SG-H-CS-35 | Andrew Chew — The Architect of Singapore's Healthcare Financing

Document Code: SG-H-CS-35 Full Title: Andrew Chew — The Architect of Singapore's Healthcare Financing System Coverage Period: 1930s–2000s Level Designation: Level 3 Profile Primary Sources Consulted:

1. Peh Shing Huei (ed.), The Last Fools: The Eight Immortals of Lee Kuan Yew (2022) — dedicated chapter
2. Ministry of Health, institutional records on Medisave and MediShield
3. National Archives of Singapore, oral history records

Related Documents:

• SG-H-CS-04 | George Bogaars — fellow "Eight Immortals" civil servant
• SG-H-CS-07 | J.Y. Pillay — fellow "Eight Immortals" civil servant
• SG-H-CS-23 | Sim Kee Boon — fellow "Eight Immortals" civil servant
• SG-H-INT-16 | Peh Shing Huei — documented in The Last Fools

Version Date: 2026-03-20

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Section 1: Key Takeaways

• Dr Andrew Chew Guan Khuan (b. 11 October 1929, Kuching, Raj of Sarawak) served as Permanent Secretary of the Ministry of Health and Director of Medical Services (April 1978–1984), then as Head of the Civil Service (1984–1994), and subsequently as Chairman of the Public Service Commission (1998–2008). He was one of the eight founding-generation civil servants profiled in Peh Shing Huei's The Last Fools: The Eight Immortals of Lee Kuan Yew (2022).

• He was instrumental in designing and implementing Medisave and MediShield — the two pillars of Singapore's healthcare financing system that made the country's approach to health funding one of the most studied models in the world. Medisave (a mandatory medical savings account funded through CPF contributions) and MediShield (a catastrophic illness insurance scheme) together created a system that combined individual responsibility with collective risk-pooling.

• Singapore's healthcare financing model — often described as the "3M" system (Medisave, MediShield, Medifund) — achieved the remarkable feat of providing universal healthcare access while maintaining fiscal sustainability. Andrew Chew's role in designing this architecture makes him one of the most consequential but least publicly known figures in Singapore's social policy history.

• The healthcare financing system he helped design has been studied and emulated by policymakers worldwide. Its combination of mandatory savings, insurance, and means-tested subsidies addressed the fundamental challenge of healthcare economics: how to provide universal access without creating unsustainable fiscal obligations.

• As a "Last Fool" — one of the founding generation who served with total dedication for modest rewards — Andrew Chew exemplified the civil service ethos that built Singapore's institutions. His work was institutional rather than personal; his legacy lives in the systems he designed rather than in public recognition.

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Section 2: The Record in Brief

Andrew Chew, a physician by training, rose through the civil service to become Permanent Secretary of the Ministry of Health and Director of Medical Services (1978–1984) — one of the most important administrative positions in the government's social policy architecture. As Perm Sec, he was responsible not merely for administering the health ministry but for designing the policy frameworks that would govern healthcare delivery and financing. He subsequently served as Head of the Civil Service (1984–1994) and as Chairman of the Public Service Commission (1998–2008), making his influence on the broader civil service and senior appointments as consequential as his health-sector contributions.

His most consequential work was in healthcare financing. The Medisave scheme, introduced in 1984, required all working Singaporeans to set aside a portion of their CPF contributions for medical expenses. MediShield, introduced in 1990, provided insurance coverage for large hospital bills and selected outpatient treatments. Together with Medifund (a safety net for those who could not afford medical care even with Medisave and MediShield), these programmes created a tiered healthcare financing system that balanced individual responsibility with social protection.

The design of this system required navigating complex trade-offs: between individual savings and collective insurance, between government subsidies and personal responsibility, between comprehensive coverage and fiscal sustainability. Andrew Chew's role in navigating these trade-offs produced a system that has proven remarkably durable and effective.

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Section 3: The Healthcare Financing Architecture

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Sources and References

• Peh Shing Huei (ed.), The Last Fools: The Eight Immortals of Lee Kuan Yew (2022).
• Ministry of Health, healthcare financing policy documents.

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This document is part of the Singapore Governance Knowledge Corpus.