Singapore controls prices through collective bargaining at the national level and unlike the US practically every purchase in its hospitals has to go through registration with the HSA (the country's relevant regulatory agency). You essentially cannot purchase any major equipment without running it by the national government. That's one of the reasons why the country has a very transparent pricing system.

It's not only savings accounts but also a very tight control over costs and acquisitions that keeps the price low, that's completely missing in the American system which just keeps growing.

And getting HSA approval doesn’t have anything to do with price - that regulatory. Even the FDA has to approve anything used in the US.

It is true you can’t purchase at the hospital level without some agreement on price, but the hospitals often do their own tenders, which are confidential prices. It’s not done at the national level for everything.

And yes, prices are tightening but companies are already deciding to just not market in Singapore if prices get too low.

Check out Germany, I think it was AZ that decided to just not launch a drug there at all because the price was too low.