is to prevent excessive and undue use of healthcare services. I will have more to say about this approach later in the book.
Cancer
With respect to one of the biggest killers of all—cancer—Singapore is making great strides. Overall, the country's five-year age standardized relative survival ratio for men improved from 14 percent in 1973–77 to 45 percent in 2003–07; the ten-year ratio improved from about 15 percent in 1978–82 to 41 percent in 2003–07. For women, the five-year ratio went from 28 to 58 percent during the same periods, and the 10-year numbers improved from 26 to 53 percent in those same 1973–77 and 2003–07 periods.4
While the Asia Pacific region contributes to half of all cancer deaths, survival is highest in Singapore, China, and South Korea with regard to cancers where prognosis depends on the stage of diagnosis. Survival rates in the three countries are in the 80 percent range for breast cancer, 60 to 80 percent for cervical cancer, 70 to 80 for bladder cancer, and 44 to 60 percent for large bowel cancers.5
One interesting comparison I found is that Singapore's one- and five-year relative survival ratios for nasopharyngeal cancer in both genders are higher than in the United Kingdom. Singapore performs at par with Europe for rectal, colon, and lung cancer five-year relative cancer survival rates, for cases diagnosed in 1995–99. And it performs better than Europe in stomach, liver (male five-year RSR), and ovarian cancer. Unfortunately, the county lags in bladder, corpus uteri, and female breast cancer survival rates.
Table 2.6
Cardiovascular Disease
Cardiovascular disease is one of the main causes of deaths in developed countries. In the Asia Pacific region, the disease now accounts for as much as one-third of all deaths. In 2004, death rates in Japan, Australia, Singapore, and the Republic of Korea were lower than 200 per 100,000 people in contrast to the majority of countries in the region where it exceeded 400 deaths per 100,000.6
Singapore does not do quite as well with in-hospital case-fatality (within 30 days of admission) rates for acute myocardial infarction—with a rating of almost nine per 100 patients in 2007. Korea did slightly better with a rate of eight for the same year. Patients in United Kingdom and United States had lower fatality rates: just over six in the United Kingdom for the same year, and just over five in the United States in 2006.7
Ischemic stroke patients in Singapore had an in-hospital case-fatality rate of five, versus the United States’ four (2006), and Korea's just over two. Korea attained a hemorrhagic stroke case-fatality rate of 11 versus Singapore's 25, with the United States at about 25 as well (see Figures 2.1, 2.2, and 2.3).
New Challenges
Singapore's success is also less clear in some of the newer health concerns arising among the populace. Diabetes is an example. Singapore's diabetes rate continues to rise, increasing by three percentage points between 2004 and 2010. As of 2010, over 11 percent of Singaporeans have been diagnosed as diabetic. This finding trends in parallel with increased obesity, which jumped almost four percentage points in the same time period to almost 11 percent of the population.8
Quality of Care
Not only does Singapore perform well in terms of achieving world-class outcomes, the quality of care as experienced by consumers is also one of the system's highest accomplishments. The Ministry of Health regularly conducts “Patient Satisfaction Surveys” to gauge the sentiments of the consumers of its health services. The seventh Patient Satisfaction Survey was done in 2010. It assessed the level of patient satisfaction, compared performance of the different healthcare institutions, and gathered feedback for service improvement. The survey found that over 75 percent of patients were satisfied with the services at the public hospitals, polyclinics, and national specialty centers. Further, almost 80 percent would recommend the services of public healthcare institutions to others9 (see Chart 2.1).
Figure 2.1
Figure 2.2
Figure 2.3
Confirming what Singapore's own self-assessments reveal, a World Health Organization report on comparative health systems issued in 2000 ranks Singapore's sixth globally in terms of overall performance. By comparison, the United States ranks 37, the United Kingdom 18, and Japan 10.10
Singapore's Healthcare Expenditure
Good healthcare is expensive, and many of the most-developed nations of the world are finding that the ever-rising costs for quality care are unsustainable. Singapore, on the other hand, has deftly managed to keep its costs low without sacrificing quality. In fact, it has achieved that exceptionally high rating from the World Health Organization while spending less per capita than any other high-income economy.
In spite of rising costs everywhere—due mainly to demographic trends, new and expensive technology, and changing disease patterns, Singapore, I am pleased to see, continues to spend less than four percent of GDP for healthcare, by far the lowest figure among all other high-income countries in the world.
The United States, by contrast, spends almost 18 percent of GDP annually—a huge price to pay that is currently causing bitter controversies and political battles as the nation debates its future approach to care.
When it comes to prices of specific procedures, one can immediately see the differences that exist in Singapore's costs vs. the United States. For example, the cost of an angioplasty in the United States is almost
Singapore's total national health expenditure as a percentage of GDP is comparable to that of the upper-middle (China–Malaysia), and lower-middle-income countries (India–Philippines), but the health outcomes achieved are on par with those delivered by the highest-income countries in the world.
Singapore's per capita expenditure was just over US