The Singapore government began to reform public hospitals in the mid-1980s because of mounting public expenditures on health care. It granted public hospitals managerial autonomy and required them to compete for patients' fees. Correspondingly, patients were required to pay a larger proportion of the costs. When subsequent evidence showed that costs were increasing rather than decreasing, in the mid-1990s the government began to reassert its control while retaining the essence of the earlier reforms. In recent years, the reforms have emphasized management autonomy coupled with strong government guidance. This article assesses the autonomy and control mechanisms in place to promote effective service delivery in public hospitals in Singapore and concludes that reliance on market competition requires more state intervention than often realized. For market competition to deliver outcomes that are not only economically efficient and consumer-friendly but also politically acceptable, constant governmental oversight and coordination is essential.
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