Un système de santé basé sur la responsabilité personnelle ? J’aime !


SingapourThe key to the Singapore system is mandatory health savings accounts: something that libertarians and many conservatives wouldn’t like. Matt Miller of the Center for American Progress describes Singapore as « further to the left and further to the right » than the American system–something that could also be said of Switzerland.

In a manner somewhat like our Social Security system, Singapore takes mandatory deductions from workers’ paychecks–around 20 percent of wages–and deposits them into health savings accounts called Medisave. Medisave accounts are used mostly for inpatient expenses, but also some outpatient ones. Singaporeans are expected to pay most of their outpatient expenses with non-Medisave cash.

On top of Medisave, Singapore has a government-run catastrophic insurance program called Medishield. Singaporeans can opt out of that plan and buy private catastrophic insurance. Premiums for Medishield can be paid for using the Medisave health savings accounts.

Then there is Medifund, a safety-net program for the bottom 10 percent of income earners, and Eldershield, a private insurance program for long-term care for those with old age-related disabilities. On top of these government-sponsored programs, Singaporeans can buy supplemental insurance for things like outpatient expenses.

Why does this system work so well? Because it incorporates the central idea behind free-market health care: that health-care spending is most efficient when that spending is executed by individual patients, rather than third parties. It’s easy to waste other people’s money. But if that money is your own, you are going to try your best to spend it wisely.

Singapore installed this system relatively recently. Prior to 1984, the former British colony had a system quite similar to that of Britain’s National Health Service. In that year, the government reversed course, with impressive results.