Increasing healthcare costs, health coverage gaps and low quality healthcare can threaten not just the overall productivity of society, but also the general well-being of individuals. However, as countries develop and economies grow stronger, governments are spending more money to increase healthcare quality and affordability for their citizens. With this in mind, we studied the healthcare industry in 13 top economies in APAC to see which country is leading the way in providing high quality and affordable healthcare for its citizens.
- Japan ranked first in terms of healthcare outcomes, affordability and accessibility.
- New Zealand and Japan's governments allocated the greatest percentage of their budget to healthcare at 22% and 23%, while India allocated the least at 3%.
- Singapore, Japan, Hong Kong & Australia rank consistently well across healthcare outcomes such as life expectancy, mortality rates and access to quality medical services.
According to our analysis Japan's healthcare system ranked first, due to its exceptional healthcare outcomes, accessibility and affordability. Citizens enjoy long lives and have access to healthcare that provides quality treatment for common health conditions, suggesting quality healthcare is a priority. Not only does Japan score the 2nd highest out of our countries on the Institute for Health Metrics and Evaluation's Healthcare Access and Quality Index (94.1) but its citizens live 13.6 years longer than the global average, suggesting that medical care is accessible and of high quality even in old age.
Japan's government also dedicates 23% of its total budget to healthcare and funds 84% of all healthcare expenditure in the country—the highest public healthcare expenditure proportion in our study. This expenditure helps pay for Japan's largely affordable universal healthcare. There are no deductible payments, co-pays are charged based on age range and premiums are adjusted based on income.
Australia ranked second in our study due to its robust government expenditure on healthcare, good citizen health and high concentration of doctors and nurses per capita. It scored exceptionally well on the Health Access and Quality (HAQ) index, suggesting that individuals have access to necessary treatment for life-threatening illnesses such as cancer, diabetes and respiratory infections. In fact, Australia's cancer mortality-to-incidence ratio is one of the lowest compared to other developed countries.
However, despite Australia's rank for government health spending, its citizens pay higher out-of-pocket expenses than 7 other countries on this list. This may stem from Australia's high rate of private healthcare coverage. Despite its public healthcare system (Medicare) providing subsidised or free healthcare, about half of the population also purchases private healthcare coverage, which can incur a 25% out-of-pocket cost. The conscious decision to pay out-of-pocket for private healthcare may be part of the reason for the relatively high individual expenditure.
3. New Zealand
New Zealand comes in third due to high accessibility and affordability scores. Its national healthcare system is publicly financed, subsidies are available to financially challenged groups, and children under 13 can enjoy free primary care. Likely due to these measures, New Zealanders pay 24% less in out-of-pocket costs compared to the other 13 countries on our list. Furthermore, as of 2016, New Zealand also had the 2nd highest physician per capita rate (30.25 per 10,000 residents) and the 3rd highest nurse and midwife rate (11.1 per 1,000 residents), suggesting citizens have ample access to medical personnel.
However, while New Zealand provides appropriate amounts of funding and accessibility, we found it has a lower DPT immunisation rate (92% of children up to 2 years old) compared to other countries in our top 5. This may be partially explained by the lower overall immunisation record of certain demographics. For instance, Maori children immunisations declined from 93% in 2015-2016 to 88% in 2018.
Singapore is known for having exceptional medical care and an enviable health insurance system. To further prove this point, we found that Singaporeans enjoy high-quality healthcare, live long lives with low maternal and infant mortality rates and are automatically covered by government health insurance. For instance, Singaporeans lead long lives, beating the global life expectancy average by over 12 years. The country also has some of the lowest infant mortality (2.2/1,000 births) and maternal mortality (10/1,000) rates worldwide. Singapore has the 5th highest rate of physicians and nurses per capita, suggesting that health services are abundant.
However, while Singaporeans are automatically enrolled in their public health insurance scheme, MediShield Life, citizens still face a higher cost burden compared to other countries on our list. In fact, the private spending proportion of 46% is almost 10% greater compared to the average private spending on healthcare compared to other countries on our list. This coincides with Singaporeans paying the greatest amount in dollars for out-of-pocket expenditure ($1,273 in current dollars, PPP). These out-of-pocket expenditures may come not only in the form of mandatory CPF contributions like Medisave, but also through decisions to get private hospitals or non-subsidised ward treatment. However, due to Singapore's high gross national income (GNI) per capita, our estimates show that Singapore's out-of-pocket cost burden relatively low compared to other countries on this list.
5. South Korea
South Korea has one of the highest HAQ scores, suggesting high quality medical treatment for common illnesses. This is evidenced by South Korea having one of the highest 5-year colorectal and cervical cancer survival rates and one of the lowest rates of inpatient mortality for stroke. Furthermore, medical services are abundant, with South Korea having one of the highest physician (23.66/10,000) and hospital bed rates (11.5/1,000) per capita out of the countries studied. It also has one of the highest DPT immunisation rates, indicating widespread access to routine childhood vaccinations.
South Korea also offers universal healthcare that is financed by the insured and the government. However, despite the government dedicating around 13% of its budget to healthcare expenses, the private cost burden is still relatively high at 41% and out-of-pocket spending is 3rd highest out of the countries studied. This high out-of-pocket spending may stem from high co-pays and the fact that chronic illnesses such as cancer are not covered by South Korea's government healthcare system.
How Does Healthcare Compare in the Rest of Asia-Pacific
The purpose of this study is to find and highlight the best healthcare systems rather than identify which countries are the worst. Therefore, it would be incorrect to view countries ranked 6-13 in our study as the worst in terms of healthcare in the region, especially since we didn't analyse every country in Asia-Pacific.
However, there are a few points for discussion regarding the rest of the countries we studied. First, we found that affordability was a contributing factor to lower rankings, with private healthcare spending making up a larger proportion of overall expenditure compared to government spending. Furthermore, these countries also ranked below average for accessibility and healthcare outcomes. This is shown not only with the below average life expectancy rates but also from the below average HAQ scores. However, because developing countries may be unable to prioritise healthcare investment across the nation, high quality healthcare in those countries may only found within large metropolitan regions. This is exemplified by the large disparity in the HAQ scores within the countries themselves. For instance, while Beijing had a HAQ score of 91.5, Tibet (which was counted as part of China) had a score of 48.
Despite below average rankings, most of these countries have seen great improvements in healthcare within the past 10 years. For instance, India, China and Indonesia saw a 32%, 26% and 24% increase in their HAQ index score between 2005 and 2016, suggesting improvements in illness survival rates. Thailand, China and South Korea see nearly 100% rates of DPT immunisations, suggesting that routine and lifesaving infant care is readily available to the majority of the population. In fact, Thailand has been a top medical tourist destination for years due to its affordability and advanced medical care.
Discussion of Categories
We looked at three main aspects of each country's healthcare system: healthcare outcomes, healthcare expenditure and affordability and healthcare accessibility. We believe these categories cover a significant array of variables regarding a country's healthcare system.
Our healthcare outcomes category measures basic indicators of human health: infant and maternal mortality rates and female/male life expectancy. We then looked at the Healthcare Access and Quality Index to see if healthcare services prevent premature death from the top diseases (cancer, heart disease, measles, respiratory infections, etc.). These figures helped us determine whether people are leading generally healthy lives and have access to quality healthcare in the event of a serious illness.
Healthcare Outcomes Metrics (Ordered by Rank)
Healthcare Spending & Affordability
Healthcare spending and affordability helped us determine the level of importance the government places of healthcare services as well as how affordable healthcare is for citizens. First, we looked at what percentage of all healthcare spending the government spends compared to its citizens. This is shown in the table below under the column "Gov't Health Spending". This metric reflects the cost burden placed on the citizens—whether it's out-of-pocket spending or private funding spending (such as private insurance costs). Next, we looked at how much the government spends on healthcare as a percentage of its total spending. This is seen in the column labeled "Gov't Spending (% of Budget)" and shows what level the government prioritises healthcare as part of its budget.
Healthcare Spending & Affordability Metrics (Ordered by Rank)
Our affordability category was measured by calculating out-of-pocket spending compared to the Gross National Income (GNI) (both indicators using Purchasing Power Parity). This showed us how much income is spent on out-of-pocket healthcare and whether or not it is a significant cost of a household's expenditure. We chose to use GNI, rather than Gross Domestic Product (GDP), because GNI takes into account income generated by citizens who are working abroad. Since some of the countries we measured have populations who work abroad to send money back to their families, we thought this would prove to be a more accurate measure of affordability.
Healthcare accessibility measures a citizen's access to healthcare services. This category took into consideration the number of hospital beds, doctors, nurses and the Universal Healthcare Coverage (UHC) score. Analysing the rate of physicians, nurses and hospital beds per capita helped us see whether a country could be lacking in medical personnel. For instance, having less hospital beds per capita than the recommended WHO amount can lead to overcrowding and long wait times in hospitals, which can decrease the quality of care. We used the UHC index score as it includes a number of factors such as immunisation rates to show us how accessible healthcare is in a particular nation.
Healthcare Accessibility Metrics (Ordered by Rank)
Study Methodology & Limitations
In order to analyse the healthcare systems of each country, we used publicly available government data as well as World Bank (WB), World Health Organisation (WHO) and other institutional databases. We used the latest available data whenever possible either from the aforementioned databases or directly from government sites. In cases where we had to calculate a new figure, data was compiled the same years. For instance, when calculating the out-of-pocket expenditure as a percentage of GNI, we used 2016 figures as this was the year that was available for both metrics.
There were a number of limitations that we encountered. First, the lack of availability of data meant we were limited to using high level indicators that had available data for every country. For example of this is consultation time, which had a significant lack of data across countries despite it being an important indicator for quality of healthcare. Additionally, the percentage of the population that dropped below the poverty level due to high out-of-pocket healthcare costs. This could have been interesting to see because it would paint a picture of how crippling out-of-pocket costs are—especially because for some countries, out-of-pocket costs were partially voluntary. Furthermore, because Hong Kong is considered to be part of China for the UHC score, we had to use China's score for both countries. Lastly, Taiwan couldn't be included in our study due to lack of data for a significant portion of our metrics.