HS820 Unit 8 MediSave Transferability Appraisal Example

The Account Without Its Setting: A Unit 8 Transferability Appraisal of Singapore's MediSave for the United States

[Student Name]

Purdue University Global

HS820: Global and National Health and Health Systems

Unit 8 Transferability Appraisal

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[Date]

The facts about Singapore and the United States and the sources cited are real; rates are rounded for the course.

The Policy at Home

MediSave is one of three layers in Singapore's health financing. It is a personal account within the Central Provident Fund, the national compulsory savings scheme. A share of each worker's wage-based contributions, set by law and rising with age, goes into the account, and the balance can be used for hospital bills, some outpatient treatment for chronic conditions and premiums for approved insurance. MediShield Life, universal and compulsory since 2015, pays for big inpatient bills and a list of expensive outpatient therapies such as dialysis and cancer drugs, with premiums payable from MediSave. MediFund, an endowment fund, helps patients who cannot pay after the other layers and family support are exhausted (Haseltine, 2013).

The accounts are often described as the reason Singapore spends little on health, about 4 to 6 percent of GDP in recent years, while achieving long life expectancy. The appraisal tests whether the accounts produce that result alone or depend on other features of the system.

Method

The appraisal uses the policy transfer framework of Dolowitz and Marsh (2000), which distinguishes what is transferred, the policy goals, content, instruments and institutions, and identifies three common reasons transfers fail: uninformed transfer, where the borrower lacks information on how the policy works at home; incomplete transfer, where essential elements are left out; and inappropriate transfer, where differences in economic, social or political context are ignored. The appraisal guards against the second and third by listing the conditions the policy depends on and testing each.

Conditions and Their Status in the United States

Financing conditions

1. Contributions are compulsory and set by law. In the United States, health savings account contributions are voluntary and available only to people in high-deductible plans. Absent.

2. Contributions come from nearly all workers through a single national scheme. U.S. accounts are held mainly by higher-income workers whose employers offer qualifying plans. Absent.

3. A universal catastrophic insurance layer sits beneath the accounts. The United States has no universal catastrophic coverage; high-deductible plans provide catastrophic protection only to those enrolled. Partly holds.

Supply conditions

4. Most hospital beds are in government-owned hospitals. U.S. hospitals are mainly private nonprofit or for-profit. Absent.

5. The government controls the number of hospital beds, the purchase of expensive equipment and the number of specialist training places. U.S. supply is largely market-driven, with certificate-of-need laws in some states. Partly holds.

6. Public hospital wards are tiered by class, with government subsidies highest in the basic wards, so patients choose a subsidy level when they choose a ward. No U.S. equivalent. Absent.

Information conditions

7. Hospitals publish typical bill sizes for common procedures. U.S. price transparency rules since 2021 require hospitals to publish prices, but compliance and usability vary. Partly holds.

8. Patients can compare costs across public hospitals before admission. Comparison remains difficult in the United States, where prices differ by insurer. Partly holds.

Governance conditions

9. A single ministry sets contribution rates, regulates prices and owns hospitals. In the United States, that authority is spread across Washington, fifty state governments, employer health plans and commercial carriers. Absent.

10. The state can change contribution rates, coverage and subsidies quickly when costs rise. U.S. changes require legislation or regulatory action in many jurisdictions. Absent.

11. A strong expectation of family responsibility supports the system, with MediSave balances usable for family members' bills. U.S. accounts can pay for dependents' expenses, but social norms differ. Partly holds.

12. A safety net, MediFund, pays for those who cannot. Medicaid covers many low-income people in the United States, with gaps in states that did not expand it. Partly holds.

Of twelve conditions, none fully holds in the United States, and the four that matter most for cost restraint, on supply and governance, are absent.

The Closest American Analog

Health savings accounts were created by the 2003 Medicare Modernization Act and must be paired with high-deductible health plans. Contributions are tax-advantaged and voluntary. Evidence suggests that account holders are on average higher-income and healthier than the general population, which limits their role in pooling risk. Unlike MediSave, U.S. accounts sit inside a market where prices differ by insurer and are set largely by negotiation between private parties.

Judgment

The appraisal reaches a divided verdict. The account mechanism itself, compulsory saving for health care, could in principle be adopted in the United States through legislation. But the cost restraint attributed to MediSave depends heavily on conditions the United States lacks: government ownership of most hospitals, control over the supply of beds and specialists, tiered subsidies and a single authority able to adjust the system quickly. Transferring the accounts alone would risk incomplete transfer in Dolowitz and Marsh's terms. Comparative profiles also note that Singapore's government intervenes heavily in supply and prices, which suggests that its low spending reflects state control as much as individual responsibility (Tikkanen et al., 2020).

What Might Travel

Two elements could be borrowed with fewer conditions: a universal catastrophic insurance layer beneath any account scheme, and published bill sizes for common procedures. Both would improve the U.S. system on their own and would make any account scheme more effective if one were adopted later.

A Worked Contrast: One Hip Replacement in Each System

A Singaporean worker in a basic subsidized ward who needs a hip replacement faces a bill that has already been reduced by a government subsidy of up to about 80 percent for that ward class. MediShield Life pays a large part of what remains above its deductible, and MediSave covers most of the deductible and coinsurance up to set withdrawal limits, so the cash the family pays is usually small. An American worker with a high-deductible plan and a health savings account faces a negotiated price that depends on the insurer and the hospital, pays from the account until the deductible is met, often several thousand dollars, and then pays coinsurance up to the out-of-pocket maximum. The account works the same way in both cases; what differs is the price it faces and the subsidy and insurance that sit around it. That contrast is the appraisal's argument in a single procedure.

Equity Concerns

Account schemes tie the amount available for care to past earnings. In Singapore, the universal catastrophic layer, ward subsidies and MediFund soften this effect. In the United States, without those layers, accounts would favor people with higher and steadier incomes, which is already the pattern among health savings account holders. Any proposal should state how lower-income and irregularly employed people would be protected.

Limits

The appraisal relies on published descriptions of both systems, and Singapore's contribution rates and schemes change frequently. It does not model costs, which a fuller analysis would need before recommending legislation.

References

Dolowitz, D. P., & Marsh, D. (2000). Learning from abroad: The role of policy transfer in contemporary policy-making. Governance, 13(1), 5-23. https://doi.org/10.1111/0952-1895.00121

Haseltine, W. A. (2013). Affordable excellence: The Singapore healthcare story. Brookings Institution Press.

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020). International health care system profiles. The Commonwealth Fund.