Sunday, August 25, 2013

What I've Been Reading

Affordable Excellence: The Singapore Health System by William A. Haseltine. Please read the book to find out the details (Kindle version is $0.00 and you will not regret reading this one); here are few excerpts:

In my study of Singapore, I have found three compelling qualities woven into the fabric of the country that have enabled it to achieve outstanding successes in so many areas, healthcare included. They are long-term political unity, the ability to recognize and establish national priorities, and the consistent desire for collective well-being and social harmony of the country.

I find these words of Lee key to understanding Singapore's approach: 
A competitive, winner-takes-all society, like colonial Hong Kong in the 1960s, would not be acceptable in Singapore… To even out the extreme results of free-market competition, we had to redistribute the national income through subsidies on things that improved the earning power of citizens, such as education. Housing and public health were also obviously desirable. But finding the correct solutions for personal medical care, pensions, or retirement benefits was not easy.

In the late 1940s, as a student at Cambridge, Lee witnessed the beginnings of the English welfare state: 
Looking back at those early years, I am amazed at my youthful innocence. I watched Britain at the beginning of its experiment with the welfare state; the Atlee government started to build a society that attempted to look after its citizens from cradle to grave. I was so impressed after the introduction of the National Health Service when I went to collect my pair of new glasses from my opticians in Cambridge to be told that no payment was due. All I had to do was to sign a form. What a civilised society, I thought to myself. The same thing happened at the dentist and the doctor. 
Over time, though, Lee realized that a system that took care of all of its citizens’ needs would diminish the population's “desire to achieve and succeed.” If anything may be identified as the guiding philosophy behind Singapore's success, it is Lee's conviction that the people's desire to achieve and succeed must never be compromised by an overgenerous state. The government made certain that Singaporeans developed and retained a sense of responsibility for all aspects of their lives— including the care and maintenance of their own physical and emotional well-being.

By the early 1990s, it became clear that healthcare costs were growing at an alarming rate that would soon put an unacceptable strain on the nation's as well as family finances. It was also recognized that increasing life expectancy was creating another challenge: how to care for the growing elderly population in Singapore. A Ministerial Committee was set up to review the role the government could play in containing costs, controlling subsidies, and ensuring the continued quality of care. In 1993, the committee issued its report in a White Paper entitled “Affordable Health Care.”The White Paper became, in effect, the blueprint for developing and refining a healthcare system that would serve the population well into the 21st century. In outlining the government's philosophy and approach to healthcare, it set forth five fundamental objectives:
  • Become a healthy nation by promoting good health;
  • Promote individual responsibility for one's own health and avoid overreliance on state welfare or third-party medical insurance;
  • Ensure good and affordable basic medical services for all Singaporeans;
  • Engage competition and market forces to improve service and raise efficiency;
  • and Intervene directly in the healthcare sector when necessary, where the market fails to keep healthcare costs down.

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