The little red dot

Milind Sabnis, director of healthcare, Asia Pacific, Frost & Sullivan, looks at how Singapore has become Southeast Asia’s hub for healthcare and maintains its position at the top. 

Singapore is known as the ‘little red dot’ on the map. Despite its small size, this little red dot is hugely significant in the Southeast Asia region.

The island city-state of Singapore is one of the wealthiest and most densely populated countries in Asia. Singapore has a smaller GDP compared to neighbouring countries, however it has the highest GDP per capita (US$52,588 in 2018) in Southeast Asia.

While Singapore’s total population is growing at a slower pace, there is a rapid increase in the proportion of residents aged 65 years and above. This can be attributed to a longer life expectancy which was 82.9 years in 2016.

The shape of Singapore’s healthcare system

Singapore’s health system is unique. On the one hand, Singapore’s hospital beds per 1,000 population ratio of 2.3 is below the OECD (4.8) and world (3.4) averages. And its average number of doctors per 1,000 population ratio in 2015 was 2.3, lower than the OECD average of 3.4, but it has one of the finest healthcare systems that attracts medical tourists around the globe.

Although Singapore’s total health expenditure as a percentage of GDP is significantly less (7%) than that of the US (~17%) and the average for OECD countries (9%), it is widely recognised as one of the most efficient healthcare systems in the world. The Bloomberg Health-Care Efficiency Index 2016 ranked the healthcare system in Singapore as the second most efficient system in the world, after Hong Kong.

Singapore offers subsidised healthcare for public hospitals, and plans such as Medifund, a medical endowment fund for patients who cannot afford to pay their medical bills despite the subsidies; Medisave, compulsory medical savings for working Singaporeans); and MediShield Life, a universal health insurance scheme. The Central Provident Fund (CPF) Board manages Medisave and MediShield Life. Private health insurance companies have
collaborated with the Government to offer Integrated Shield Plans (IPs), which combines private health insurance with the MediShield Life, allowing consumers to avoid having to pay for double premiums.

The Ministry of Health is responsible for implementation and enforcement of healthcare policies, regulation of healthcare service providers, financing of public healthcare services, allocating manpower, and monitoring health epidemics.

The MOH licences and regulates all healthcare establishments in the public and private sector, including hospitals, clinical laboratories, nursing homes, as well as medical and dental clinics.

Public healthcare fees are heavily regulated and subsidised as all residents are entitled to basic affordable care. Corporate groups and standalone professionals own and operate private health institutions.

Although the MOH does not regulate the fees at private facilities, it requires both the private and public health providers to publish hospital bill sizes to the public to create transparency in pricing.

MOH’s facilitator, MOH Holdings (MOHH), is a private group that is the holding company of public hospital clusters, and is in charge of managing all operations, implementation, and
execution planning. Each cluster’s chief executive officer is a board member of MOH Holdings, chaired by the permanent secretary of the MOH.

Supervising delivery

There are two statutory boards under the supervision of the MOH to monitor various aspects of the healthcare system, namely the Health Promotion Board and Health Sciences Authority. Another body, the Singapore Medical Association, manages the code and conduct of healthcare professionals.

In early 2018, Singapore reorganised and streamlined its public healthcare into three integrated clusters to cater to the main regions across the island.

The reorganisation merges six regional health systems into the following clusters:

• Singapore Health Services (SingHealth)
and the Eastern Health
Alliance (overseeing Changi General
Hospital) cluster serving the
Eastern region

• National Healthcare Group (NHG)
and Alexandra Health System
(operates Khoo Teck Puat Hospital
and others) cluster serving the
Central region

• National University Health System
and Jurong Health Services
(oversees Ng Teng Fong General
Hospital) cluster serving the Western
region

Each cluster provides a full range of services and has a medical school as well. All polyclinics have been reorganised in line with the clusters.

The purpose behind the initiative is to ensure optimal utilisation of resources and provide comprehensive holistic care to residents. However, 80% of the primary care demand is met by private general practitioner clinics, allowing the private primary healthcare sector to thrive.

80% OF THE
PRIMARY CARE
DEMAND IS
MET BY PRIVATE
GENERAL
PRACTITIONER
CLINICS,
ALLOWING THE
PRIVATE PRIMARY
HEALTHCARE
SECTOR TO THRIVE

There are nine public and ten private acute hospitals in Singapore and nine public and one private community hospital, for rehabilitation catering to post stroke, post joint-surgeries patients.

Public private partners

Recognising the high burden on the public system, the MOH is initiating efforts to work alongside the private sector to ease the volume of patients going to the public sector.

Example: a government-led initiative Emergency Care Collaboration between the MOH and Raffles Hospital, in which patients referred by the Singapore Civil Defence Force ambulances receive subsidised emergency care similar to the rates of public hospitals for non-life threatening conditions at Raffles Hospital.

Another example: Parkway Hospitals, which inked an agreement to accept dengue patients from two public hospitals.

A rapidly growing ageing population and the associated increase in the prevalence of chronic diseases are among the critical issues putting further strain on Singapore’s healthcare system, given the shortage of healthcare professionals and limited facilities.

To address this challenge, the government is prioritising preventive healthcare by implementing programmes that stress prevention, early detection, and promoting a healthy lifestyle.

The MOH has released the Singapore Healthcare 2020 Master Plan that serves as a roadmap to provide healthcare services that are accessible, affordable, and of high quality to Singaporeans.

To tackle the shortage of health professionals and the high burden to the healthcare system, the Manpower Plan, under the Master Plan, intends to add new facilities and healthcare professionals to manage the system efficiently.

Singapore is well-known for its advanced medical technology and highly skilled doctors, which attract affluent medical tourists.

Branding a service

The Singapore Tourism Board brands Singapore as an advanced medical care destination, and continually collaborates with private healthcare providers on marketing and promotional efforts to expand their reach to key target markets.

Singapore attracts medical tourists from diverse regions, including the Middle East, Asia-Pacific, and Europe, due to its state-of-the-art health facilities and advanced medical expertise.

Recognised for its cutting-edge procedures, the city-state draws in primarily affluent medical travellers who are able and willing to pay the high costs associated with private healthcare care in the country.

There has been a decrease in medical visitors coming from neighbouring ASEAN countries, as medical infrastructure is improving and healthcare in these regions are comparatively more affordable. Several private hospitals are addressing these concerns by offering a luxury experience to potential affluent travellers, whereas others are looking to diversify investments by procuring healthcare projects overseas.

The Singapore Tourism Board continues to work alongside private healthcare providers to position Singapore as an advanced medical care destination and expand their reach in key target markets. Private healthcare providers are bringing more innovative approaches to increase the comfort and treatment options for patients, and ensuring that the facilities adopt new medical technology to attract a higher-end consumer base of medical tourists.

Leading specialities that drive demand include oncology, organ transplant, stem cell therapy, and cosmetic surgery.

International acclaim

The gold standard of healthcare accreditation, the JCI has given 23 healthcare certifications in Singapore, of which seven are private hospitals and four are public health hospitals. The remaining 12 consist of accreditation for specific programmes such as the Acute Myocardial Infarction programme in Changi Hospital, primary care, and ambulatory care facilities.

Having globally recognised accreditation is especially critical for Singapore, which is aiming to advertise its medical tourism industry as advanced tertiary care compared to other countries in the region.

SINGAPORE IS A
MELTING POT OF
MULTI-RACIAL AND
MULTI-RELIGIOUS
DIVERSITY

Singapore is a melting pot of multi-racial and multi-religious diversity, with the ready availability of a diverse range of cuisines (including halal food) and understanding of different cultures attracting tourists from all over.

English is one of the main languages in the country and is spoken at all healthcare centres, allowing for ease of communication between healthcare providers and the patients.

A throbbing hub

In summary, Singapore’s healthcare market is well-developed, with accessibility to high-quality care in both the public and private healthcare service sectors. It is renowned for the availability of advanced and complex medical and technology within the Southeast Asian region. The public healthcare system is a unique blend of compulsory medical saving with universal health insurance and subsidised healthcare.

The universal health insurance and medical saving can also be utilised in the private healthcare sector. This allows healthcare to be affordable while still placing importance on individual responsibility.

In short, the red dot is a throbbing hub for healthcare, almost like the heart of the region.