BOOK REVIEW
Myth or Magic The Singapore Healthcare System, By Jeremy Lim; Select Publishing; ISBN-13: 978-9810773625
Reviewed By Manish Shah
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.
THE DEBATE SURROUNDING the approaches to providing health care coverage have never been more prevalent than today. Media coverage related to health care policy can be seen on the evening news, on the front page of local and national newspapers, and in the opening monologues given by late night show hosts. This debate at a base level comes down to a choice: Should the state absorb health care costs through single-payer coverage (tax-funded) or should individuals purchase individual and family coverage via open markets (marketmodel)? In the US, we have a hybrid of partial coverage paid by state programs (Medicare/ Medicaid) and market-based programs paid through exchanges and employer programs. In “Myth or Magic - The Singapore Healthcare System,” the author Jeremy Lim offers a deeper look at the Singapore health care system with a paralleled reflection of the U.S. health care coverage architecture. The Singapore health care system is known to be a marvel of the developed world, and has inspired many conservative frameworks for market-based health care coverage in the U.S. In fact, the life expectancy in Singapore is 80 years old, which is two years older than in the U.S. In addition, the Singaporean approach to health care delivers results while managing to spend only 4.6 percent of GDP while the U.S healthcare spending is 17.8 percent of GDP (and growing). The structure of the system is based on three main pillars: Medisave, MediShield, and Medifund (3-Ms). Author, Jeremy Lim, provides a guide to the 3-Ms with a necessary depth to understand the effectiveness of each. Medisave − A mandatory health savings
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account that is withdrawn from paychecks (much like Social Security in the U.S.) and deposited in bank accounts owned by the individual (not like Social Security). Individuals are able to use these funds to purchase health care services for themselves and their extended family. MediShield − A government-run health plan that protects people during catastrophic situations that would not be fundable via accrued savings within Medisave accounts. Should individuals require more than catastrophic coverage, they are able to purchase extra coverage on the open market. However, all individuals must first have a MediShield plan. Medifund − A safety net structured as an endowment fund to cover the care of the most at-risk population (below the poverty line and unable to build Medisave funds or purchase MediShield coverage). This program functions as an endowment, meaning the funds available for spending are capped based on investment returns and fluctuates based on the health of the economy. Beyond documenting the pillars and basic structures of the Singaporean health care coverage model, Lim illustrates how the social and political climate of Singapore shaped the system all together. In 1958, Singapore shifted from a colony into a self-governing state. At the time, with the precarious nature of the state, options such as tax-funded health care coverage were not available, as government tax receipts were not fully developed. These options were considered an expense that the state could not, and should not, bear. The state chose to invest in public health measures such as sanitation,