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Commentary: Values and Health Policy: The Case of Singapore
Christopher Ham
From: Journal of Health Politics, Policy and Law
Volume 26, Number 4, August 2001 pp. 739-745 |
In lieu of an abstract, here is a brief excerpt of the content:
Journal of Health Politics, Policy and Law 26.4 (2001) 739-745
Health care systems do not develop in isolation. They are products of the societies in which they are embedded and of the values held to be important in those societies. There could be no better illustration of this truth than the comparison between Sweden and the United States. The commitment in Sweden to equity and to the belief in that country in the benefits of action by the state has resulted in the development of a
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Its attractions will only increase following the ranking of Singapore as sixth in the World Health Organization's assessment of health systems performance (WHO 2000).
As Barr shows, Singapore has developed a health care system involving a mix of public and private funding and provision. Equally important, the system combines a commitment to personal responsibility and government regulation. In primary care, most services are delivered by private practitioners operating on a fee-for-service basis and paid for directly by patients. These services are supplemented by government polyclinics offering subsidized (but not free) care to patients who prefer polyclinics to the private sector. Similarly, public hospitals coexist with private hospitals, and patients can choose different standards and costs of care. The government subsidizes public hospitals, but patients there also have to bear part of the cost even in the lowest standard of accommodation. The role of the state is not to provide services from the cradle to the grave along the lines aspired to by western European governments, but to offer a minimum level of support and to encourage individuals to supplement this.
The feature of health care that has attracted most interest in Singapore is the use of medical savings

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