Singapore health

The healthcare
system of

SINGAPORE

Presented by:
Ms. Gharam Ahmad Alawneh
Ms. Asmaa Asaad Shaheen
Ms. Haleema Mohammed Ali Alshehhi

Course:
Executive Master in Healthcare management
& Economics - EMHME -2019

Singapore Population: 5.2 million
Size of Country: 707 km sq.
is an island country
located in Southeast Asia

Mandate
Mission
Vision

Philosophy - The Ministry of Health be-
lieves in ensuring quality and afforda-
ble basic medical services for all

Mission 12

Characterized by 3 stratgies Promote good health Ensure access to good
and reduce illness and affordable health-
Core values include
dedication, excellence, care
professionalism, integrity,
and teamwork 3

Their vision is championing Pursue medical
a healthy nation with out people - excellence
To live well, live long & with peace of mind

Factors that Influenced Historic
Helathcare Roots
System Development
• Singapore used to be a coun-
There are four main contributing factors to Singa- try of poor incomes and poor
pore’s successful healthcare system: health outcomes
1. Movement towards outpatient services after In-
• The country gained independ-
dependence in 1965 ence in 1965, but faced hous-
2. Sending doctors abroad to train in specialties (i.e. ing shortages and high rates of
unemployment
Healthcare Manpower Development Program)
3. 1983 National Health Plan, which reconstructed • The People’s Action Party pro-
vided political stability for Sin-
the public hospital system and introduced Me- gapore and has contributed
disave to the many successes of the
4. The release of the White Paper entitled “Afforda- country.
ble Health Care” in the 1990’s
• Early initiatives were put in
place to improve housing,
clean water, etc.

• In 2011 there was increased
concern that families were ex-
periencing bankruptcy when
trying to pay for the elderly
care

Major Stakeholders

1. Patients
2. Government
3. Healthcare Providers
4. Hospitals administrators and

governing bodies
5. Helath Insurance

Healthcare Analysis of
Fundig Structure Helathcare

• Spends less than 4% of GDP on System
healthcare (vs. Canada at 11.2%)
• Funding structure
• Consists of the 3M system (Me- • Regulatory bodies
disave, Medishield and Medi- • How healthcare is delvered
fund) • How the system ranks worldwide

• The most recent addition is El- Medifund
dershield
• This is an endowment fund setup by the
• Private insurers also help fund Government for individuals whose Me-
the healthcare system disave and Medishield are not adequate
enough to cover their hospital expenses

• Elderly peiople are a priority
• Medifund is added when there is a sur-

plus in the healthcare budget
• Medfund-approved Institutions (MFI) give

approval to Medifund applications

Age Medishield Yearly Medishield
Premiums
1 to 30 $ 33 • A complementary service to Medis-
31 to 40 $ 54 ave
41 to 50 $ 114
51 to 60 $ 225 • This is a medical insurance that al-
61 to 65 $ 332 lows individuals to settle part of the
66 to 70 $ 372 expenses from out patient treat-
71 to 73 $ 390 ments for serious illness and pro-
74 to 75 $ 462 longed hospitalization
76 to 78 $ 524
79 to 80 $ 615 • Premiums change depending on
81 to 83 $ 1087 age
84 to 85 $ 1123

Singapore’s helathcare system is a mixture of both public and private sectors and would fit
under an etatist social health insurance system according to Bohm et al. (2013).

Medisave Eldershield

A national medical insurance in which Singa- • An affordable insurance for severe
poreans build savings for future healthcare illness or disability to those who
needs need basic financial protection

• These savings can pay for hospitalization • Ran by private insurers
and outpatient treatments for the individual
and their immediate family Private Finance
• Can also help pay for Medishield pre-
miums and Private Medical Insurance • There are five private insurers that
Scheme offer private plans for individuals
and groups
• Monthly contribution to the Medisave ac-
count is mandatory • Plans cover inpatient and outpa-
tient medical expenses, surgical
• Increasing population leads to an increase costs, critical illness, disability,
in Medisave accounts and long term care

• Offer two types of plans
1. Private Medical Insurance
Scheme (PMIS)
2. Non-PMIS

Regulatory Bodies

The state regulates the public and private providers through the requirement of a license

Ministry of Health Legislative acts under the MOH
• Public health and safety
Oversees the provisions and regulation of • Drugs and medicinal related sub-
healthcare services
• Promoting health education stances
• Preventing and controlling disease • Biosafety and biosecurity
• Allocating resources • Healthcare and professionals
• Monitoring accessibility and quality of • Diseases and other medical condi-

healthcare services tions
• Administering licenses for healthcare • Medical practices and research
• Others
facilities

In Singapore, all healthcare Health Sciences
professionals are self-regulat- Authority
ed under one of the following
professional bodies: Works under the MOH and has three
main functions:
• Singapore Medical Council
• Singapore Dental Council • It is the national regulator for health products
• Singapore Nursing Council • It creates blood supply for hospitals through-
• Singapore Pharmacy Council
• Traditional Chinese Medicine out the nation through its operation of the na-
tional blood bank
Practitioners Board • It represents expertise in forensic medicine,
• Optometrist and Opticians forensic science and analytical chemistry
testing capabilities
Board
• Allied Health Professional Monetary Authority of
Singapore
Council
Singapore’s Central Bank:

• It regulates the financial aspect of the insur-
ance sector

• Administers the Insurance Act
• Regulates insurer’s activities (including regis-

tration and licensing requirements)

Organization of
Health Services
and Delivery

Supplies its citizens with primary, hospital, Service Delivery
long term and other integrated care ser- Private 80%
vices.
80% of healthcare services are provided Public 20%
through private practitioners, while the
other 20% is publicly delivered

Hospitals Medical Clinics

• Provide inpatient, outpatient, and emergency • Provide medical treatments, up-
care stream programs, and education

• 80% of this care is pblicly funded and 20% is • 80% of these services are private-
privately funded ly funded, while the other 20% are
publicly funded.
• Approximately 75% of all physicians and nurs-
es work within public facilities

Health Clusters 1. Alexandra Health (anchored by Khoo Teck Puat
Hospital in the North)
• The MOH has recently re-
constructed the healthcare 2. Eastern Health Alliance (anchored by Changi Gen-
system to provide patients eral Hospital in the East)
with more holistic and inte-
grated care. The country is 3. National Healthcare Group (anchored by Tan Tock
split into 6 regional health- Seng Hospital in the central region)
care systems, each con-
taining a regional hospital 4. National University Health System (anchored by
and a variety of primary, in- National University Hospital)
termediate, and longterm
care services and facilities. 5. Jurong Health (anchored by the upcoming Jurong
General Hospital in the west)

6. SingHealth (anchored by the Singapore General
Hospital)

Health Status of Aging Population
Nation Served
• By 2030, 20% of the population is
Including population health concerns, expected to be 65+
whether or not the system is meeting
the needs of the population, and bar- • Result of increased life expectancy
riers to service provision. and declining fertility rates

Health Concerns of the How is Singapore addressing these
Population Being Served issues?
There is a shift from episodic care to
• Aging population longterm care, treatment of chronic
• Management of chronic disease disease, and community disease pre-
• Communicable disease control vention.

Communicable
Disease Control

Management of • SARS outbreak of 2003 demon-
Chronic Disease strated a need for infection control

• Some of the most prevalent chronic illness- • 200 reportable cases of Chikun-
es that impact Singapore include: Asthma, gunya (mosquito borne disease) in
COPD, Diabetes Mellitus, Hypertension, 2008
High Cholesterol, and Stroke
• Preparation for influenza outbreaks
• Growing diabetic and obese population • Dengue fever (vector control)
• In 2010, apporximately 11% of Singa-
pore’s citizens were living with a diagno-
sis of diabetes. This number increased
3% between 2004 and 2010.

Are Healthcare
Needs Being Met?
Yes!

• Life expectancy How is this possible?
• Women - 84 years
• Men - 79 years Patient Satisfaction Surveys:
• In 2010, over 75% of patients reported being
• Infant mortality
• 2 deaths per 1000 live births satisfied with healthcare services
annually • 80% of patients would recommend the servic-
• One of the lowest rates world-
wide! es of public healthcare institutions to others
Government Responsiveness to Citizen Con-
• Childhood diseases cerns:
• National Childhood Immuniza- • During the 2011 elections, a need for affordable
tion Programme
• Decrese in diphtheria, tetanus, healthcare for the elderly was expressed. As a
polio, and congenital rubella result, the Ministry of Health’s budget was dou-
bled to support the aging population
• Adult mortality rate • Finances were directed towards subsidizing
• 60 deaths per 1000 adults an- caregivers, long-term care, nursing homes,
nually day care, rehabilitation care, and home care.
• Signifantly lower than the rest
of Southeast Asia

Barriers to
Service Provision

1. Aging Population 1. Aging Population
• Affordability
• Elders face may issues in re- • Accessibilty
gards to affordability and ac- 2. Manpower challenges
cebility of services
How is Singapore Addressing This Issue?
• Elderly people with chronic
diseases who are living in pov- • Engaging a wide variety of government minis-
erty do not have access to ap- tries (eg. Finance, Transportation, Housing, etc.)
propriate treatment services
• Expanding Eldercare Facilities and integrating
• Quality of care tends to de- these services into neighbourhoods
crease after discharge from
hospital • Orgnizations ensure all patients receive care in
the community following discharge
• Patients have difficulty access-
ing support and treatment ser- • Linding acute care and community services that
vices in the community are supported by primary care providers and
community organizations

2. Manpower Challenges

• Current shortage of nurses and specialists
• Lead to overseas recruitment
• Make it difficult to initiate changes in healthcare

Conclusion

• Singapore ranks sixth in the world
in healthcare outcomes

• Singapore spends less on health-
care than any other high-income
country

• Overall, Singapore appears to be
providing exceptional healthcare
services to their entire population
through a variety of delivery meth-
ods

The healthcare
system of

SINGAPORE

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