey of Singapore’s success is another reminder of what is achievable when politicians are focussed on what works, instead of ideology.

The World Health Organization’s most recent full report on global health statistics says we spend 8.9% of our GDP on healthcare, while Singapore spends just 3.7 percent. Their health statistics are better than ours. Their infant mortality (under 5 years) is half ours (3 per thousand live births compared with our 6).

“What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381 (all dollars in this article are U.S.) per capita on health—or one-seventh what the U.S. government spends. 

Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care. As the Health Ministry puts it, “Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, government subsidies help to keep basic healthcare affordable.” 

The reason the system works so well is that it puts decisions in the hands of patients and doctors rather than of government bureaucrats and insurers. The state’s role is to provide a safety net for the few people unable to save enough to pay their way, to subsidize public hospitals, and to fund preventative health campaigns. ”

Of course it would all be easier here if we had their levels of average income, and their sustained growth rate (on the back of no natural resources). We’ve chosen to be poor.

When I first visited Singapore, from recollection their per capita incomes were about half ours. Now they earn an average US$4500 more per capita. They spend in total on health US$ 1,140 per person, about half what we spend.