Healthcare in Singapore
Healthcare in Singapore is mainly under the responsibility of the Singapore Government's Ministry of Health. Singapore generally has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organisation's ranking of the world's health systems in the year 2000. Bloomberg ranked Singapore’s healthcare system the most efficient in the world in 2014.
Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls.
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. This mechanism is intended to reduce the overuse of healthcare services. Out-of-pocket charges vary considerably for each service and level of subsidy. At the highest level of subsidy, although each out-of-pocket expense is typically small, costs can accumulate and become substantial for patients and families. At the lowest level, the subsidy is in effect nonexistent, and patients are treated like private patients, even within the public system.
A component within the Central Provident Fund allocates a portion of one's monthly income savings for future medical expenses and approved medical insurance policies. The medical savings account, Medisave, accumulates funds that are individually tracked, and such funds can be pooled within and across an entire extended family. The vast majority of Singapore citizens have substantial savings in this scheme. One of three levels of subsidy is chosen by the patient at the time of the healthcare episode.
Launched in 1990, Medishield is a low cost basic insurance scheme intended for those whose savings are insufficient to meet their medical expenses. 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. 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. 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. 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. In addition to the insurance schemes, Medifund is 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. A total of $155.2 million was allocated to patients in 2015.
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.
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. Health-related spending is the third largest expenditure item, after defence and education expenses.
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.
Approximately 70–80% of Singaporeans obtain their medical care within the public health system. Overall government spending on public healthcare amounts to only 1.6% of annual GDP. This amounted to an average of $1,104 Government Health Expenditure per person, partly because government expenditure on healthcare in the private system is extremely low. According to Mark Britnell total expenditure on healthcare is 4.6% of GDP and has stayed almost constant since independence.
Healthcare today in SingaporeEdit
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," according to an analysis by global consulting firm Towers Watson. Apart from the strong reliance on medical savings accounts and cost-sharing, government regulation is considered a crucial factor for the system's perceived efficiency. 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.
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.
Patients are free to choose the providers within the government or private healthcare delivery system and can walk in for a consultation at any private clinic or any government polyclinic. For emergency services, patients can go at any time to the 24-hour Accident & Emergency Departments located in the government hospitals.
The Agency for Integrated Care was established in 2009 to improve services in the community and in nursing homes. Regional health systems have been established to link hospitals with rehabilitation centres and primary care. Many of its initiatives have been supported through Temasek Cares.
Singapore's medical facilities are among the finest in the world. As of 2012, Singapore had a total of 10,225 doctors in its healthcare delivery system. This gives a doctor to population ratio of 1:520. The nurse (including midwives) to population ratio is 1:150, with a total of 34,507 nurses. There are 1,645 dentists, giving a ratio of 1 dentist to 3,230 people.
Hospitals in SingaporeEdit
In 2012, there were a total of 10,756 hospital beds in the 25 hospitals and specialty centres in Singapore. 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). 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).
The Singapore General Hospital is the largest and oldest hospital in Singapore, of which the foundation of its first building was laid in 1821.
The Tan Tock Seng Hospital is the second largest hospital in Singapore after the Singapore General Hospital, but its accident and emergency department is the busiest in the country largely due to its geographically centralised location. Set up in 1844 by an entrepreneur and philanthropist, Tan Tock Seng, the hospital came into the international spotlight when it was designated as the sole treatment centre for the SARS epidemic which struck the country in 2003.
There is one psychiatric hospital in Singapore, the Institute of Mental Health, previously known as Woodbridge Hospital after its old location near a wooden bridge in Yio Chu Kang. It is now located in Hougang.
Obstetrics and gynaecologyEdit
Singapore Medical Group Ltd acquired six obstetrics and gynaecology clinics in 2016 for $60m in October 2016.
Restructuring in 1990sEdit
In the 1990s, all public hospitals were "restructured" which means that they have been operated as government-owned corporations rather than the typical model of public hospitals in other countries.
There are six healthcare groups operating public hospitals and national specialty centres:
- Alexandra Health System
- Eastern Health Alliance
- National Healthcare Group
- National University Health System
However, MOH is currently reorganizing these healthcare groups from six to three.
Means testing in Singapore hospitalsEdit
Patients warded in B2 and C class wards in public hospitals with effect from 1 January 2009 will be means-tested to determine the level of subsidy they will be entitled.
- Patient subsidy will be based on the average monthly income received over the last available 12-month period including bonuses for salaried employees.
- Services such as Day surgery, A&E services, Specialist Outpatient and polyclinic visits will not be means tested and standard subsidies rate applied to citizens and PR as usual.
- People with no income, such as retirees or housewives, will have their subsidy rate pegged to the value of their homes.
- All unemployed residents of HDB flats excluding those in executive condominiums (EC) will be entitled to full subsidy.
|Means testing in public hospitals as of 1 January 2009 |
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.
Healthcare for workers and visitorsEdit
Foreign residents in Singapore who are not classed as Permanent Residents do not enjoy any subsidised or preferential access to healthcare in Singapore. They can, and do, use the primary healthcare facilities such as general practitioners, polyclinics at cost, however their quality varies widely: it is normally recommended to ask locals to advise on which doctors to use. For inpatient services, the government restructured hospitals provide a reasonably good service, but it is costly and patients will normally be asked to provide a credit card and pay a very large deposit upon admittance. The cost of these services can easily exceed the cost of private healthcare, especially for maternity/childbirth.
Many white collar foreigners are provided with health insurance by their employers. If not, local organisations such as NTUC Income have a number of schemes, usually with co-payment terms, for health coverage (NTUC is the National Trades Union Congress, a non-profit making organisation). The main NTUC Income medical plans used by foreigners (called iMedicare) are configurable to allow patients to visit primary and secondary health providers, with just their passport and iMedicare card to enjoy immediate, cashless, treatment (or treatment for a very low flat rate, perhaps just $5).
In general, Singaporeans tend to subscribe to a number of insurance plans, which may include healthcare, total and permanent disability (TPD) insurance, dread disease insurance and life insurance. Foreign residents may wish to inquire into similar schemes.
Short-term foreign visitors to Singapore are generally advised to ensure that they have medical coverage as part of their travel insurance.
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