• Vol. 42 No. 1, 42–48
  • 15 January 2013

Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?



Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine —that of inquiry, innovation, pedagogy and clinical exceptionalism—can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.

Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values.

—Louis D Brandeis

As a small island state with finite resources, Singapore’s healthcare philosophy is governed by pragmatism, rationing and cost-effectiveness (see Appendix 1 for definition) with an unrelenting emphasis on keeping healthcare spending on a fiscally sustainable path. In recent years, selected restructured hospitals have been given the expanded
mandate of promoting the development of academic medicine within Singapore’s clinical health services clusters. This mandate pushes any academic medical centre into a
potential conflict with the overarching priority of providing basic and affordable healthcare and raises deeper questions about the cost-intensive role of medical research in the context of publicly financed healthcare institutions.

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