Learning from Singapore and Switzerland
So this week’s question from the Washington Post RX Blog was:
Which country has the best health-care system and why? Can the U.S. follow its model?
My response -- Learning from Singapore, Switzerland -- is below.
To realize the goals of providing increased access while maintaining fiscal responsibility, we have to dramatically change how we 'do health' today -- whether we're doctors, hospitals, or consumers.
Health is complicated no matter where you go in the world, and there are different challenges in every country. There is no 'best' system anywhere, but there are best practices from around the world worth exploring. Two immediately come to mind:
Singapore's system has characteristics that reflect what we'd expect to see in our own system - personal responsibility, competition and choice. Working people are obliged to put money into a personal savings account for out-of-pocket expenses. The money remains completely in each person's control; each decides how to spend it. And there's choice -- at the Raffles Hospital, one can choose a $1,438 luxury suite with a 24-hour nurse and other amenities OR a $99 a night dormitory room with the six other beds. Procedures cost the same, and are transparent (Publication of the cost of hospital procedures is mandatory, turning the purchase of a hip replacement into something similar to buying a pair of shoes), but there's choice. Contrast this to our system where it's difficult to even get a price in advance, let alone make choices.
Switzerland's system also offers interesting models for consideration -- universal access, individual choice from an array of private insurance options, and a higher level of personal accountability (shared costs by individuals). All citizens are required to buy health insurance and private insurers are required to offer coverage to everyone - regardless of age or any previous medical conditions. Insurers offer a basic package on a not-for-profit basis, and supplemental packages on a for-profit basis that consumers can choose for things like home care, alternative medicine, and so on. Competition is basically about price and service. For those who can't afford the basic package, the government offers direct cash subsidies. In addition, the system provides incentives for consumers to avoid unnecessary treatments by requiring them to share some costs at a higher level than in the U.S. It's not perfect, but it is customer-driven.
In a democratic nation where capitalism flourishes, personal accountability and choice ought to be at the heart of the system.
Please feel free to comment with your own thoughts – I’d like to hear from you.
Comments
- Anonymous
January 01, 2003
Thank you for sharing your personal story in the earlier blog. Best wishes to your wife's recovery. In our busy life, we often forget to put our health as top priority. I'm from Toronto, Canada and as a summer student (many years back), have volunteered in one of the city's General Hospital's health records department. My job was to file patients' health records stored in a room full of paper files and folders, organized in alphabetical order. The files and folders would pile up in carts and we'd filed them away throughout the day. It is now great to see that technologies such as MSFT HealthVault are helping to modernize health care. It seems Canadian government is also investing in E-Health - read about the http://www.ehealthontario.on.ca/about/index.asp. Hope healthcare system would become more efficient worldwide and affordable to everyone.