Why Singapore’s Healthcare Model Cannot Be Directly Replicated in Mainland China: A Comparative Policy Perspective

Abstract

Singapore achieves a world-leading life expectancy of 83 years while allocating only 4.47% of its GDP to healthcare, whereas mainland China’s health expenditure reached 7.9% of GDP in 2023 with a life expectancy gap of 5 to 6 years. This paper argues that Singapore’s apparent efficiency stems from four institutional mechanisms embedded in its colonial legacy, compulsory savings architecture, direct state payment to physicians, and exclusion of foreign workers. None of these mechanisms can be transplanted into mainland China, given fundamental differences in fiscal capacity, population scale, urban-rural duality, and demographic trajectory. Using a comparative institutional analysis framework, this review demonstrates that China’s post-2000 demographic inversion, incomplete contribution base, and self-financing hospital model collectively render the Singaporean template inapplicable. The paper concludes that healthcare system reform must respect path dependence as a structural given rather than a policy failure.