Manual Affordable Excellence: The Singapore Health System

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Note that this includes payments out of the government-run MediShield scheme and related insurance schemes, MediSave accounts, and other private insurance schemes or employer-provided medical benefits. The figure for the United States is 52 percent, 17 percent for the United Kingdom, and 18 percent Japan. By the way, here are some changes they likely will be making to the Singaporean health care system , moving it closer to traditional welfare state policies for better or worse.

Alex Tabarrok Email Alex Follow atabarrok.

Singapore’s health care system holds valuable lessons for U.S.

Tyler Cowen Email Tyler Follow tylercowen. Email Address. Superlatives abound, and occasionally the data is massaged so that it can be presented in the most favorable light. It's clear that a lot of the research involved reading government websites and interviews with government officials. Sentences frequently begin, "The government has created many programs to address these issues Even so, this was a useful primer, and it's impossible to argue with the Kindle price free!

Singapore: Building on excellence

Mar 16, Liothe rated it it was ok Shelves: s , , 21st-century , american. According to this book it is the only one available on the subject of Singapore's Healthcare system. This is sad because it is a fascinating subject which this book does not do justice.

Despite the many editorial issues repeats, including whole paragraphs, bad lay out, miserable graphs - table 3. I would have wished for a more pithy and succinct overview and a greater comparison to other systems n According to this book it is the only one available on the subject of Singapore's Healthcare system. I would have wished for a more pithy and succinct overview and a greater comparison to other systems not just in various stats. I feel like the task should've been given to an intelligent journalist rather than a healthcare specialist.

The information is there, but it need a lot, A LOT, of cleaning. Review: KEY POINTS The author needs to learn how to write for a proper audience, including decent overviews and presentation of statistics, and not as if it was a powerpoitn presentation for an undergraduate course. Aug 27, Luke Meehan rated it really liked it. Well worth reading. An accessible summary-level work on a world-class set of institutions. Recommended for economists, policy makers and health professionals.

About the author

Could have been markedly improved by increased comparative analysis, as at times it read like a Singaporean government press release. Good enough. It's not perfect and it doesn't do everything you want but it does what it promises to do pretty well. Also, it's freaking free on Kindle, so you've nothing to lose. I echo other reviewers in noting that the book is clearly written by a fan, with extensive citations of Singaporean ministry white papers and Lee Kuan Yew's bio.

It does, at times, sound like an infomercial or PR puff piece. It would have been a much better book in the hands of a competent journalist — some "man on the Good enough.

Affordable Excellence has been added

But obviously there wasn't a journalist out there willing and able to do the job or they would have written it and I give kudos to the author for attempting to shed light on a very important subject. The author has a point of view, clearly, but it never reaches the level of dogmatic praise and the author doesn't try to make sweeping generalizations or recommendations based on what works in Singapore. Instead, it comes across as the starting point to a larger conversation. Some more detailed comparisons with other health systems is offered, mostly on outcomes, but some additional compare and contrast segments would have been nice.

That said, the author never promised this was a multi-country health system study but a primer on Singapore's system and it delivers. Nov 11, B rated it liked it. Good primer, but felt a little too fawning at times. Would have appreciated more critical analysis. Mar 09, Alex MacMillan rated it liked it. In contrast, in countries with third-party reimbursement systems, neither providers nor consumers of healthcare bear the major burden of cost. Since someone else is paying - government programs, insurance companies - there is little incentive to be prudent in decisions about which and how many tests and treatments are appro "Perhaps when people have to spend their own money, as the Singapore system requires, they tend to be more economical in the solutions they pursue for their medical problems.

Since someone else is paying - government programs, insurance companies - there is little incentive to be prudent in decisions about which and how many tests and treatments are appropriate for a given situation. The country's policies and results are encouraging evidence for reforms offered by Paul Ryan and others on the center-right spectrum: in order to keep costs reasonable without the sacrifices to quality and access seen in Europe, we should use means-tested premium support to guarantee universal health care, while relying on free market competition between suppliers as well as tax incentives motivating consumers to economize on what economist Arnold Kling calls "premium medicine.

Aug 31, Nathanael rated it liked it.

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The first few chapters start out strong, with a bird's eye view of the philosophy and framework underlying Singapore's healthcare system. Those were well worth the read, though the author's adulation of the Lee Kwan Yew and the Singapore system felt a bit excessive at times. The later chapters were long on facts and figures, short on analysis and implications, and occasionally repetitive. I would have liked a focused chapter taking a critical look at the challenges facing the Singapore healthcare The first few chapters start out strong, with a bird's eye view of the philosophy and framework underlying Singapore's healthcare system.


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I've been looking forward to reading this book for a long time, since it promised to describe a health care system far better than either the pre- or post-Obamacare American system and any of the various European arrangements. As a description, it was fine, but as a book, it fails in many ways. Specifically, Haseltine quotes what politicians say as if it's the unvarnished truth, and he sometimes sounds like he's part of the Singapore propaganda machine. Assuming they have a propaganda machine. He also tells us that the government limits the number of doctors to limit costs, and also that there is a widespread shortage of doctors - without mentioning the conflict.

Under Medisave, workers and employers contribute monthly amounts that change over time as the employee ages. Medishield provides insurance against catastrophic illness for a nominal fee—citizens are automatically covered unless they choose to opt out.

Imagine creating a sustainable health system

The survey also recorded open-ended feedback, which had respondents indicating that waiting times and procedures needed improvement. Singapore continues to develop aspects of its infrastructure that facilitate value-based care, such as data collection. In the government set up the National Registry of Diseases Office to publish information on disease trends and health conditions in Singapore; in it passed the National Registry of Diseases Act, which required the reporting of patient health outcome data for cancer, renal failure, stroke and other ailments.

Within this system, individual doctors are experimenting with value-based strategies. Dr Ngeow recently published a paper: Using quality improvement methods and time-driven activity-based costing to improve value-based cancer care delivery at a cancer genetics clinic. The main measure of outcomes was the number of patients seen per week at the clinic.

To address non-attendance rates, the group initiated telephone reminders done manually. The team used process mapping to track activity and responsibilities, detailing every step and eliminating those that proved unnecessary. They developed plan-do-study-act cycles to assess the outcome of each intervention, so that if the right result were not achieved, the team could re-evaluate and adjust their practices. A main goal was to demonstrate the importance of genetic counsellors. For Dr Ngeow, the critical question in this study was: Is there a value in having a genetic counsellor?

Despite this increase in efficiency, patient satisfaction was not adversely affected. These findings show the impact of value-based cancer care delivery in cancer genetics. Therefore, measurement of outcomes and cost is an integral part of deliver[ing] high-value healthcare. Access to care is an important outcome measure.