A Comparison of Healthcare Systems

Introduction

Singapore is an interesting nation in which to compare to the United States in regards to health care for several reasons. Singapore’s government is a Parliamentary Representative Democratic nation. The United States is a Federal Republic and a Constitutional Democracy. This means that Singapore has a President and a Prime Minister, whereas the United States only has a President. In addition, the population is vastly different, with Singapore’s population being almost 6 million and the United States population being over 322 million. The differences in government and population can influence how health care is funded and provided to citizens, which makes comparing the two nations quite interesting.

Health Statistics and Costs

According to the World Health Organization, life expectancy in Singapore in 76 years old for men and 81 years old for women. In the United States, life expectancy for men is 81 years old and for women is 85 years old (WHO, United States, 2019). Life expectancy is slightly better for those who live in the United States rather than in Singapore. The mortality rate for those under the age of 5 in Singapore is 3 per 1,000 live births (WHO, Singapore, 2019). The mortality rate for those under the age of 5 in the United States is 7 per 1,000 live births (WHO, United States, 2019). The mortality rate for those under the age of 5 is greater in the United States. The mortality rate for those between the ages of 15 and 60, in Singapore, per 1,000 citizens for men is 65 and for women is 38 (WHO, Singapore, 2019). The mortality rate for those between ages 15 and 60, in the Unites states, per 1,000 citizens for men is 142 and for women is 86 (WHO, United States, 2019).  This shows that the mortality rate is greater in the United States than in Singapore, which could be influenced by culture, population amount, government, and health care access.

The health care expenditure per capita is 4,047 in Singapore (WHO, Singapore, 2019). The health care expenditure per capital is 9,403 in the United States (WHO, United States, 2019). This means that the United States pays more per person for healthcare than Singapore. The health care expenditure as a percentage of the gross domestic product in Singapore is 4.9% (WHO, Singapore, 2019). The health care expenditure as a percentage of the gross domestic product of the United States is 17.1% (WHO, United States, 2019). This means that the United States relies more heavily on health care being a gross domestic product than Singapore does.

Health Care Financing

Singapore’s health care is divided into three categories. The health care categories are Medisave, Medishield, and Medifund (Singapore, 2019). Medisave is mandated and every person in Singapore pays a percentage of their income into it, which employers meet. Medishield is low cost insurance that one can pay for in addition to Medisave. Medishield covers prolonged illness and severe injuries, it has copayments and deductibles. Medifund is paid for by the government and covers those who are indigent. Citizens in Singapore can also opt to enroll in private health insurance as well, but the government insurance is mandatory. In addition, you only receive what you have paid into mandatory government healthcare. For example, if you have paid in $3,000, but your bill is $5,000 you are responsible for $2,000.

In the United States one pays taxes for Medicaid/Medicare, but not every citizen is eligible to receive Medicaid/Medicare. In 2016, 17.2% of the population had Medicare (Djordjevic, 2019). Medicare tax is 1.45% of a person’s income. Employers can offer insurance, which employees pay premiums to be able to be considered ‘covered’. Individuals can purchase their own health care as well. In the United States Medicare is totally funded by taxpayers. In Singapore, Medisave is funded entirely by employees paying into the fund. In both the United States and Singapore, they have private health insurance that can be fully funded by individuals in addition to health insurance that are partially paid for by employers.

Health Care Administration

In Singapore, health care is overseen, regulated, and dispersed by the Ministry of Health. In the United States, Medicare and Medicaid are overseen by the U.S. Department of Health and Human Services. Health care is regulated by the U.S. Department of Health and Human Services, Congress, and even state laws when they are applicable.  Singapore utilizes the Medifund to help those who are unemployed, low income, or homeless. Military members in Singapore, as well as, veterans, all obtain their health care through the branches of the SAF Military Medicine Institute. In the United States, military members and veterans have something called TriCare. The United States government, funded by the taxpayers, pays for the health care of military members and their immediate family. The United States offers Medicare/Medicaid to all who would meet the requirements, but those who fall just beyond the requirements will be denied. For example, a low-income household could be denied insurance because they make too much money.

Health Care Facilities

There are 2.4 hospital beds for every 1,000 people in Singapore (Bank, Hospital Beds (per 1,000 people), 2019). In the United States there are 2.9 hospital beds per 1,000 people (Bank, Hospital Beds (per 1,000 people), 2019). In Singapore there are 7.2 Nurses/Midwives for every 1,000 people (Bank, Nurses and Midwives (per 1,000 people), 2019). In the United States there are 8.6 Nurses/Midwives for every 1,000 people (Bank, Nurses and Midwives (per 1,000 people), 2019). There are 2.8 Physicians for every 1,000 people in Singapore (Bank, Physicians (per 1,000 people), 2019). There are 2.6 Physicians for every 1,000 people in the United States (Bank, Physicians (per 1,000 people), 2019). Examining these numbers makes both Singapore and the United States appear to be under equipped, in terms of availability for treatment, but more so the United States because its population is so much greater than Singapore.

Conclusion

Health care has been perfected in neither Singapore nor the United States. There are still citizens in both nations who must avoid treatments because they cannot afford it. It could be because they have not paid enough into Medisave to cover treatment in Singapore, or they simply do not have insurance in the United States. Low-income people tend to be the ones caught in the middle, they are not considered indigent but they do not have a great enough income to be able to pay for their own health care coverage. Those who are extremely poor in the United States may be able to seek assistance at a free health clinic, but they are not always available.  In both nations, it appears as though the better off one is, economically speaking, the better health care they can afford.

References

• AHRQ. (2019). Healthcare Cost and Utilization Project (HCUP). Retrieved from U.S. Department of Health and Human Services: https://www.ahrq.gov/data/hcup/index.html
• Bank, W. (2019). Hospital Beds (per 1,000 people). Retrieved from The World Bank: https://data.worldbank.org/indicator/SH.MED.BEDS.ZS
• Bank, W. (2019). Nurses and Midwives (per 1,000 people). Retrieved from The World Bank: https://data.worldbank.org/indicator/SH.MED.NUMW.P3
• Bank, W. (2019). Physicians (per 1,000 people). Retrieved from The World Bank: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
• CDC. (2017, January 20). Health Expenditures. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/fastats/health-expenditures.htm
• Djordjevic, N. M. (2019, February 17). 30 Staggering Healthcare Statistics to Know in 2019. Retrieved from Med Alert Help: https://medalerthelp.org/healthcare-statistics/
• Singapore, G. o. (2019, April 5). Government Health Expenditure and Healthcare Financing. Retrieved from Ministry of Health Singapore: https://www.moh.gov.sg/resources-statistics/singapore-health-facts/government-health-expenditure-and-healthcare-financing
• WHO. (2019). Singapore. Retrieved from World Health Organization: https://www.who.int/countries/sgp/en/
• WHO. (2019). United States. Retrieved from World Health Organization: https://www.who.int/countries/usa/en/