Singapore’s healthcare market is well-developed, with accessibility to high-quality care in both the public and private healthcare service sectors. Known for the availability of advanced and complex medical care and technology within the Southeast Asia region, it is promoting itself to affluent medical travellers as an advanced medical care destination. Milind Sabnis, director of healthcare, Asia Pacific, Frost & Sullivan, looks at Singapore’s healthcare offer.
Singapore is known as the ‘little red dot’ on the global map. Despite its small size, this dot is hugely significant in the Southeast Asia region. The island city-state is one of the wealthiest and most densely populated countries in Asia. It 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 slow 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 most efficient healthcare systems in the world, that attracts affluent medical tourists from around the globe. 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 (MOH) 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.
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. 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.
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, for 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
- 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.
Advanced tertiary care destination for medical travellers
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 the world. 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.
The city-state 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.
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. These are 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. Some facilities are adopting new medical technology to attract a higher-end consumer base of medical tourists.
Leading specialities that are actively driving medical travel demand include oncology, organ transplant, stem cell therapy, and cosmetic surgery.
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. 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.