There were two primary research activities undertaken as part of this project. The first involved the collection of health and health expenditure data in Singapore; and the second involved studying the methods involved in health related cost-effectiveness studies. Both involved work to improve cross-country comparisons in health economic research. The first set of work involved collecting demographic, health status, health behavior, health expenditure, and risk/time preferences data for a Singapore population that could then be used to make comparisons to similar data collected in the United States. With such different health care systems both in terms of funding and health delivery, these data can be used for future work to compare how the differences in health systems, individual preferences, and cultures may affect decisions on seeking health care or performing health seeking behaviors (e.g. choice of diet or exercise). While the general version of this survey has not been conducted yet, abridged versions are currently being fielded as part of studies on persons with diabetes, persons who have had a stroke, and infants. Data from these studies will hopefully become available to provide a better idea of how the Singapore health system affects health behaviors. For the work on cost-effectiveness analyses, we wrote an editorial for the American Journal of Preventive Medicine describing the need to include all costs in cost-effectiveness studies as well as highlighting the need to distinguish between cost-effectiveness and cost-saving when making health policy decisions. We also conducted a cost-effectiveness study of a program to provide epidermal growth factor receptor mutation testing and resulting mutation-specific therapy. Though the initial estimates were based on Singapore, we also compared results for both the United States and Italy and analyzed how differences between the countries affected how cost-effective the treatment was. The work showed that the treatment appeared to be cost saving, and particularly so in Italy because of the lower costs of treatment there. Overall the data collected in this project and the methods used are intended to lead to future research opportunities to make cross-country health economic comparisons between the US and Singapore. Given recent interest in Singapore as a potential model for a health care financing system, more data need to be collected to allow future comparisons between the US and Singapore to see which factors (the health financing system, culture, income, or others) help explain differences in health outcomes between the two countries.
