Healthcare in Singapore

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 Organisation's ranking of the world's health systems in the year 2000.[1] Bloomberg ranked Singapore’s healthcare system the most efficient in the world in 2014.[2] The Economist Intelligence Unit placed Singapore 2nd out of 166 countries for health-care outcomes. [3] Bloomberg Global Health Index of 163 countries ranked Singapore the 4th healthiest country in the world and first in Asia.[4]

Overview

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.

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

As the median age of the population increases, Singapore's healthcare spending is expected to rise. Healthcare spending has risen from $4 billion in 2011 to $9.8 billion in 2016.[6][7] Health-related spending is the third largest expenditure item, after defence and education expenses.[8]

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 three healthcare groups operating public hospitals and national specialty centres:

  1. National Healthcare Group
  2. National University Health System
  3. SingHealth

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.[5][9]

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 & NTFGH), a women's and children's hospital (KKH) and a psychiatry hospital (IMH).[10] In addition, there are 8 national specialty centres for cancer (NCCS), cardiac (NHCS), eye (SNEC), skin (NSC), neuroscience (NNI), dental care (NDCS) and a medical centre for multiple disciplines (NCIS and NHCS).[10]

Public healthcare

Singapore's healthcare system uses a mixed financing system that includes nationalised life insurance schemes and deductions from the compulsory savings plan, or the Central Provident Fund (CPF), for working Singaporeans and permanent residents.[11] This mechanism is intended to reduce the overuse of healthcare services.

Medisave

A portion of one's monthly CPF contribution is allocated to the medical savings account, also known as Medisave, for future medical expenses and approved medical insurance policies.

Medishield

Launched in 1990, Medishield is a low cost basic insurance scheme intended for those whose savings are insufficient to meet their medical expenses.[12] Premiums can be paid out of Medisave accounts. A new scheme, Medishield Life, replaced the Medishield in November 2015. Co-insurance payment rates are to be reduced from 10–20% to 3–10% and the lifetime claim limit is to be removed.[13] The scheme helps to pay for hospital bills and selected outpatient treatments. The government provides premium subsidies to lower- to middle-income residents, the elderly and new policyholders transitioning from cheaper policies.

The Integrated Shield Plan (IP) includes both the MediShield Life component and an additional private insurance coverage component run by private insurers, to cover for optional benefits in public hospitals and private hospitals. Premiums for the IP can be paid by the Medisave funds.[12]

Eldershield

Eldershield is a severe disability insurance scheme which insures against the cost of private nursing homes and related expenses. Since 2002, members with a CPF Medisave account will automatically be enrolled in the scheme at the age of 40, unless they choose to opt out. Three private insurers, Aviva, Great Eastern and NTUC Income were chosen to manage ElderShield.[14] It has 1.2 million policyholders as of 2015, with $2.6 billion collected in premiums, and around $100 million in payout claims and $130 million in premium rebates between 2002 and 2015.[15][16]

Medifund

In addition to the insurance schemes, Medifund is government endowment fund for those who are unable to meet their assessed contribution. Risks are not pooled, so an individual may be exposed to catastrophic expenses.[17] A total of $155.2 million was allocated to patients in 2015.[18]

Means testing in Singapore hospitals

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 [19]
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.

Private healthcare

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

The government uses the capacity of the private sector to reduce waiting times in the public sector. In 2015 it plans to use the Raffles Medical Group to receive non-critical ambulance cases.[20]

Medical tourism

In October 2003, acting Minister for Health Khaw Boon Wan launched SingaporeMedicine to promote Singapore as a regional medical hub. He said more than 200,000 foreigners visited Singapore for medical services in 2002 and that the Economic Review Committee reaffirmed its ambition of serving 1 million foreign patients annually by 2012.[21] In his speech, Khaw said,

"SingaporeMedicine that we are launching today shall be the rallying point and a powerful symbol of our collective will and commitment towards this ambition...

In three specialties alone, heart, eye and cancer, I see tens of millions of middle-class patients within a 7-hour flying radius, waiting to be served. If they can be attracted here, they will keep us all very busy...

This is my dream for Singapore as the regional medical hub, where regional doctors and nurses compete to work here to learn, and where international patients seek us out for care and treatment."[22]

Government initiatives

National University Hospital
Singapore Chung Hwa Medical Institution

National Electronic Record Programme

The National Electronic Record Programme was launched in 2011 and is used by more than 280 institutions to support telehealth and telemedicine.[23]

Pioneer Generation Package

The Pioneer Generation Package (PGP) is a S$9 billion package launched in 2014 aimed at helping approximately 450,000 Singaporeans born on or before 31 December 1949 and obtained citizenship before 31 December 1986 through a series of healthcare and social support schemes over an estimated 20-year period.[24][25]

Healthcare Issues

Hospital bed crunch

The number of hospital beds was 11,936 in 2001, 11,394 in 2011 and 12,505 in 2014.[26] Against this, the population was 4.14 million in 2001, 5.18 million in 2011 and 5.47 million in 2014. The rate of increase of hospital beds did not keep up with the rapid population growth, leading to serious shortages of hospital beds.[27]

It was reported that Changi General Hospital had to resort to housing patients waiting for beds in a large tent[28] while Tan Tock Seng Hospital housed patients along corridors, convert rooftop gardens into wards and transfer more stable patients to Ren Ci Community Hospital to manage bed crunch.[29] Also, day surgery is being introduced where patients are admitted and discharged on the same day of their operation.[30]

According to research firm ValuePenguin, the average occupancy rates of Singapore public hospitals hovers around 85% but usually peak to as much as 93% during weekdays. It added that based on data from Ministry of Health, patients spent around 2.5 hours waiting to be admitted to a ward from the emergency department suggesting inadequate capacity and understaffing.[31]

See also

References

  1. ↑ The World Health Report 2000 : Health Systems : Improving Performance (PDF). Geneva, Switzerland: World Health Organization. 2000. p. 154. ISBN 92-4-156198-X.
  2. ↑ "Most Efficient Health Care Around the World". Bloomberg.com.
  3. ↑ "Singapore ranked world's No. 2 for health-care outcomes: EIU". Bloomberg.com.
  4. ↑ "Singapore healthiest Asian country; Italy tops global list despite economic crisis". Bloomberg.com.
  5. 1 2 "Singapore Health Facts". Ministry of Health, Singapore. Retrieved 29 August 2014.
  6. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 43. ISBN 978-1-137-49661-4.
  7. ↑ Basu, Radha (7 October 2017). "Long-term care: If this is so important, why aren't we putting our money where our mouth is?". The Straits Times. Retrieved 24 October 2017.
  8. ↑ Ramchandani, Nisha (21 February 2017). "A smaller budget surplus of S$1.91b likely for FY17". The Business Times. Retrieved 24 October 2017.
  9. ↑ Overview of Doctors and Dentists in Singapore Archived 26 January 2013 at the Wayback Machine. at DoctorPage.sg
  10. 1 2 "Hospital Services". Ministry of Health, Singapore. Ministry of Health, Singapore. Retrieved July 25, 2017.
  11. ↑ "Costs and Financing". Ministry of Health. Retrieved 22 October 2017.
  12. 1 2 Huang, Claire (15 July 2017). "The Good, the Bad, and the Ugly of Integrated Shield Plans". The Business Times. Retrieved 24 October 2017.
  13. ↑ Khalik, Salma (31 October 2015). "MediShield Life coverage to kick in at midnight". The Straits Times. Retrieved 24 October 2017.
  14. ↑ Tan, Weizhen (7 July 2017). "Govt studying proposal to take over running of ElderShield". TODAY. Retrieved 24 October 2017.
  15. ↑ "S$90m paid out in ElderShield claims since its 2002 launch". Channel NewsAsia. 4 April 2016. Archived from the original on 2017-10-24. Retrieved 24 October 2017.
  16. ↑ "Parliamentary Debates Singapore – Official Report" (PDF). National Archives of Singapore.
  17. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 42. ISBN 978-1-137-49661-4.
  18. ↑ "Medifund assistance dropped to S$155.2m last year". TODAY. 24 November 2016. Retrieved 24 October 2017.
  19. ↑ Means Testing at Singapore public hospitals
  20. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 44. ISBN 978-1-137-49661-4.
  21. ↑ https://www.theonlinecitizen.com/2018/10/02/sg-medical-tourism-started-by-khaw-asking-philip-yeo-to-implement-khaw-exhorts-yeo-with-may-the-force-be-with-you/
  22. ↑ http://www.nas.gov.sg/archivesonline/speeches/view-html?filename=2003102098.htm
  23. ↑ Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 15. ISBN 978-1-137-49661-4.
  24. ↑ "Singapore Budget 2015 Annex B-1: Pioneer Generation Package" (PDF). Retrieved 27 March 2018.
  25. ↑ "Pioneer Generation Package".
  26. ↑ http://www.singstat.gov.sg/docs/default-source/default-document-library/publications/publications_and_papers/reference/monthly_digest/mdsapr15.pdf
  27. ↑ https://www.businesstimes.com.sg/top-stories/hospital-bed-crunch-a-cumulative-problem
  28. ↑ https://www.straitstimes.com/singapore/hospitals-facing-severe-bed-crunch-take-unusual-steps
  29. ↑ https://www.ttsh.com.sg/page.aspx?id=6105
  30. ↑ https://www.straitstimes.com/singapore/tackle-bed-crunch-now
  31. ↑ https://sbr.com.sg/healthcare/news/singapore-public-hospitals-cave-under-pressure-overcrowding-0

This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.