Healthcare

SINGAPORE: A thread on X (formerly Twitter) on how Singapore “created the world’s most efficient healthcare system from scratch in one generation”, posted on Apr 2, has gone viral, getting 3.5 million views just this week.

Its author, a US-based entrepreneur named Justin Mares, who founded TrueMed and other startups, explained the differences between how Singapore and the US have approached healthcare. From the beginning of his thread, he pointed out that while Singapore spends $4,000 (S$5,341) per person on healthcare, the US spends $15,000.

He traced this back to the choices made by the government of founding Prime Minister Lee Kuan Yew before the 1960s when Singapore’s gross domestic product (GDP) was low, and the ratio of doctors to the population was quite small.

Despite this, Singapore chose to make healthcare its fifth priority after international recognition, defence capabilities, economic development, and housing.

“Why? Building wealth creates resources for healthcare,” Mr Mares wrote, explaining Singapore’s “secret weapon most analysts miss: The ‘outpatient dispensary’ network.”

Singapore first built small healthcare facilities that were extensions of larger hospitals or healthcare centres that provided primary healthcare services before the government invested in more expensive hospitals.

“They moved most primary care away from expensive hospitals to these clinics that former Health Minister Khaw Boon Wan called ‘low-hanging fruit,’” Mr Mares explained, noting its “High return on low investment.”

He went on to show how Medisave, the autonomy and price transparency of public hospitals, how polyclinics work, how the number of doctors has increased over the years, and so on. The proof of Singapore’s success has been increased life expectancy, which is one of the highest in the world.

Mr Mares also listed suggestions for the US to “implement Singapore-style reforms,” which includes insurance reform.

For him, by far, the most crucial element is for the “Government as a system architect, not just payer. This means regulating hospital expansion, managing doctor supply, controlling medical school seats, and setting price ceilings. Not full control, but smart oversight,” although he admitted that this may not be popular with many.

He ended his thread by writing, “Could the US implement these reforms? Politically, it would be incredibly difficult, but with healthcare bankrupting families and crippling businesses, we’re running out of alternatives. The Singapore model isn’t perfect, but it’s better than what we have now.”

On r/Singapore, where the tweet thread was shared, the Americans who commented agreed that their healthcare system leaves much to be desired, especially for people who do not have a lot of resources.

“The US is completely two-tiered and depends almost exclusively on your employer/access to different health plans. It’s either great or (otherwise), and a lot of people don’t get this, but in the US, what health insurance a company offers can be a key deciding factor in choosing a job offer,” one wrote.

A commenter added, “Previously, for the price of insulin per month in the US, you could get a Nintendo Switch 2. Imagine needing to have the money to buy a Nintendo Switch 2 every month just to survive.”

Another recalled: “Anecdotes of how people need to set up gofundmes to afford healthcare, or those people in ambulances who insist on being brought to a different hospital (which may not be the nearest) so that the medical care can be covered under their insurance.”

A Singaporean commented, “Our healthcare isn’t 100% free because LKY looked at the UK’s NHS and believed that making healthcare 100% free will cause citizens to neglect their health, so he wanted the citizens to pay something reasonable but not too high. We also have a safety net to provide free healthcare for those who really cannot afford it.”

Another agreed, writing, “We have multiple safety nets for people who know where to look. If people need, go to an MTP session, and people can point you in the right direction.”/TISG