be invoked, as universal coverage will not be financially sustainable without the intervention of many different stakeholders and especially the state. This message was unambiguously conveyed by the government’s call for all to shoulder part of the cost as a society to support those in need. Finally, one’s understanding of individual responsibility must in turn be informed by both principles of solidarity and fairness – not in an atomistic manner, but as a person inextricably embedded in multiplicities of social relations and contexts. In its review, the MLRC noted that certain preferred trade-offs were not sustainable. For instance, it would not be possible to provide those who stay healthy with lower premiums and lower deductibles. In the public meetings, the MLRC found that most people accept the need (and responsibility) to pay higher premiums in order to be protected against large health care costs. In this respect, we find all three principles closely intermeshed. A further insightful observation of Chen and Phua (2013) is that (perhaps ironically) Singapore’s capacity to achieve UHC could be attributed to its focus on wider social determinants that have no direct link to health. As they have noted, the early national priorities in Singapore were on political unity, developing a prosperous economy and having an efficient and corruption-free government. From this vantage point at least, the road to achieving UHC has in reality been reliant on collective interests and values, even if this is not explicitly acknowledged. Endnotes 1 Medisave is a personal medical savings account for out-ofpocket health care expenses, financed by mandatory employee and employer contributions (as a percentage of the wage). 2 The Prime Minister’s National Day Rally Speech is available at: www.pmo.gov.sg/mediacentre/prime-minister-lee-hsien-loongsnational day-rally-2013-speech-english. 3 The ‘Pioneer Generation’ is defined as living Singaporeans who: i) were aged 16 and above in 1965 (aged 65 and above in 2014); and ii) obtained citizenship on or before 31 December 1986. U n i v e r s a l h e a l t h c o v e r a g e i n S i n g a p o r e References Chen, L. C. and Phua, K.-H., 2013. ‘Transferring lessons from Singapore: An art or a science?’. The Lancet, 382, pp. 930–931. Haseltine, W. A., 2013. Affordable Excellence: The Singapore Healthcare Story. Singapore: Ridge Books. Lim, J., 2013. Myth or Magic – The Singapore Healthcare System. 2013. Singapore: Select Publishing. Lim, M.-k., 2012. ‘Values and health care: The Confucian dimension in health care reform’. Journal of Medical Philosophy, 37 (6), pp. 545–555. MoH (Ministry of Health), 2014. ‘Government responds to MediShield Life Review Committee’s preliminary observations’. Press release 4 February 2014. Available at: www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomI temRelease/2014/government-responds-to-medishield-life-reviewcommittees prelim.html Accessed 9 April 2015. WHO (World Health Organization), 2014. Making Fair Choices on the Path to Universal Health Coverage. Geneva: WHO. DR CALVIN HO is an assistant professor at the Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore; co-head of the World Health Organization Collaborating Centre for Bioethics; and research associate at the Ethox Centre, Nuffield Department of Population Health, University of Oxford. He has published articles on biomedical law and ethics, intellectual property law, law of banking and other financial services, conflict of laws and scientific integrity. He has served as the deputy editor of the Singapore Law Review, associate editor of the Cornell International Law Journal and assistant guest editor of the Singapore Academy of Law Journal. He formerly practiced law in London and Singapore, and was the senior research associate of Singapore’s Bioethics Advisory Committee (2001–11). Ho read law at Cornell University (New York), the National University of Singapore and the University of Cambridge (UK). In addition, he read sociology and economics at the London School of Economics and Political Science, and at the School of Oriental and African Studies (University of London), as well as training in mathematical statistics. Apart from law practice and policy work, Ho has taught at Cornell University and at the Singapore Institute of Management University. Commonwealth Health Partnerships 2015 121
Commonwealth Health Partnerships 2015
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