Overview

Singapore's reputation of having a well-established healthcare infrastructure with an excellent reputation for quality medicine has been recognised and consistently ranked by the World Health Organisation to be among the world's best. In its last World Health Report on health systems, Singapore was ranked top in Asia and sixth globally1.


Member State Attainment of Goals Health expenditure per capita in international dollars Performance
Health Responsiveness Fairness in financial contribution Overall goal attainment On level of health Overall
health
system
performance
Level (DALE) Level
France 3 16-17 26-29 6 4 4 1
Italy 6 22-23 45-47 11 11 3 2
San Marino 11 32 30-32 21 21 5 3
Andorra 10 28 33-34 17 23 7 4
Malta 21 43-44 42-44 31 37 2 5
Singapore 30 20-21 101-102 27 38 14 6
Japan 1 6 8-11 1 13 9 10
United Kingdom 14 26-27 8-11 9 26 24 18
Switzerland 8 2 38-40 2 2 26 20
Germany 22 5 6-7 14 3 41 25
Canada 12 7-8 17-19 7 10 35 30
Australia 2 12-13 26-29 12 17 39 32
USA 24 1 54-55 15 1 72 37
New Zealand 31 22-23 23-25 26 20 80 41
Malaysia 89 31 122-123 55 93 86 49
China 81 88-89 188 132 139 61 144


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Healthcare Management

Singapore’s healthcare management is based on the philosophy of building a healthy population through preventive healthcare programmes and promoting a healthy lifestyle. This is achieved through an integrated healthcare system comprising of public and private healthcare, complemented by high standards of living, housing, education, medical services, water supply and sanitation and preventive medicine. Our philosophy also promotes individual responsibility towards healthy living and medical expenses through financing schemes such as Medisave, Medishield, ElderShield and Medifund that help Singaporeans “co-pay” their medical expenses.

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Primary, Intermediate and Long-Term Healthcare

About 80% of primary healthcare is provided through some 2,000 private medical clinics which are located at the doorstep of the population in the city, housing estates and satellite towns, while the remaining 20% is provided through the 18 polyclinics in the public sector. Each polyclinic serves as a one-stop health centre that provides outpatient medical care, follow-up of patients discharged from hospitals, immunisation, health screening and education, investigative facilities and pharmacy services. There is also a comprehensive range of residential and community-based healthcare services that caters to the long-term care needs of Singaporeans. These services include community hospitals, chronic sick hospitals, nursing homes, sheltered homes for the ex-mentally ill, inpatient hospice institutions, home medical, home nursing and home hospice care services, day rehabilitation centres, dementia day care centres, psychiatric day care centres and psychiatric rehabilitation homes.

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Secondary and Tertiary Healthcare

Approximately 20% of secondary and tertiary healthcare is provided by the private sector. The remaining 80% is provided by the public sector in 15 hospitals and specialty centres with a total of about 8,368 hospital beds2. The Government's role as the dominant health care provider allows it to influence the supply of hospital beds, the introduction of high-tech/high-cost medicine, and the rate of cost increases in the public sector which sets the bench mark in terms of pricing for the private sector.

Within the public hospitals, patients have a choice of the different types of ward accommodation on their admission. 80% of the public hospitals' beds (class B2 and C) are heavily subsidised with the remaining 20% with lower subsidy at 20% for class B1 and no subsidy for A class wards3. Since January 2009, public hospitals also practice means-testing in determining the level of subsidies that each patient is entitled to – subsidies are now also pegged according the patient’s financial capabilities (e.g monthly income & annual value of their residence). It is estimated that means-testing will only affect a minority of higher income earners who choose Class B2 or C wards, but even they will continue to be heavily subsidised, by at least 50 per cent.

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Structure of Public Healthcare Institutions in Singapore

The public healthcare institutions in Singapore, while wholly owned by the government, are run as private companies, with management autonomy and flexibility to respond more promptly to the needs of the patients. They receive an annual government subvention or subsidy for the provision of subsidised medical services to the patients, and are managed like not-for-profit organisations. They are subject to broad policy guidance by the Government through the Ministry of Health. All the seven hospitals in Singapore are Joint Commission International (JCI) accredited, accounting for a third of all JCI-accredited facilities in Asia.

The public healthcare institutions had been broadly grouped into two clusters - the National Healthcare Group (NHG) and the Singapore Health Services (SingHealth) – till a recent restructuring initiative announced by Health Minister, Mr Khaw Boon Wan, in April 2008 aimed at making public healthcare more accessible to its patients.

These hospitals will move from a two-cluster system to operate under a new pyramid model, which will be anchored by Regional Hospitals, each serving the island’s north, west, east and central zones. These hospitals would refer patients to the National Centres – which occupy the apex of the pyramid – at the Outram and Kent Ridge sites. SingHealth will run the Outram medical research campus, where the Duke Graduate Medical School is currently co-located with the Singapore General Hospital; while the National University Health System (NUHS), the joint venture between the National University Hospital, Faculty of Dentistry and the Yong Loo Lin School of Medicine will operate at Kent Ridge.

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Pyramid Model

Under this new model, the Regional Hospitals will be given more autonomy in day-to-day operations, manage polyclinics, their own networks of general practitioners and a step-down care facility in their respective zones. This integrated structure will allow for seamless and integrated primary as well as secondary care more optimally than the previous dual-cluster system.

1 WHO’s World Health Report in 2000 on health systems, Singapore was ranked 6th out of 191 countries and top in Asia for our health system.

2 Statistics as at 2007.

3 Class A - Single room, Class B1 – 4 bed room, Class B2 – 6 bed room and Class C - ≥ 6 bed room.


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