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Journal of Public Health Advance Access originally published online on July 4, 2006
Journal of Public Health 2006 28(3):209-214; doi:10.1093/pubmed/fdl023
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Can health care financing policy be emulated? The Singaporean medical savings accounts model and its Shanghai replica



Weizhen Dong, Professor
Department of Sociology, University of Waterloo, 200 University Ave, W Waterloo, Ontario, Canada N2L 3G1

Address correspondence to Weizhen Dong, E-mail: weizhen{at}uwaterloo.ca

Background Each nation’s government is searching for a cost-effective health care system. Some nations are developing their health care financing methods through gradual evolution of the existing ones, and others are trying to adopt other nations’ successful schemes as their own financing strategies.

Results The Singaporean government seems able to finance its nation’s health care with a very low gross domestic product (GDP) input. Since the implementation of the medical savings accounts schemes (MSAs) in 1984, Singaporean government’s share of the nation’s total health care expenditure dropped from about 50% to 20%. Inspired by Singapore’s success, the Chinese government adopted the Singaporean MSAs model as its health care financing schemes for urban areas. Shanghai was the first large urban centre to implement the MSAs in China. Through the study of the Singapore and Shanghai experiences, this article examines whether it is rational to borrow another nation’s health care financing model, especially when the two societies have very different socioeconomic characteristics.

Conclusion However, the MSAs’ success in Singapore did not guarantee its Shanghai success, because health care systems do not work alone. Through study of the MSAs’ experiences in Singapore and Shanghai, this paper examines whether it is rational to borrow another nation’s health care financing model, especially when the two societies have very different socioeconomic characteristics.

Keywords: cost containment, health care access equity, health care financing model replication, medical savings accounts, Shanghai, Singapore


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