Intended for healthcare professionals


Medical savings accounts: Singapore’s non-solution to healthcare costs

BMJ 2013; 347 doi: (Published 31 July 2013) Cite this as: BMJ 2013;347:f4797
  1. Martin McKee, professor of European public health1,
  2. Reinhard Busse, professor of healthcare management2
  1. 1London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  2. 2Technische Universität, Berlin, Germany
  1. Martin.McKee{at}

One small part of a complex patchwork of funding

Not a model worth emulating

Because of the obvious failings of the American health system, health policy analysts in the United States have traditionally looked abroad for inspiration.1 William Haseltine, president of ACCESS Health International, is among the latest to do so. Inspired by a 2010 lecture on the health system in Singapore, he searched for a book that would provide him with a detailed explanation of how it worked. Finding that none existed, he set out to fill the gap. The result is a short, highly readable book whose title, Affordable Excellence, summarises accurately, if somewhat uncritically, his judgment on Singapore’s achievements.2 In it, he documents how Singapore has managed to contain costs while ensuring access to healthcare and achieving health outcomes that are as good, and in many cases better, than those in other developed countries.

One reason why Singapore has attracted international interest is its unique system of healthcare financing, with the concept of the medical savings account (Medisave) at its core.3 Under this system, all people are responsible for their own healthcare and that of their family. Money is saved into an account from which they can draw when …

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