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.[1] Bloomberg ranked Singapore’s healthcare system the 1st most efficient in the world in 2014.[2]

Overview

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

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.

Funding

A key principle of Singapore's national health scheme is that no medical service is provided free of charge, regardless of the level of subsidy, even within the public healthcare system. This mechanism is intended to reduce the over-utilisation 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.

Singapore's system uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalised health insurance plan known as Medisave. Within Medisave, each citizen 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.

Medishield is a low cost 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, was agreed by parliament in January 2015. Co-insurance payment rates are to be reduced from 10–20% to 3–10% and the lifetime claim limit is to be removed. Eldershield is part of the Central Provident Fund which insures against the cost of private nursing homes and related expenses. It already has more than a million policy holders. Medifund is a safety net for those who are unable to meet their assessed contribution. Risks are not pooled, so an individual may be exposed to catastrophic expenses. [3]

See also Central Provident Fund.

Government funding

Government spending on healthcare was planned to rise from SG$5.8 billion in 2013/4 to SG$7.1 billion in 2014/5, an increase of 22%.[4]

Private healthcare

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. [5]

Statistics

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,[6] 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 DDP and has stayed almost constant since independence.[7]

Healthcare today in Singapore

National University Hospital
Singapore Chung Hwa Medical Institution

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.[8] 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.[8]

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.

The National Electronic Record Programme was launched in 2011 and is used by more than 280 institutions to support telehealth and telemedicine. [9]

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.[6][10]

Hospitals in Singapore

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 & AH), a women's and children's hospital (KKH) and a psychiatry hospital (IMH).[6]

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.

Mental health

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 gynaecology

Singapore Medical Group Ltd acquired six obstetrics and gynaecology clinics in 2016 for $60m in October 2016.[11]

Restructuring in 1990s

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 restructured hospitals and Specialist Centres:

  1. Alexandra Health System
  2. Eastern Health Alliance
  3. Jurong Health Services
  4. National Healthcare Group
  5. National University Health System
  6. SingHealth

Means testing in Singapore hospitals

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.

Means testing in public hospitals as of 1 January 2009 [12]
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.

Healthcare for workers and visitors

Those working in Singapore who are not classed as Permanent Residents (which includes almost all foreign workers and a large proportion of expatriates) do not enjoy any subsidised or preferential access to healthcare in Singapore, despite paying the same tax (usually more) than Singapore citizens. 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[13]) 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.

Crisis

See also

References

  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 2014, Bloomberg], accessdate 11/30/2014
  3. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 42. ISBN 978-1-137-49661-4.
  4. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 43. ISBN 978-1-137-49661-4.
  5. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 44. ISBN 978-1-137-49661-4.
  6. 1 2 3 "Singapore Health Facts". Ministry of Health, Singapore. Retrieved 29 August 2014.
  7. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 15. ISBN 978-1-137-49661-4.
  8. 1 2 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.
  9. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 15. ISBN 978-1-137-49661-4.
  10. ↑ Overview of Doctors and Dentists in Singapore at DoctorPage.sg
  11. ↑ "Singapore Medical Group to acquire obstetrics and gynaecology clinics". Singapore Business review. 11 October 2016. Retrieved 6 November 2016.
  12. ↑ Means Testing at Singapore public hospitals
  13. ↑ "NTUC Commercial Insurance". Retrieved 2 July 2014.
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