The Nhs's 50th Anniversary As others see us: views from abroad

The importance of social context

BMJ 1998; 317 doi: (Published 04 July 1998) Cite this as: BMJ 1998;317:51
  1. Judy M E Lim (, healthcare services adviser.
  1. Economic Development Board, 250 North Bridge Road #24-00, Raffles City Tower, Singapore 179101

    The NHS is in a reflective mood today and rightly so. The comprehensive “cradle to grave” care envisioned by the architects of the NHS in 1948 has been called the most socialist achievement of the Labour government of that era. Indeed, being 85% funded from taxes, free at point of use, and accessible to all, it may be seen as the part of Britain's welfare system that goes the furthest in the direction of welfarism.

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    In May 1981, the then Minister for Health in Singapore declared that a cradle to grave health system was not for Singapore; K H Phua surmised that the “objectives of the restructuring programme were to avoid the problems of a welfare state system such as the British NHS.”1 In his 1996 National Day speech, Prime Minister Goh reiterated this point: “People often want the government to assume the full burden of the cost of medical care and provide treatment free to Singaporeans. Because of the painful lessons learned in other countries we have not done this. All the countries which have done this—Britain, France, Germany, Canada, and Communist China—have failed. Their systems break down as people overuse so-called ‘free’ health care, which they actually pay for indirectly through higher taxes. Their health services deteriorate. Waste and inefficiency become endemic. Now these countries are forced to cut back on services, introduce cost controls, and reform the system.”

    Summary points

    If the NHS depends on the collective role of society, the emphasis in Singapore is on individual responsibility

    Singapore's politicians worry that an ostensibly free service promotes overuse and rising costs

    Singapore therefore relies on compulsory savings to fund health care, together with copayments, in a system that rewards patients for staying well

    Has the NHS had an influence in Singapore?

    The NHS depends on the collective role of society, whereas …

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