Book Review: From Third World to First, by Lee Kuan Yew.

I stumbled on this brilliant review (and I genuinely hope, it stays up)- that’s why I have pasted the most relevant idea on healthcare in Singapore.

Having worked there for quite some time, I personally feel it is the best model that can be replicated for any country. Healthcare is the primary responsibility of the elected government, and I am on course to finish a write up on health outcomes. How we approach healthcare, determines the demographic dividend for the nation, as a whole. Here’s a checkpoint here (emphasis mine):

Speaking of blithe self-assurance and scornful dismissal, he dismisses the British National Health Service as idealistic but impractical and destined to cause ballooning costs, then takes a shot at the American system with its “wasteful and extravagant diagnostic tests paid for out of insurance.” He reports that at least in Singapore, the ideal of free health care clashes with human behavior. Doctors prescribe free antibiotics, patients take them for a few days, don’t feel better, and toss them out. Then they go to private doctors, pay, and take the medicine properly. (100)

The first solution was a token 50-cent fee to attend outpatient dispensaries. The full solution, and part of the reason Singapore’s per capita health care costs are half the UK’s and less than a quarter of the US’s, once again went through the CPF pensions: 1% set aside into “Medisave” for health care costs at first, gradually increasing to 6%, capped at S$15,000. “To reinforce family solidarity and responsibility”, LKY reports, accounts could be used for immediate family members as well. (101)

That’s not to say he wanted no subsidies. At government hospitals, patients chose wards subsidized up to 80%, moving to more comfortable and less subsidized wards as they desire. Medisave funds could be used for private hospital fees in order to compete with government hospitals and pressure them to improve, but not for outpatient clinics or private general practitioners. Why? LKY didn’t want to encourage people to see doctors unnecessarily for minor ailments. (102) This constant tinkering and fine-tuning around incentive systems is core to LKY’s planning.

From there, Singapore added optional insurance for catastrophic cases, then added a fund from government revenue to provide total waivers for those who lacked Medisave, insurance, and immediate family. Per LKY’s reporting, “no one is deprived of essential medical care, we do not have a massive drain on resources, nor long queues waiting for operations.” (102)


Singapore’s system evolved more out of their urgent, unmet socio-cultural needs. NHS was funded by taxpayers, and it remains “underfunded and understaffed”; the American system has grown into the complexity that is beyond anyone to understand. I was initially surprised to read a lot of treatises and dissertations written about “fixing the American Healthcare”. I realised that the system wouldn’t allow itself to be healed.

Is the Singaporean system, the best system? It borrows heavily from both the elements and tries to wade a middle ground. They have made several questionable investments to try “spur” innovation, but it requires a bottom-up approach. They wouldn’t have the pharmaceutical breakthrough or move away from industry-sponsored trials unless they invest in original thoughts and ideas coming in from within themselves.

I think the only way out is to break the insular mould and break away from the tradition that shackles them. It has a huge potential (and I have beautiful memories), and I genuinely hope that they find their feet in the world.

via Book Review: From Third World to First, by Lee Kuan Yew [PART ONE] : TheMotte