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Healthcare Around the World, Singapore and Switzerland

“Every country in the world, at least all of the wealthy developed nations, are facing the same challenges that the U.S. is, that is a growing influx of new technology, much of it extraordinarily valuable that people are increasingly clamoring for, aging populations that are going to require more healthcare…and slow economic growth. Those are the three big challenges everyone is facing,” said Paul Howard, of the Manhattan Institute, in this exclusive Bold Business Interview.

He adds that while every country faces the same basic challenges, the way they address healthcare questions and how it is paid for, varies with their unique cultural constraints. Whether it be France, Germany, or the United Kingdom, the delivery and payment for healthcare is largely the result of history and traditions that have shaped the healthcare system within their own cultural environment.

Singapore has a system that might be said to be a hybrid of private and public. Many services are private, yet the government has no qualms about reviewing prices and imposing controls.

Howard suggests that if we are looking for models that may be applicable to the U.S., Singapore and Switzerland both offer interesting features that are worth considering. Both countries have achieved excellent healthcare outcomes, with universal coverage, and a private insurance market that helps to foster innovation and efficiency.

In terms of quality of care, access to service, and health outcomes, both Singapore and Switzerland rank among the top nations in the world. Singapore in particular is renowned for not only providing excellent health outcomes, in 2014 it was ranked as the most efficient healthcare system in the world. Singapore spends a mere 3% on healthcare, which compared to the U.S. figure at 18%, is stunning.

The Swiss system is also regarded as excellent by the Swiss themselves and international comparisons show it to be one of the best in the world. However, it is far more expensive than the Singapore model. On the other hand, the Swiss system is a bargain compared to that of the U.S.

In Switzerland, the details of services and coverage are regulated by the cantons, but they all offer a reasonable standard of care for the minimal base insurance rates. Patients have an annual deductible, which in Switzerland is called a “franchise” that varies from 300 to 1500 CHP, depending on one’s insurance plan. All citizens and residents are required to purchase an approved government plan, and all plans are required to accept all comers regardless of pre-existing conditions. The Swiss also generally face small co-pays for services below their “franchise” limits. One example is 15 CHP fee per day whn staying in a hospital.

Singapore and Switzerland, Models for Healthcare Success

Policy analysts who have looked at how to emulate parts of the Swiss model and use it to improve the U.S. system under the Affordable Care Act, suggest that a necessary first step is to disentangle health insurance from employment, as the current U.S. model results in unacceptable coverage gaps and distorts the market. To follow the Swiss model, all residents would be required to purchase individual health insurance, creating a large, robust pool to spread risks and guarantee universal coverage.

Map of the world with three countries identified.

Singapore is unique in that as matter of national policy, no health service is entirely free of charge. It is believed that a small charge helps to prevent overuse of services. The fees for many services are applied on a sliding scale and subsidized for the poor. Everyone is required to be insured, but there is a complex system of ways and means to achieve that. The system combines purely private insurance, with mandatory savings systems, and subsidies; which is why many say that the Singapore system cannot be copied anywhere else. Yet the affordability may lie less in how services are purchased, than with how costs are controlled.

Singapore has a system that might be said to be a hybrid of private and public. Many services are private, yet the government has no qualms about reviewing prices and imposing controls. This is a somewhat unique feature of Singapore and may be the key to their extremely low percentage costs in terms of GDP. The remarkable aspect is that unlike in many countries where price controls lead to scarcity and poor quality, in Singapore the system has continued to maintain extremely high standards, excellent outcomes, and access.

Elements of either or both systems could provide a path to reform for the Affordable Care Act, which seems to be a failure on almost every front. The Swiss system of universal individual-based coverage could provide for a more representative insurance pool than can be obtained currently. And the Singapore method of price controls, while anathema to the medical community, may help American business be more competitive as it brings healthcare costs more in line with those of the global competition.

Capitalizing on Collective Intelligence For Healthcare

Dr. Jack Stockert had one of those a-ha moments while jogging one day. As he jogged, he pushed his daughter in her stroller with his dog running behind; Stockert neared a busy four-lane road with no traffic light. To his astonishment, and totally uncharacteristically, a vehicle slowed to a stop as he neared the street, enabling Stockert to cross promptly and safely. Stockert discovered the “courteous driver” was one of Google’s self-driving cars. Stockert immediately recognized the knowledge transfer that must occur among the fleet of Google vehicles, a kind of ‘collective intelligence’. “It stopped as if it had seen me a thousand times before and knew my intent,” he realized.

As Managing Director of Health 2047, Dr. Stockert is one of a group of “visionary problem-solvers” with a goal “to co-create a highly functional, information-driven, value-based and market-driven healthcare system that delivers quality, connectivity, health and productivity outcomes”.

“to co-create a highly functional, information-driven, value-based and market-driven healthcare system that delivers quality, connectivity, health and productivity outcomes”

With the American Medical Association as a founding investor, this multi-disciplined team of innovators has the collective capability to transform healthcare by distributing the latest knowledge and techniques worldwide, for example the use of ‘collective intelligence’ in machine learning, to improve human health and longevity.

Stockert continued to muse, wondering if there was a way to apply this “collective intelligence model” to healthcare by leveraging information technology. Currently, new knowledge is shared the old-fashioned way. Researchers and clinicians develop groundbreaking treatments and write their findings in professional journals. Innovation inefficiently filters out as the articles are read. Stockert’s bold idea is to use technology to distribute knowledge and share insights in real time (in a similar manner to the Google fleet) so that healthcare providers located in even remote areas have immediate access to the latest ideas and techniques.

At this point, creating a business model of collective medical intelligence is just an idea, but every innovation starts with an idea.  When bold leaders such as the Health 2047 team take bold action to change the status quo, self-driving care can become a reality.

Newton watches an apple fall from a tree, and the concept of gravity is born. Archimedes is sitting in his bathtub and Eureka; he recognizes the relationship between volume and density. The essence of innovation is the human ability to make connections between the mundane and the profound. Another manifestation of this ability is the transfer of knowledge from one area to spur progress in another.

Sometimes the most mundane encounter can spark a bold idea.

Agricultural Research Funding To Improve Food Security

The US government launched its Feed the Future initiative to help global hunger and food security initiatives, both in the United States and further afield.

Now, thanks in part to a 1.4 million USD grant from USAID’s Food Security Bureau, the University of California, Davis, are taking the initiative abroad to help those in Kenya.

The project will conduct research and development on policies and programs to help poor and smallholder farmers to manage risk, adopt productive technologies and take an active part in economic growth.

The focus of the team will be to use a randomized, controlled trial to evaluate the impacts of combining programs that offer training, support and aid with affordable insurance to reduce chronic poverty.

According to the Kenyan government, more that 1.3 million of their citizens have been experiencing the impact of ongoing drought, and are suffering in poor conditions.

Led by Michael Carter, a professor of agricultural and resource economics and director of the Feed the Future Innovation Lab for Assets and Market Access at UC Davis, and Andrew Mude from the International Livestock Research Institute in Kenya, researchers hope the project will create a pathway out of poverty and reduce the need for aid.

The project will test several interventions, including: the BOMA graduation program which teaches hard and soft skills, followed by how to start and run a business, and the HSNP transfer program is one of five cash-transfer programs under Kenya’s national Safety Nets Program.

An important element of the program is to ensure that the farmers are covered if their crops or livestock are damaged by natural disasters, such as drought, through index insurance.

Index insurance, a low-cost protection measure, is different to standard insurance because rather than basing payouts on verified losses, “it estimates losses based on an index of factors that can be measured and monitored externally, like rainfall or vegetation”.

According to UC Davis, Index insurance is already changing lives in Kenya and will trigger more than 2 million USD worth of payouts to farmers affected by drought.

Governments and organizations have faced many obstacles when it comes to resolving the world’s poverty and food crisis. Now experts believe they have found a way of helping farmers in Kenya solve food shortages in their communities and bring people together to combat poverty.