HEALTH care has always been both an emotional and political issue, said Prime Minister Lee Hsien Loong, and "it is always tempting to say we will do more, we will do better and it will cost less... maybe even free".
But governments have to be trustworthy stewards and present the trade-offs as they are to citizens and not sacrifice tomorrow for today's political gain, he said.
Every dollar the Government spends on health care is a dollar taken from taxpayers.
It is "a dollar we cannot spend on education, housing, defence, or on personal needs of our people", Mr Lee noted.
Opening the Ministerial Meeting on Universal Health Coverage yesterday, he said providing good health care is one of the most important responsibilities of any government - but is very challenging to achieve.
"It requires an honest conversation among ourselves, and hard choices made."
He gave a 30-minute summary of Singapore's health-care evolution, from the days of night soil collectors just 40 years ago to the setting up of MediShield Life, the compulsory all-inclusive health insurance scheme to be introduced later this year.
The two-day meeting at the Grand Copthorne Waterfront Hotel is organised by the Health Ministry.
When it comes to health care, the usual economic models do not work, Mr Lee told the 300-strong audience, including the health ministers from Bangladesh, Brunei, Finland, Indonesia, Myanmar, Thailand and Vietnam.
Expanding capacity for future needs may stimulate a supply-induced demand. As doctors know far more than patients, a "willing buyer, willing seller" model does not work. And protecting patients from financial consequences could lead to overtreatment.
So, a variety of tools are needed, Mr Lee said, from pricing and regulation to incentives, exhortation and, sometimes, even compulsion, "to shape behaviour by doctors, patients, administrators, drug suppliers, in order to produce a good collective outcome".
Giving the keynote address, Dr Margaret Chan, director-general of the World Health Organisation, praised Singapore for achieving a good health-care system at a relatively low cost. "In terms of return on investment, you are No. 1 in the world," she said, pointing to the 4.2 per cent of gross domestic product spent on health care here, compared with the 18 per cent in the United States.
Dr Chan told delegates that each country has to develop its own model of universal health care, based on its culture, existing system and people's expectations.
She outlined Bangladesh's success. Through a few high-impact interventions, such as getting community health workers to cover the shortage of doctors and nurses and building and running 12,000 community clinics, the country now has the longest life expectancy and lowest child mortality in South Asia.
She said: "Any country that really wants to move towards universal health coverage can do so. Even barriers like a dense and very poor population and frequent natural disasters will not stand in the way."
This article was first published on February 11, 2015.
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