Healthcare is the biggest long-term policy issue facing governments worldwide.
It's immensely expensive, and getting costlier. People demand much more of it, and of higher quality, but expect others to pick up most of the cost. Because of the scale of the industry and the numbers of workers required, it's a managerial nightmare.
No country seems to have come up with a credible approach to dealing with this growing problem… except perhaps one.
Singapore's amazing success is conveyed by this metric: It spends less than 4 per cent of its GDP (annual economic output) on healthcare compared to almost 18 per cent in the US, yet its system is ranked by the World Health Organization as the sixth best in the world (Britain's is ranked 18th, America's 37th).
The life expectancy of Singaporeans is now two to three years longer than the citizens of the US or the UK. Its newborn mortality rate is less than one per thousand live births (it's four in the US and Canada). Its survival rates from cancer and cardiovascular disease treatment are among the world's best. And almost 80 per cent of patients treated at hospitals and clinics are so satisfied they would recommend them to others.
All this at remarkably low expense. Singapore is world leader at keeping costs under control. When last surveyed in 2008, public spending on healthcare was about $600 a year per person, compared to $3,500 in the US, $2,600 in the UK, $2,300 in Japan, with healthcare accounting for about 8 per cent of total government expenditure.
How has this been achieved, and what lessons can be drawn by policymakers of other countries? William Heseltine, a medical academic, explains in considerable detail in a new book*.
The key is a system that expects and to some extent forces individuals to accept responsibility for the expense of healthcare for themselves and their families, restraining costs and encouraging them to follow healthy lifestyles.
This is backed up by government measures to prevent exploitation by the private sector in supply of medical services, support for the weakest members of society, and well-co-ordinated long-term state planning for expanding and improving the system.
David Fuller's view Singapore used to be patronised for its paternalistic approach, but today it is more often seen as an enviable role model for responsible governance.
I have been an admirer of Singapore since I first visited the country in the early 1970s. Every other government in the world could learn something useful from Singapore.
Here are the last two paragraphs from Martin Spring's assessment:
The fundamental approach is that "a welfare system, or an entitlement mentality, has no place in Singapore". The focus is on "individual responsibility and self-reliance on the part of the citizenry in all personal matters, including healthcare."
No wonder some of us regard the quality of governance in Singapore as the best in the world.