Healthcare in Singapore

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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 Organization's ranking of the world's health systems in the year 2000.[1] Bloomberg ranked Singapore’s healthcare system the 2nd most efficient in the world after Hong Kong.[2]

Overview[edit]

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. Singapore's system uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalized 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.

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 overutilisation of healthcare services, a phenomenon often seen in fully subsidised universal health insurance systems. 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.

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 amount to very large out-of-pocket payments above the levels provided by government subsidies.

Statistics[edit]

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,[3][dubious ] partly because government expenditure on healthcare in the private system is extremely low.

Singapore currently has the lowest infant mortality rate in the world (equalled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization.[4]

Healthcare today in Singapore[edit]

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.[5] 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 programs.[5]

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.

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.[3][6]

Singapore has a medical savings account system known as Medisave.

Hospitals in Singapore[edit]

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).[3]

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[edit]

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.

Restructuring in 1990s[edit]

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

Means testing in Singapore hospitals[edit]

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 [7]
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[edit]

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 subsidized or preferential access to healthcare in Singapore, desipite 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 organizations 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 organization). The main NTUC Income medical plans used by foreigners (called iMedicare[8]) 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[edit]

See also[edit]

References[edit]

External links[edit]