Increasing healthcare costs, coverage gaps and low-quality care can threaten not just individuals' well-being, but also the overall productivity of society. However, as countries develop and economies grow stronger over time, governments are spending more to improve healthcare quality and affordability for their citizens. With this in mind, we studied the healthcare industry in 13 top APAC economies to see which are 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's and Japan's governments allocated the largest percentage of their budgets to healthcare at 22% and 23%, respectively, while India allocated the least (3%).
- Singapore, Japan, Hong Kong & Australia rank highly across healthcare outcomes such as life expectancy, mortality rates and access to quality medical services.
According to our analysis, Japan's healthcare system ranked 1st 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 is a priority. Japan scores the 2nd highest out of our countries on the Institute for Health Metrics and Evaluation's Healthcare Access and Quality Index (94.1), and its citizens live 13.6 years longer than the global average, suggesting that medical care is accessible and of high quality even into old age.
Japan's government also dedicates 23% of its budget to healthcare and funds 84% of all the country's healthcare expense—the highest public healthcare expenditure proportion of countries we studied. 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 2nd in our study due to its high government expenditure on healthcare, good citizen health and high concentration of doctors and nurses per capita. It scored very well on the Health Access and Quality (HAQ) index, suggesting that individuals have access to necessary treatment for life-threatening illnesses like cancer, diabetes and respiratory infections. In fact, Australia's cancer mortality-to-incidence ratio is one of the lowest compared to other developed nations.
However, despite Australia's high 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, around half of the population also buys 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 level.
3. New Zealand
New Zealand comes in 3rd 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' out-of-pocket costs are 23% less than the other 13 countries on our list. Furthermore, as of 2016, New Zealand also had the 2nd highest number of physicians per capita (30.25 per 10,000 residents) and the 3rd highest nurse and midwife rate (11.1 per 1,000 residents), suggesting citizens have sufficient access to medical personnel.
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) versus the other countries among our top 5. This may be partially explained by the lower overall immunisation rate of certain demographics. For instance, Maori children' immunisations declined from 93% in 2015-2016 to 88% in 2018.
Singapore is known for exceptional medical care and an enviable health insurance system. In our study, we found that Singaporeans enjoy high-quality healthcare, live long lives, have low maternal and infant mortality rates and are automatically covered by government health insurance. For instance, Singaporeans' life expectancy is 12 years higher than the global average. The country also has some of the lowest infant mortality (2.2/1,000 births) and maternal mortality (10/1,000) rates worldwide. It also has the 5th number of physicians and nurses per capita, which suggests that health services are abundant.
However, while Singaporeans are automatically enrolled in their public health insurance program, MediShield Life, they still face a higher cost burden versus other countries on our list. The country's private spending proportion (46%) is nearly 10% greater than the average private spending on healthcare of other nations in our study. This coincides with Singaporeans paying the most in dollars for out-of-pocket expenditure ($1,273 in current international 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 the country's out-of-pocket cost burden is relatively low in comparison to other countries on our 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 numbers of physicians (23.66/10,000) and hospital beds (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 approximately 13% of its budget to healthcare expenses, the private cost burden is still relatively high (41%) and out-of-pocket spending is 3rd highest out of the countries we 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 the government healthcare system.
How Does Healthcare Compare in India and 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. So, it is important to highlight that the countries ranked 6-13 in our study are not classified as the worst in terms of healthcare in APAC, as we didn't analyse every country in the region.
That said, India ranked at the low end of the countries studied due to multiple factors. For example, the average individual is only expected to live into his/her late 60s, and infant and maternal mortality rates are the highest of the 13 countries studied. Next, although the government funds 65% of all healthcare expenditures, which puts India in the top 5 for this metric, out-of-pocket spending as a percentage of GNI is one of the highest at 2.4%. Last, the country only has 7.8 doctors per 10,000 people, 2.1 nurses per 1,000 people and 0.7 hospital beds per 1,000 people.
There are also some broader points to be mindful of regarding the countries who did not comprise the top 5. First, since developing countries may be unable to prioritise healthcare investment across the nation, high-quality healthcare in those countries may only be 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.
Next, 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, respectively, suggesting improvements in illness survival rates. And, 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 their populations. 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. An 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 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. Last, Taiwan couldn't be included in our study due to the lack of data for a significant portion of our metrics.