Singapore's Health Care Ranked First in an International Comparison
August 14, 2001
A new study shows that Singapore's health-care system places first when compared with the health-care systems of seven other countries. Canadian health economist Cynthia Ramsay ranked the health-care systems of Singapore, Canada, the United States, the United Kingdom, Switzerland, Germany, Australia and South Africa.
The study uses an index similar to the United Nations Human Development Index and the Fraser Institute Index of Human Progress. An index score, ranging from zero to 100, indicates how a health care system performs relative to others.
- Quality is measured using such categories as health status, mortality rates, preventable illnesses, appropriateness of services and patient satisfaction.
- Access to care measures insurance coverage in a population, equity in health outcomes, how health spending is distributed between acute and other health-care services, and the availability of medical expertise and technology.
- Cost variables include efficiency and total health spending, and sustainability.
According to the overall rankings Singapore, which relies heavily on private sector financing, has the "best" health-care system with a score of 62.1. Singapore puts much responsibility on patients to finance at least a portion of the costs of their care.
Second-place United Kingdom (60.5), which operates a private system alongside its National Health Service, ranked high largely for its low spending. By contrast, the United States (53.6) ranked just behind Canada (56.7) partially due to its high level of expenditure. Because containing costs is considered beneficial, says Ramsey, "more spending on health is worse than less."
In addition, the U.S. score likely suffered because using insurance coverage in a population as a measure for "access" fails to take into account the large safety net -- such as free medical care that public and private hospitals are required to provide -- available to those who do not have private health insurance or do not enroll in a government program.
Source: Cynthia Ramsay, "Beyond the Public-Private Debate: Access, Quality and Cost in the Health-Care Systems of Eight Countries," Marigold Foundation Ltd., July 2001, 1700-801 6 Avenue, S.W., Calgary, AB T2P 3W2, (403) 303-1804.
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