As Haseltine notes, the medical savings account is only one small element of Singapore’s health system, even if it is the one that has attracted most attention. It has never accounted for more that 10% of total health expenditure. As he shows, it only works by being wrapped up in a complex network of mechanisms that compensate for its failure to deal with the fundamental challenge in delivering universal healthcare—those in most need of healthcare, typically older and poorer people, are least able to pay for it. [...]
The cost of care is limited by major subsidies to hospitals—up to 80% of the cost of inpatient treatment—on top of other payments for capital expenditure. There are also strict controls on what hospitals can do and what they can charge, including limits on purchase of advanced technology.
That’s Martin McKee and Reinhard Busse in a BMJ editorial on William Haseltine’s new book on Singapore’s health system. Apparently, Haseltine was motivated to write it because he searched and could not find a satisfactory, detailed explanation for how Singapore’s system works. I share his frustration and am grateful he did the work.
UPDATE: Here’s Haseltine speaking at Brookings about Singapore’s health system. (H/t Brad Flansbaum.)