Shifting the burden of health care finance: a case study of public-private partnership in Singapore.
Since becoming independent in 1965, Singapore has attained high standards in health care provision while successfully transferring a substantial portion of the health care burden to the private sector. The government's share of total health care expenditure contracted from 50% in 1965 to 25% in 2000. At first glance, the efficiency-driven health care financing reforms which emphasize individual over state responsibility appear to have been implemented at the expense of equity. On closer examination, however, Singaporeans themselves seem unconcerned about any perceived inequity of the system. Indeed, they appear content to pay part of their medical expenses, plus additional monies if they demand a higher level of services. In fact, access to needed care for the poor is explicitly guaranteed. Mechanisms also exist to protect against financial impoverishment resulting from catastrophic illness. Singapore's experience provides an interesting case study in public-private partnership, illustrating how a hard-headed approach to health policy can achieve national health goals while balancing efficiency and equity concerns.
Department of Community, Occupational and Family Medicine, Faculty of Medicine, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore. coflimmk@nus.edu.sg
Meng-Kin
MK
Lim
D001294:Attitude to Health; D002388:Catastrophic Illness / Q000191:economics; D017047:Cost Sharing; D003906:Developing Countries / Q000191:economics; D017598:Efficiency, Organizational; D005380:Financing, Government; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D007373:Interinstitutional Relations; D009313:National Health Programs / Q000191:economics* / Q000458:organization & administration; D019982:Organizational Case Studies; D017149:Private Sector / Q000191:economics*; D011332:Privatization; D017150:Public Sector / Q000191:economics*; D012846:Singapore