Bryan Caplan  

Why Don't the Chinese Learn from Singapore?

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I can vaguely understand why Western democracies won't deign to emulate Singapore's miraculously cheap and effective health care system.  But when the Chinese ignore Singapore and copy Western socialized medicine, I can only roll my eyes in disgust:

China has unveiled an ambitious plan to achieve universal health care. The plan, released for public debate last week, lays out in broad strokes plans to introduce greater health-care funding and control prices.

[...]


Out-of-pocket payments constituted more than 60% of health spending at the end of the 1990s in China, a significantly larger percentage than in developed countries, according to the World Health Organization.

[...]

According to the plan, all revenue raised by public hospitals will have to be funneled to state coffers. The government aims to set pricing standards for medical services, according to the plan, reflecting broad nationalization of the health-care system.

If I didn't know anything else, I'd be tempted to see this as an atavistic "back to Mao" movement.  But alas, it's Western advisors who are to blame:

The draft proposal was crafted in a year-long process of consultations with groups such as the World Health Organization, the World Bank, management consultancy McKinsey & Co. and a few Chinese university-based public health experts.

Admittedly, if the goal of the plan is to maintain the popularity of the Communst Party rather than deliver low-cost quality health care, the foreign advisors may have it right.  After all their crimes against humanity, the Chinese Communists almost desperately need to "show that they care."


HT: Tyler

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COMMENTS (5 to date)
dWj writes:

In your post on Singapore, you note that, among other things, "Private healthcare providers are required to publish price lists to encourage comparison shopping." As far as small steps go, I think this one could have huge long-term implications, particularly if incorporated into a McCain-style health care plan.

student writes:

I love the Autocratic Ghosts and Chinese Hunger paper. I am surprised however that the Independent Review missed this error:

"As in the Ukrainian famine under
Stalin, the most prosperous areas often had the highest quotas and suffered the worst;
and as the famine raged, China, like Russia in the 1930s, exported grain."

That should be imported, shouldn't it?

Ann writes:

Student -

No, China actually exported grain during the Great Leap famine. People didn't die because there wasn't enough, they died because the government took what grain there was, to make Mao look good. The government also increased stockpiles in the storehouses and refused to allow grain out to be eaten, because that would be a tacit admission that the people were starving. [There were one or two provinces where the local government officials opened the storehouses to save the people. Those officials of course were punished for this, along with their families, in the Cultural Revolution.]

You see, the official line was that Mao's brilliant policies had led to unusually good harvests. Since taxes were paid in grain, based on a percentage of the harvest, the government had to collect an unusually large amount of grain to keep up the lie. When peasants claimed to not have enough to pay the taxes, the government simply claimed that they were hiding grain and took all that they could find, saying that the farmers could simply eat what they had hidden.

While people starved, China was exporting grain and telling the world that Mao and communism had eliminated famine for the first time in Chinese history. The people in Hong Kong knew the truth, because a few escaped from the mainland, but liberals in the US were celebrating the 'fact' that Mao had eliminated hunger in China. China exported grain to keep up the lie.

Ann writes:

Hong Kong's system is similar to Singapore's in at least one respect - the amount you pay the hospital and all doctors depends on what type of room you choose. I gave birth twice there and had to pay the obstetrician, the anesthetist, etc. more because I chose a private room rather than a semi-private or ward room, even though they only saw me in the delivery room. It's an interesting way to price-discriminate.

Anyone with a Hong Kong ID number (i.e. any resident) could get care in a ward room for something ridiculously cheap like less than $10 a day. If you were sick enough to be in intensive care, you got top of the line care for very little. But outside of intensive care, the cheap ward room rate wasn't very attractive.

At least in the 1990s, nurses in the ward room didn't expect to feed or bathe patients or help them to the bathroom. Their family was supposed to come and do that sort of thing. I took someone to the hospital that was severely dehydrated and they put him in a ward room without even asking. The room had at least 20 beds, so close together that one couldn't fit a chair between each bed. More than half the beds were empty, but rather than spreading the patients out, all patients were crammed next to each other at one end of the room, so that the one nurse, who sat in the middle, wouldn't have to turn her head to keep an eye on everyone. My friend was put next to a little boy with a cough, and he came out sicker than he went in, thanks to being only a few feet from that cough.

So, everyone can get care when they really need it, and those who can afford to pay more have an incentive to do so. It's not a perfect system but it has advantages.

mr. Econotarian writes:

Under this plan, if you speak out against the government, you don't get healthcare...

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