Healthcare in Singapore

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The Bowyer Block at the Singapore General Hospital now houses the SGH Museum which was officially opened in May 2005.

Healthcare in Singapore is supervised by the Ministry of Health of the Singapore Government. It largely consists of a government-run universal healthcare system with a significant private healthcare sector. In addition, financing of healthcare costs is done through a mixture of direct government subsidies, compulsory savings, national healthcare insurance, and cost sharing.

Singapore generally has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organization's ranking of the world's health systems in the year 2000.[1] Bloomberg ranked Singapore’s healthcare system the most efficient in the world in 2014.[2] The Economist Intelligence Unit placed Singapore 2nd out of 166 countries for health-care outcomes. [3] Bloomberg Global Health Index of 163 countries ranked Singapore the 4th healthiest country in the world and first in Asia.[4]

According to global consulting firm Towers Watson, Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes".[5] This has been attributed to a combination of a strong reliance on medical savings accounts, cost sharing, and government regulation.[6] The government regularly adjusts policies to actively regulate "the supply and prices of healthcare services in the country" in an attempt to keep costs in check. However, for the most part the government does not directly regulate the costs of private medical care. These costs are largely subject to market forces, and vary enormously within the private sector, depending on the medical specialty and service provided.[5] However, Towers Watson has claimed that the specific features of the Singapore healthcare system are unique, and have been described as a "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the government's programmes.[5]

Healthcare providers[edit]

The healthcare system in Singapore is divided into two sectors; statutory boards and institutions (which are then divided into public and private streams).[7] There are a variety of statutory boards in place, including the Medical Council, Dental Council, Nursing Board, Pharmacy Council, and Optometrists and Opticians Board.[7] Healthcare institutions can be divided into public and private hospitals and healthcare providers. All hospitals in Singapore have been structured as government corporations since the 1990s, constantly competing with one another to have the most advanced services, and technology available.[8] There are multiple spheres and levels to both the public and private streams.

Cost comparison of public and private sectors[edit]

There is a vast difference in the cost of health insurance, hospital bills, and procedures from the public to private sector. The table below illustrates some of the differences in cost associated with a variety of conditions/procedures.[9]

Cost Comparison of Procedures in Public/Private Hospitals[9]
Condition/Procedure Government Hospitals Private Hospitals
Hip replacement surgery $8,171 SGD $19,538 SGD
Kidney stones $3,545 SGD $5,610 SGD
Cataract surgery $853 SGD $2,547 SGD
Appendix removal $3,300 SGD $12,041 SGD
Colonoscopy $1,334 SGD $1,674 SGD

Public health system[edit]

Since the 1990s, all public hospitals, polyclinics, and specialty centres have been restructured as government-owned corporations, and operate under three healthcare groups or "clusters":

  1. National Healthcare Group
  2. National University Health System
  3. SingHealth

The 8 public hospitals comprise 6 acute general hospitals (SGH, NUH, CGH, TTSH, KTPH & NTFGH), a women's and children's hospital (KKH) and a psychiatry hospital (IMH).[10] In addition, there are 8 national specialty centres for cancer (NCCS), cardiac (NHCS), eye (SNEC), skin (NSC), neuroscience (NNI), dental care (NDCS) and a medical centre for multiple disciplines (NCIS and NHCS).[10]

As of 2012, Singapore had a total of 10,225 doctors in its healthcare system, giving a doctor-to-population ratio of 1:520. The nurse-to-population ratio (including midwives) was 1:150, with a total of 34,507 nurses. There were 1,645 dentists, giving a ratio of 1 dentist to 3,230 people.[11][12]

Approximately 70–80% of Singaporeans obtain their medical care within the public health system. Overall government spending on public healthcare amounts to 1.6% of annual GDP. This amounted to an average of $1,104 Government Health Expenditure per person.[11] Health-related spending is the third largest expenditure item, after defence and education expenses.[13] As the median age of the population increases, Singapore's healthcare spending is expected to rise. Healthcare spending has risen from $4 billion in 2011 to $9.8 billion in 2016.[14][15]

Singapore has an incredible reputation for health services and healthcare systems; in 2000, the country was ranked sixth in the world by the World Health Organization.[16] Public hospitals have autonomy over management decisions, and compete with one another for patients.[17] General hospitals have a variety of functions and services; they mainly represent multi-disciplinary acute inpatient and specialist outpatient services, have 24-hour emergency centers, and often specialize in a specific field of medicine (cancer research, neuroscience, dental care, cardiac care, etc.).[17] Singapore has an array of hospitals and health services available, as well as community hospitals that exist as an intermediate form of healthcare for people who do not require the services of a general hospital but cannot cope at home.[17] The funding behind Singapore's public health sector can be broken down into the Ministry of Health of Singapore, MediSave, MediShield Life, and MediFund.

Emergency Medical Services[edit]

Emergency medical services (EMS) in Singapore are provided by the Singapore Civil Defence Force (SCDF). SCDF operates a fleet of ambulances, "fast response paramedics" on motorcycles as well as first response fire-bikers. SCDF is characterized as a nationally-funded, multi-tiered, fire-based EMS system.[18][19] SCDF responded to 150,155 calls in 2013, of which 96.1% were classified as emergency calls.[19]

Financing[edit]

Singapore's healthcare system uses a mixed financing system that includes nationalised life insurance schemes and deductions from the compulsory savings plan, or the Central Provident Fund (CPF), for working Singaporeans and permanent residents.[20] This mechanism is intended to reduce the overuse of healthcare services.

Medisave[edit]

Medisave is a medical savings account under an individual's CPF account that is used for payment of future medical expenses as well as premiums of medical insurance policies. Funds can be pooled within and across an entire extended family.

The Central Provident Fund Board, a social security system, allows the citizens of Singapore to put aside funds for a variety of expenses including retirement, healthcare and mortgage. Citizens can make monthly contributions to three different accounts: 1) ordinary accounts for housing, insurance, investment, and education, 2) special accounts for retirement, and investment, and 3) MediSave accounts for hospitalization expenses and medical insurance.[21] MediSave contributions are usually between 8-10.5% of an individual's wage, and is capped at a $52,000 limit.[21] This form of a health savings account is required by all workers; those below the age of 55 are required to deposit 20% of their earnings.[21] This contribution is almost matched by the employer who contributes 17% of the workers earnings.[21]

Medishield[edit]

Launched in 1990, Medishield is a low cost basic insurance scheme intended for those whose savings are insufficient to meet their medical expenses.[22] Premiums can be paid out of Medisave accounts. A new scheme, Medishield Life, replaced the Medishield in November 2015. Co-insurance payment rates are to be reduced from 10–20% to 3–10% and the lifetime claim limit is to be removed.[23] The scheme helps to pay for hospital bills and selected outpatient treatments. The government provides premium subsidies to lower- to middle-income residents, the elderly and new policyholders transitioning from cheaper policies.

The Integrated Shield Plan (IP) includes both the MediShield Life component and an additional private insurance coverage component run by private insurers, to cover for optional benefits in public hospitals and private hospitals. Premiums for the IP can be paid by the Medisave funds.[22]

Eldershield[edit]

Eldershield is a severe disability insurance scheme which insures against the cost of private nursing homes and related expenses. Since 2002, members with a CPF Medisave account will automatically be enrolled in the scheme at the age of 40, unless they choose to opt out. Three private insurers, Aviva, Great Eastern and NTUC Income were chosen to manage ElderShield.[24] It has 1.2 million policyholders as of 2015, with $2.6 billion collected in premiums, and around $100 million in payout claims and $130 million in premium rebates between 2002 and 2015.[25][26]

Medifund[edit]

MediFund is Singapore's safety net program, which covers only the lowest class of hospitalization fees and services.[27] This form of coverage and insurance is only available to citizens of Singapore once they have depleted their MediSave and MediShield funds.[27] The amount of funding and coverage is dependent on the individuals' income, health condition, and socioeconomic status.

It is a government endowment fund for those who are unable to meet their assessed contribution. Risks are not pooled, so an individual may be exposed to catastrophic expenses.[28] A total of $155.2 million was allocated to patients in 2015.[29]

Subsidies[edit]

Singapore citizens and Permanent Residents warded in public hospitals receive government subsidies for their medical fees, which scale according to their chosen class of ward as well as their income. Since 1 January 2009, patients warded in B2 and C class wards in public hospitals undergo means testing to determine the level of subsidy they are entitled to, based on the average monthly income received over the last available 12-month period including bonuses for salaried employees. However, patients receiving services such as Day Surgery, A&E services, Specialist Outpatient and polyclinic visits receive standardised subsidies regardless of income without requiring means testing.

People with no income, such as retirees or housewives, will have their subsidy rate pegged to the value of their homes, whereas all unemployed residents of HDB flats excluding those in executive condominiums (EC) will be entitled to the highest tier of subsidy.

The following table details the subsidies available:

Means testing in public hospitals as of 1 January 2009 [30]
Average Monthly
Income of Patient (SGD)
Citizens Subsidy Permanent residents Subsidy
Class C Class B2 Class C Class B2
$3,200 and below1 80% 65% 70% 55%
$3,201 – $3,350 79% 64% 69% 54%
$3,351 – $3,500 78% 63% 68% 53%
$3,501 – $3,650 77% 62% 67% 52%
$3,651 – $3,800 76% 61% 66% 51%
$3,801 – $3,950 75% 60% 65% 50%
$3,951 – $4,100 74% 59% 64% 49%
$4,101 – $4,250 73% 58% 63% 48%
$4,251 – $4,400 72% 57% 62% 47%
$4,401 – $4,550 71% 56% 61% 46%
$4,551 – $4,700 70% 55% 60% 45%
$4,701 – $4,850 69% 54% 59% 44%
$4,851 – $5,000 68% 53% 58% 43%
$5,001 – $5,100 67% 52% 57% 42%
$5,101 – $5,200 66% 51% 56% 41%
$5,201 and above2 65% 50% 55% 40%

1. No income declare and property with AV below $11,000.
2. No income declare and property with AV exceeding $11,000.
3. Foreigners no longer receive any subsidies at public hospitals since 01-Jan-08.

Community Health Assist Scheme[edit]

In 2012 the Community Health Assist Scheme was introduced. This provides subsidies for Singapore Citizens from lower-to-middle income households, and the Pioneer generation, born before 1950, who need treatment for common illnesses, chronic health problems and specific dental issues. Beneficiaries get a blue or orange Health Assist card, depending on household income. From 2019 the scheme is to be extended. Orange cardholders who only got subsidies for chronic conditions will get subsidies for common illnesses. All Singaporeans will be covered for chronic conditions, and the subsidies for complex chronic conditions will be increased.[31]

Private healthcare[edit]

The increasingly large private sector provides care to those who are privately insured, foreign patients, or public patients who are able to afford what often amounts to very large out-of-pocket payments above the levels provided by government subsidies.

The government uses the capacity of the private sector to reduce waiting times in the public sector. In 2015 it plans to use the Raffles Medical Group to receive non-critical ambulance cases.[32]

Private sector[edit]

The private healthcare sector in Singapore has a huge market, with a more exclusive clientele.[33] Private healthcare often attracts individuals in search of more advanced and complicated treatments such as stem cell therapy, or specialized cancer treatments. The private sector is more appealing and preferred by expatriate citizens as opposed to public for the short wait times, and greater availability of services.[34] The private sector consists of private hospitals, and private insurance.

Three hospital groups operate the majority; Parkway Holdings, Pacific Healthcare Holdings, and Raffles Medical Group.[35] These private hospitals are typically smaller, offer patients more privacy, and typically specialize in certain procedures or surgeries.

Raffles Medical Group[edit]

Raffles Medical Group (RMG) is one of the largest private healthcare providers in Asia, with hospitals and clinics located in several cities, including Singapore.[36] RMG owns Raffles hospital in Singapore, which specializes in obstetrics and gynecology, cardiology, oncology, and orthopedics.[36]

Private health insurance[edit]

There are a variety of choices for healthcare insurance in Singapore, and within the private sector. Depending on an individual, or families level of income, lifestyle, location, and medical history, there are monthly insurance plans ranging from $75 SGD to $400 SGD.[7] Companies include but are not limited to Allianz, Aviva, Great Easter, and Prudential.[7]

Government initiatives[edit]

Medical tourism[edit]

In October 2003, acting Minister for Health Khaw Boon Wan launched SingaporeMedicine to promote Singapore as a regional medical hub. He said more than 200,000 foreigners visited Singapore for medical services in 2002 and that the Economic Review Committee reaffirmed its ambition of serving 1 million foreign patients annually by 2012.[37] In his speech, Khaw said,

"SingaporeMedicine that we are launching today shall be the rallying point and a powerful symbol of our collective will and commitment towards this ambition...

In three specialties alone, heart, eye and cancer, I see tens of millions of middle-class patients within a 7-hour flying radius, waiting to be served. If they can be attracted here, they will keep us all very busy...

This is my dream for Singapore as the regional medical hub, where regional doctors and nurses compete to work here to learn, and where international patients seek us out for care and treatment."[38]

See also Medical tourism#Singapore

National Electronic Record Programme[edit]

The National Electronic Record Programme was launched in 2011 and is used by more than 280 institutions to support telehealth and telemedicine.[39]

Pioneer Generation Package[edit]

The Pioneer Generation Package (PGP) is a S$9 billion package launched in 2014 aimed at helping approximately 450,000 Singaporeans born on or before 31 December 1949 and obtained citizenship before 31 December 1986 through a series of healthcare and social support schemes over an estimated 20-year period.[40][41]

Issues[edit]

Shortage of hospital beds[edit]

Since 2010, the healthcare system has often faced shortages of hospital beds.[42][43] This has been attributed to an aging population.[44] According to research firm ValuePenguin, the average occupancy rates of Singapore public hospitals hovers around 85% but usually peak to as much as 93% during weekdays. It added that based on data from the Ministry of Health, patients spent around 2.5 hours waiting to be admitted to a ward from the emergency department.[45] In certain situations, hospitals had to temporarily locate patients in airconditioned tents, along ward corridors, or in rented wards off-campus.[46]

Since 2010, the government has opened three general hospitals and three community hospitals to cater to the increasing demand for hospital beds, and plans to open four new hospitals between 2020 to 2030.[47] In addition, it has invested in the redevelopment and expansion of existing hospitals.[48][49] As of April 2017, there were approximately 10,500 beds in the public health system.[50]

See also[edit]

References[edit]

  1. ^ The World Health Report 2000 : Health Systems : Improving Performance (PDF). Geneva, Switzerland: World Health Organization. 2000. p. 154. ISBN 92-4-156198-X.
  2. ^ "Most Efficient Health Care Around the World". Bloomberg.com.
  3. ^ "Singapore ranked world's No. 2 for health-care outcomes: EIU". Bloomberg.com.
  4. ^ "Singapore healthiest Asian country; Italy tops global list despite economic crisis". Bloomberg.com.
  5. ^ a b c John Tucci, "The Singapore health system – achieving positive health outcomes with low expenditure", Watson Wyatt Healthcare Market Review, October 2004. Archived 19 April 2010 at the Wayback Machine
  6. ^ Carroll, Aaron E.; Frakt, Austin (2 October 2017). "What Makes Singapore's Health Care So Cheap?". The New York Times. ISSN 0362-4331. Retrieved 24 October 2017.
  7. ^ a b c d "Singapore : International Health Care System Profiles". international.commonwealthfund.org. Retrieved 2 December 2018.
  8. ^ "What Makes Singapore's Health Care So Cheap?". Retrieved 28 November 2018.
  9. ^ a b "Healthcare in Singapore: A guide to Singapore's healthcare system". TransferWise. 7 November 2017. Retrieved 2 December 2018.
  10. ^ a b "Hospital Services". Ministry of Health, Singapore. Ministry of Health, Singapore. Retrieved 25 July 2017.
  11. ^ a b "Singapore Health Facts". Ministry of Health, Singapore. Retrieved 29 August 2014.
  12. ^ "Find a Doctor in Singapore - DoctorPage". Web.archive.org. 26 January 2013. Retrieved 14 November 2018.
  13. ^ Ramchandani, Nisha (21 February 2017). "A smaller budget surplus of S$1.91b likely for FY17". The Business Times. Retrieved 24 October 2017.
  14. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 43. ISBN 978-1-137-49661-4.
  15. ^ Basu, Radha (7 October 2017). "Long-term care: If this is so important, why aren't we putting our money where our mouth is?". The Straits Times. Retrieved 24 October 2017.
  16. ^ World Health Organization (2000). "The World Health Report 2000: Health Systems: Improving Performance" (PDF). WHO Library Catalogue.
  17. ^ a b c "News Highlights". www.moh.gov.sg. Retrieved 28 November 2018.
  18. ^ Lim, S. H.; Anantharaman, V. (March 1999). "Emergency medicine in Singapore: past, present, and future". Annals of Emergency Medicine. 33 (3): 338–343. ISSN 0196-0644. PMID 10036349.
  19. ^ a b Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng (July 2015). "Prehospital Trauma Care in Singapore". Prehospital emergency care: official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 19 (3): 409–415. doi:10.3109/10903127.2014.980477. ISSN 1545-0066. PMID 25494913.
  20. ^ "Costs and Financing". Ministry of Health. Retrieved 22 October 2017.
  21. ^ a b c d "CPF Overview". www.cpf.gov.sg. Retrieved 28 November 2018.
  22. ^ a b Huang, Claire (15 July 2017). "The Good, the Bad, and the Ugly of Integrated Shield Plans". The Business Times. Retrieved 24 October 2017.
  23. ^ Khalik, Salma (31 October 2015). "MediShield Life coverage to kick in at midnight". The Straits Times. Retrieved 24 October 2017.
  24. ^ Tan, Weizhen (7 July 2017). "Govt studying proposal to take over running of ElderShield". TODAY. Retrieved 24 October 2017.
  25. ^ "S$90m paid out in ElderShield claims since its 2002 launch". Channel NewsAsia. 4 April 2016. Archived from the original on 24 October 2017. Retrieved 24 October 2017.
  26. ^ "Parliamentary Debates Singapore – Official Report" (PDF). National Archives of Singapore.
  27. ^ a b "MediFund". www.moh.gov.sg. Retrieved 28 November 2018.
  28. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 42. ISBN 978-1-137-49661-4.
  29. ^ "Medifund assistance dropped to S$155.2m last year". TODAY. 24 November 2016. Retrieved 24 October 2017.
  30. ^ "Means Testing at Singapore public hospitals" (PDF). Moh.gov.sg. Retrieved 14 November 2018.
  31. ^ "What Chas expansion means for healthcare in Singapore". Today online. 26 February 2019. Retrieved 26 February 2019.
  32. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 44. ISBN 978-1-137-49661-4.
  33. ^ Pocock, Nicola S; Phua, Kai Hong (2011). "Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia". Globalization and Health. 7 (1): 12. doi:10.1186/1744-8603-7-12. ISSN 1744-8603. PMC 3114730. PMID 21539751.
  34. ^ "Healthcare in Singapore". Retrieved 2 December 2018.
  35. ^ Pacific Prime (6 October 2017). "Public and Private Healthcare in SINGAPORE". Pacific Prime.
  36. ^ a b "Hospitals and Other Healthcare Organisations - medtech.sg". medtech.sg. 3 May 2013. Retrieved 2 December 2018.
  37. ^ "SG medical tourism started by Khaw asking Philip Yeo to implement - Khaw exhorts Yeo with 'May the Force be with you' - The Online Citizen". Theonlinecitizen.com. 2 October 2018. Retrieved 14 November 2018.
  38. ^ "Speech By Ag Minister Khaw Boon Wan, At The Launch Of Singaporemedicine, 20 October 2003, 4.00 Pm". Nas.gov.sg. Retrieved 14 November 2018.
  39. ^ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 15. ISBN 978-1-137-49661-4.
  40. ^ "Singapore Budget 2015 Annex B-1: Pioneer Generation Package" (PDF). Singaporebudget.gov.sg. Retrieved 27 March 2018.
  41. ^ "PIONEER GENERATION PACKAGE". Retrieved 21 November 2018.
  42. ^ Lim, Jeremy (March 2010). "The Bed Crunch: A Systems Perspective" (PDF). SMA News. Singapore Medical Association. Retrieved 15 October 2018.
  43. ^ Huang, Claire. "Hospital bed crunch a cumulative problem". Businesstimes.com.sg. Retrieved 14 November 2018.
  44. ^ Ng Jing Ying (21 January 2014). "Ageing society contributes to hospital bed crunch: Gan". TODAYonline. MediaCorp Press. Retrieved 15 October 2018.
  45. ^ "Singapore public hospitals cave under pressure of overcrowding". Sbr.com.sg. Retrieved 14 November 2018.
  46. ^ Salma Khalik (8 January 2014). "Hospitals facing severe bed crunch take unusual steps". The Straits Times. Singapore Press Holdings. Retrieved 15 October 2018.
  47. ^ "New hospitals in the pipeline". The Straits Times. 15 February 2014.
  48. ^ Kimberly, Spykerman (5 February 2016). "SGH campus to be redeveloped over 20 years to boost capacity, accessibility". Channel NewsAsia. MediaCorp. Retrieved 15 October 2018.
  49. ^ "Singapore's largest healthcare complex planned for Novena area". TODAYonline. MediaCorp Press. 30 August 2013. Retrieved 15 October 2018.
  50. ^ Salma Khalik (7 April 2017). "Extra 2,500 beds ease hospital crunch". The New Paper. Retrieved 15 October 2018.

External links[edit]