Healthcare System Recap

Since I was in the hospital most of the time, I wasn't really acutely exposed to how the healthcare system manages payments and reimbursements but I was still able to get a working understanding of how the health care system works and it is rather different that in the US.  

The government requires all Singaporean citizens to deduct 20% of their paychecks to go into a medical fund like an HSA.  There are different tiers (Medisave, Medishield) but it boils down to the fact that the patient is responsible for payment of services.  Everything has a fee or cost associated with it so the system creates a disincentive for patients to abuse the system.  When they are in the hospital, one large fee is charged to cover all in house costs.  When the patient is discharged, they must use their Medisave/Medishield to pay for the fees.  With am care, clinic visits have copays but medications are charged by the tablet, both of which also require patients to pay with their Medisave/Medishield funds.  Patients can use the Medisave/Medishield funds of their spouses and children as well if they don't have enough on their own.  Only when all the funds are exhausted will the government step in and government help is very strict and limited.

There's really no way the US government would be able to require everyone to save 20% of their paychecks for medical expenses.  There would probably be mass protests if the idea even came up.  The idea to disincentivize abuse of the healthcare system by making patients responsible for their own costs would definitely help reduce costs but the challenge is finding a way to do it effectively given the limitations of the US system.  Until then, costs will continue to rise with all the unnecessary things that occur in the US healthcare system.