Introduction
The aspect of healthcare is one of the crucial elements that make or break a nation’s stability. Healthcare systems vary widely from one country to another and many international health organizations have been concerned with determining which countries have done well in taking care of their populace and which ones have done poorly over the years. Comparing and contrasting two countries whose healthcare systems are highly different from one another may help us understand better (1) the advantages of a country with a good healthcare system and policy, (2) the strategies that make a healthcare approach successful, and (3) what the countries with less-developed healthcare systems are missing. To fulfill the goals of this paper, we take Singapore as the subject or representative country to be compared and contrasted with USA in reference to their healthcare systems.
Leading the Asian countries and ranking sixth worldwide (WHO, 2000) in terms of providing good healthcare service, Singapore casts a great shadow over the wealthy and powerful nation of USA, which ranks 37th worldwide in terms of the quality of healthcare system for its citizens (WHO, 2000). Choosing Singapore amongst all the other countries that ranked high in overall healthcare systems worldwide provides us an opportunity to compare and contrast USA with an Asian country whose government structure, policy implementation, population characteristics, and topography are remarkably different.
Health Statistics and Costs: Comparison between USA and Singapore
Having landed two distanced spots in overall healthcare system ranking, USA and Singapore significantly differ from one another in terms of the usual measures that determine the stability and efficacy of a country’s healthcare system and those measurements are (1) life expectancy, (2) mortality rate, (3) management of major health issues/illnesses, (4) gross domestic product (GDP) percentage spent on healthcare, and (5) per capita healthcare expenditures. An effective healthcare system is one that is high in quality but low in cost—an aspect that the abovementioned parameters measure.
Life expectancy in Singapore is higher than in USA. On average, a Singaporean is expected to live up to 80 years (Haseltine, 2013) while an American has a life span of 77.8 years (Anderson & Squires, 2010). This rate also differs in men and women. In Singapore, women and men have life expectancy spanning 84 and 79 years respectively (Haseltine, 2013). However, in USA, female and male life expectancy is slightly lower, spanning 81.1 years and 76.2 years respectively (Irvine, 2013).
Mortality rates are also a mean of measuring the efficiency of a healthcare system. A country with an effective healthcare system has a low mortality rate. According to Haseltine (2013), the adult mortality rate in Singapore amounts to below 60 per 1,000 of the population, while in the USA, it amounts to more than 100 per 1,000 of the population. A more detailed statistics for the USA’s mortality rate amenable to healthcare amounts to 96 per 100,000 deaths (Commonwealth Fund, 2011 as cited in Irvine, 2013). Also, infant mortality rate differs widely in Singapore and USA. Singapore has recorded five (5) neonatal deaths for every 1,000 births (Haseltine, 2013). In USA, infant mortality rate amounts to 6.1 per 1,000 births.
Just like most of the First-World countries, USA and Singapore are heavily plagued by non-communicable chronic diseases (NCDs) brought about by their populations’ lifestyle. Heart attack is the most common NCD that causes the most morbidity and mortality in USA and Singapore. According to Haseltine (2013), myocardial infarction in Singapore in 2007 amounted to nine in-hospital case-fatality in every 100 patients while in USA it amounted to five in-hospital case-fatalities per 100 cases in 2006. Furthermore, the two types of heart attacks: ischemic and hemorrhagic, constitute different statistics for heart attack rates both in USA and Singapore. It is reported that ischemic strokes caused five in-hospital case-fatalities in every 100 patients in Singapore and four in-hospital case-fatalities in every 100 patients in USA in the year 2006 (Haseltine, 2013). Hemorrhagic heart attack causes 25 in-hospital case-fatalities in every 100 affected patients both in Singapore and USA in the year 2007 (Haseltine, 2013).
Healthcare system may account for a great expenditure in a country’s gross domestic product (GDP) and its per capita income. Singapore spends almost 4% of its GDP on healthcare while it allots only USD 2,000.00 per capita on healthcare (Haseltine, 2013). Despite the low costs, it will be a mistake to presume that Singapore has a low quality healthcare service. In fact, Singapore, being the leading Asian country, offers one of the best medical facilities worldwide. In contrast, USA spends an excessive amount of its GDP and per capita expenditures on healthcare. USA has been reported to spend 17.6% of its GDP and a stunning USD 8,232.9 per capita on healthcare services (Irvine, 2013)—an excessive spending on healthcare with poor results that do not meet the health standards of most Americans.
Healthcare Financing: Comparison between USA and Singapore
In healthcare financing, Singapore and USA share a common feature: both of them are funded more dominantly by private sectors than the public. According to Thomson, Osborn, Squires, and Jun (2013), USA gets 48% of its healthcare funding from government revenue while 33.8% comes from private insurance. Singapore, on the other hand, gets more than 65% of its national healthcare fund from private sectors (Haseltine, 2013). Healthcare in USA is publicly financed through Medicare and Medicaid— both supported by the government revenue—while private funding comes from private insurance companies whose mode of payments are voluntary and tax-exempted (Thomson, Osborn, Squires, & Jun, 2013). Singapore has its own way of financing healthcare that is somewhat similar with the Medicare and Medicaid of USA, except, it is more systematized and successful. Singapore gives emphasis on the ability of its citizens to hold themselves responsible for their own well-being. Singaporean healthcare can be accessed mainly through regular mandatory contributions dispersed among the accounts called Medisave, MediShield, and Medifund which Singaporean citizens can use to avail of healthcare services once they retire, or in cases of urgent and unexpected health incidences (Haseltine, 2013). Fundings of both USA and Singapore come from both private and public sectors.
Healthcare Administration: Comparison between US and Singapore
Currently in USA, the main regulators of healthcare are the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), the Center for Disease Control and Prevention (CDC), National Institutes of Health (NIH), the Health Resources and Services Administration (HRSA), and Agency for Healthcare Research and Quality (AHRQ)—administrative bodies that work to make sure that the established laws in connection with the health of the American population is implemented, complied with and interpreted accordingly (Thomson et al., 2013). On the other hand, Singapore has three administrative agencies that look after its population’s healthcare, namely: The Ministry of Health (MOH), the Central Providence Fund (CPF), and the Monetary Authority of Singapore (MAS) which work together to ensure that proper policies in healthcare are implemented, resources are properly allocated, the accessibility and quality of healthcare facilities are monitored and healthcare personnel and facilities are evaluated accordingly (Bai, Shi, Li, & Liu, no date).
Health Care Personnel and Facilities: Comparison between US and Singapore
According to the study by Haseltine (2013), Singapore’s physician density rate is at 18 while USA’s is at 27 per 10,000 of the population. Furthermore, it is reported that both Singapore and USA have 31 hospital beds per 10,000 of their population (Bai et al., no date). We may conclude then that USA has fewer hospital beds for its population as compared with Singapore.
Access and Inequality Issues: Comparisons between US and Singapore
Issues on healthcare access are somewhat common in most developed countries with the most developed healthcare systems. Inequality issues stem from racisms, demographic differences between the populations, and variations in individual income. In USA, this problem is addressed by annually releasing reports that focus on access and inequality disparities that are more pressing at the moment (Thomson et al., 2013). Also, the Federally Qualified Health Centers (FQHCs) are providing comprehensive primary and preventive care that covers even the poorest American individuals (Thomson et al., 2013). In the case of Singapore, the discrimination among patients is not common and almost all the citizens of Singapore have access to its healthcare system. A system of subsidies with wards providing varying level of comfort to patients is devised, helping to target the poorer members of the society and allocate to them the greatest healthcare subsidies which corresponds to a less comfortable room (Abeysinghe, Himani, & Lim, 2010; Haseltine, 2013).
References
Abeysinghe, T., Himani, & Lim, J. (2010). Singapore’s healthcare financing: Some challenges. Retrieved from http://courses.nus.edu.sg/course/ecstabey/Singapore%20health%20chapter-earlier%20version.pdf.
Anderson, G.F. & Squires, D. (2010). Measuring the US health care system: A cross-national comparison. The Commonwealth Fund, 1412(90), 1-10. Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2010/jun/measuring-the-us-health-care
Bai, Y., Shi, C., Li, X., & Liu, F. (n.d.). Healthcare System in Singapore. Retrieved from http://assets.ce.columbia.edu/pdf/actu/actu-singapore.pdf
Haseltine, W.A. (2013). Affordable excellence: The Singapore healthcare story. Washington, DC: Brookings Institution Press. Retrieved from http://www.brookings.edu/~/media/press/books/2013/affordableexcellence/affordableexcellencepdf.pdf
Irvine, B. (2013). Health care systems: The USA. In E. Clarke & E. Bidgood (Eds.). Retrieved from http://www.civitas.org.uk/nhs/download/USABrief.pdf
Thomson, S., Osborn, R., Squires, D., & Jun, M. (2013). International profiles of health care systems, 2013. The Commonwealth Fund, 1717, 1-138. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_sys_2013_v2.pdf
WHO (World Health Organization). (2000). Health systems: Improving performance. The World Report 2000. Retrieved from http://www.who.int/whr/2000/
