Affordable Excellence: The Singapore Healthcare Story

Affordable Excellence: The Singapore Healthcare Story

by William A. Haseltine

The Singapore healthcare system produces world-class outcomes at half the cost of Western European countries and less than one-fourth the cost of the United States: Singapore spends 4% of GDP on healthcare; the United States spends 18%.  The World Health Organization ranked Singapore 6th in overall performance; the United States ranked 37th. (See page 200, The World Health Report 2000.)

Looking at costs of specific procedures, ”an angioplasty in the United States is almost $83,000, while in Singapore the cost is about $13,000. A gastric bypass in the United States is almost $70,000, while in Singapore the cost is $15,000. (These figures are in US dollars and include at least one day of hospitalization).”

This book explains how the system works. Continue reading

Healthy Competition

Healthy Competition: What’s Holding Back Health Care and How to Free It

by Michael F. Cannon and Michael D. Tanner

Healthy Competition was published in 2005, but I pulled it off my shelf and reread it in early 2017, in the midst of the discourse about how to “repeal and replace” the Affordable Care Act (ACA, also known as Obamacare). Both the ACA and the proposed replacement focus on insurance, ignoring the exorbitant cost of health care in the United States. In this book, Cato Institute scholars Michael Cannon and Michael Tanner examine how the basic economic principles of price transparency, competition, and consumer choice could lower costs, reduce waste, and increase quality of care. Continue reading

Urgent Care: 10 Cures for America’s Ailing Healthcare System

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Urgent Care: 10 Cures for America’s Ailing Healthcare System

by Minda Wilson, J.D.

As I write this in early 2017, there is much chatter about the potential repeal and replacement of the Patient Protection and Affordable Care Act (ACA) commonly known as Obamacare. I was motivated to read this book to get beyond the myopic hysteria and gain a deeper understanding of the problems and possible solutions presented by healthcare attorney Minda Wilson.

“The United States has the world’s highest [per-capita] healthcare cost, double that of Canada… The number one cause of personal bankruptcy in the United States is due to overbearing healthcare costs… A devastating illness means that, beyond your deductible, you could be responsible for a minimum of 30 percent of the medical bills incurred if you stay in-network. If you go outside of your network, then you could be responsible for between 50 percent and 100 percent of every bill.”

Wilson asks, “Why did the [ACA] focus on providing insurance and not healthcare?” I think this is the fundamental issue. The cost of insurance is a function of the cost of claims. So if the main focus is on subsidizing premiums, the law simply masked the underlying problem rather than solving it. “To be clear, deductibles, copays, and/or the costs of excluded care or limits on care were not included in this measure of affordability.” Continue reading

Being Mortal

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Being Mortal: Medicine and What Matters in the End

by Atul Gawande, M.D.

This book is about quality of life for the elderly who can no longer live independently and for patients with terminal illness.

“The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing homes and intensive care units—where regimented, anonymous routines cut us of from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need… What if there are better approaches, right in front of your eyes, waiting to be recognized?”

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The Checklist Manifesto

the-checklist-manifesto

The Checklist Manifesto: How to Get Things Right 

by Atul Gawande

Routine errors are frequently caused by little things that slip through the cracks due to poor communication and distractions.  A simple checklist can eliminate these oversights.  This book explores how checklists can improve quality and efficiency—and even save lives—in a wide range of industries. Given the crisis with health care affordability in the United States, I am impressed with the dramatic cost savings in the medical examples. Continue reading

The Innovator’s Prescription

The Innovator’s Prescription

By Clayton Christensen, Jerome H Grossman M.D., and Jason Hwang M.D

Building on the framework of disruptive innovation presented in his prior book The Innovator’s Dilemma, Christensen and two medical doctors present a vision for how to make the American health care system “higher in quality, lower in cost, and more conveniently accessible to all.” Continue reading