The Singaporean Healthcare System
This article will introduce foreigners to the extent and the delivery method of healthcare in Singapore.
Singapore has one of the world’s most effective and respected healthcare systems. Seen as a model by President Barack Obama as the United States explored ways to reform its own healthcare system, Singapore has consistently led Asia – ahead of Japan and Hong Kong – and placed highly globally and in international rankings by the World Health Organisation (WHO). Additionally, the Political and Economic Risk Consultancy (PERC) has recognised Singapore as having the third best healthcare system in the world.
The city’s 5.5 million residents are more than adequately served by 25 hospitals and specialty centres, including six acute general hospitals, a psychiatric hospital and a women and children’s hospital. Twelve of the city’s hospitals and medical facilities are accredited by the Joint Commission International (JCI), meaning one-third of all JCI-accredited medical institutions in Asia are located in Singapore. The comprehensive healthcare system and leading medical centres mean that any type of required medical treatment is available at a reasonable cost in Singapore.
A mixture of private and public facilities makes up Singapore’s healthcare infrastructure. Both offer exceptional, world-leading standards of medical care, but differentiate in the level of comfort and service offered to patients. Your employer and your immigration status will largely be the determinant of what health insurance, plans and benefits are available to you. Citizens and permanent residents can avail themselves of government-subsidised healthcare services delivered through a compulsory national savings scheme, while foreigners residing on work passes will either have to purchase the healthcare they need with their own money or access coverage through their employer. Employers are not required to provide health insurance for employees and plans are made available at the employer’s discretion. A general rule of thumb is that the larger the company you are working for, the higher the chance that you will be provided with some kind of health insurance benefits.
Government (public) healthcare facilities
Public facilities primarily exist t deliver subsidised healthcare services to Singaporean citizens and permanent residents. The government funds and owns a number of hospitals providing a range of inpatient services, as well as numerous polyclinics across the city for outpatients. While wholly owned by the government, the public healthcare sector operates on the model of a private limited company to encourage it to compete with the private healthcare sector on the metrics of quality of care and service. This differentiates them sharply from what other companies would term a ‘government hospital’. Singapore’s public healthcare sector not only provides an exceptional standard of healthcare to the majority of residents, but also receives referrals of complicates cases from other, less well-equipped hospitals both domestically and from neighbouring countries. A list of major public hospitals is provided towards the end of this article.
The government health system is also used to set benchmarks for the private sector on fees and professional medical standards. In practice, this means that the government has the power to influence long-term trend such as the total number of available hospital beds in the city, the rate and scale of introduction of high-tech or high-cost medical or surgical practices, and the rate of cost increases in the public sector, which in turn sets the benchmark for the private sector’s pricing. Private health services are charged directly to the patients who pay on a fee-for-service basis, while public health service charges are subsidised by the government.
Private healthcare facilities
The standard of healthcare provided in Singapore’s private system is considered to be equal or superior to that of anywhere else in the world. Non-Singaporeans on working visas will find the difference in cost between the public and private sectors to be negligible, as they are encouraged to compete on price with each other. Due to the lack of subsidisation, private healthcare facilities are less frequently used by permanent residents and citizens, resulting in shorter waiting times for procedures. This, combined with the overall higher standard of service, means that most foreigners working in Singapore utilise private facilities.
The private sector is composed of numerous private clinics providing a wide range of outpatient services, as well as a number of private hospitals. The majority of private hospitals in Singapore are accredited by the JCI. A list of the major private hospitals in Singapore is provided toward the end of this article.
Government health insurance
Permanent residents and citizens of Singapore are entitled to access government subsidised healthcare services provided through public healthcare hospitals and clinics. The rate of subsidy ranges from between 50 per cent and 80 per cent of total costs depending on a number of factors. The Central Provident Fund (CPF) – a compulsory saving scheme for permanent residents and citizens – provides additional help in co-paying the balance of the individual’s medical bills. A percentage of an employee’s monthly salary – dependent on their age and income – is contributed to their private CPF account. As such, the CPF is not a nationally redistributive account, and only the amount in there is available for use by you or your dependents. This is to say that it will not be used to subsidise the benefits of another employee on a lower wage than you. A portion of your CPF contributions are paid towards medical insurance schemes, including Medisave, Medishield, Eldershield and Medifund. Collectively, these schemes can handle the majority of many co-pay amounts.
An example: Mr X is a citizen of Singapore on a current salary of S$4,167 per month. He is hospitalised, and elects to stay in a Class C ward. A breakdown of how the costs will be distributed and subsidised, and what he can expect to pay under two separate scenarios is found below:
Medisave Bill Subsidy (source: Ministry of Health)
|If he earns S$5,201 or more||65%||$1,008||0||$1,008||0|
|If he earns S$5,201 or more||65%||$4,011||$1,034||$2,977||0|
Please refer to the Ministry of Health to learn more about Singapore’s subsidised healthcare system.
Private health insurance
Foreigners working in Singapore are exempt from making CPF contributions, but conversely are locked out of accessing government subsidised medical care and health insurance schemes as described above. The positive is that day-to-day healthcare expenses are considered to be quite affordable in Singapore, even without health insurance coverage. However, careful thought must be given to your health insurance options to ensure minimal financial impact in the event of critical illness in your or in a dependent.
If your employer in Singapore is a medium to large-sized company, it’s likely that you will be provided with a health insurance policy that offers coverage for both you and your family. It is recommended that you check with your employer about any health insurance benefits offered if you are in the proves of moving to Singapore for work.
If you are an entrepreneur looking to start your own business or considering offering health benefits to your current employees, we encourage you to explore the range of options for private health care offered in Singapore. The minimal level of coverage recommend is one that at least covers critical illnesses. Healthy competition between the various insurance providers means the monthly cost per insurance person is quite reasonable. Depending on the age of the person being insured, their lifestyle, and the level of coverage chosen, the monthly cost of a critical illness private health insurance can range from S$75 to S$400. Below is a list of some of the most popular choices of provider in Singapore:
- Great Eastern
It can be a time-consume and potentially error-prone task to find the right medical insurance policy. Different insurance companies will stipulate different exceptions and exclusions to their coverage policies in their contracts, meaning it’s crucial you read the fine-print and potentially enlist the help of someone more knowledgeable in insurance law to ensure you know precisely what you are getting for your money. An alternative is to enlist the services of an independent insurance broker. Their in-depth knowledge can help you decide between the various policies of different insurance companies, recommending one best suited to your specific requirements and budget.
Singapore’s public healthcare facilities are divided into six clusters across the city. These are:
- Alexandra Health Pte Ltd (anchored by Khoo Teck Puat Hospital in Yishun)
- Eastern Health Alliance (anchored by Changi General Hospital in Simei)
- National Healthcare Group (anchored by Tan Tock Seng Hospital in Novena)
- National University Health System (anchored by National University Hospital adjacent to NUS)
- Jurong Health (anchored by Ng Teng Fong General Hospital in Jurong East)
- SingHealth (anchored by the Singapore General Hospital in Bukit Merah)
The government chose to organise public healthcare services into these clusters in an effort to foster vertical integration between the different elements each cluster’s healthcare system and enhance the synergy and economies of scale of each healthcare group. This is part of the government’s drive to spur innovation in the public healthcare sector, keeping services affordable while improving the overall quality of care delivered to patients.
Below is a list of major public hospitals and healthcare centres:
- Tan Tock Seng Hospital
- KK Women’s and Children’s Hospital
- Changi General Hospital
- Institute of Mental Health/Woodbridge Hospital
- Singapore General Hospital
- Alexandra Hospital
- Khoo Teck Puat Hospital
- National University Hospital
- Ng Teng Fong General Hospital & Jurong Community Hospital
- Polyclinics SingHealth
- National Skin Centre
- National Cancer Centre Singapore
- NHG Polyclinics
- National Dental Centre
- National Heart Centre
- The Eye Institute
- National Neuroscience Institute
- The Heart Institute
- Singapore National Eye Centre
Below is a list of major private hospitals and medical centres in Singapore:
|Major Private Hospitals||Major Private Medical Centres|
|Mount Elizabeth Hospital||Camden Medical Centre|
|Gleneagles Hospital and Medical Centre||Thomson Medical Centre|
|Mount Alvernia Hospital and Medical Centre||Novena Medical Centre|
|Raffles Hospital||Johns Hopkins Singapore International Medical Centre|
A comprehensive list can be found in the Ministry of Health’s hospital directory.
Healthcare cost examples
Below is a list of approximate charges for various medical procedures and consultations. The charges listed here are provided as general information for illustrative purposes only. The costs are before subsidies or insurance payouts and will thus mostly be relevant to non-insured individuals. The majority of the bill for a government subsidised and privately insured individual’s medical services will obviously be absorbed by the third-party.
Primary healthcare costs
Day-to-day healthcare services are considered to be relatively expensive in Singapore, even when paid upfront by the patient. A routine check-up by a general practitioner plus generic medicine from a pharmacist will generally cost around S$20-S$30. Blood work at a pathologist or X-rays at a radiography clinic will generally cost between S$50 and S$80. Around 20 per cent of the nation’s primary healthcare is provided through government-owned polyclinics, and around 80 per cent through the country’s private clinics, of which there are around 2,000. Specialist consultation in a private clinic will vary in cost depending on the specific nature of the specialist seen, but generally costs between S$75 and S$125 per consultation.
Hospitalisation charges in Singapore can vary. The size, type and quality of the ward chosen will determine your ultimate costs. Singapore offers a range of wards from open wards with no air conditioning to private medical suites resembling luxury hotel suites at five-star hotels, meaning daily charges can vary from as little as $30 to a high of $3,000. For non-subsidised patients, the cost difference between private and government hospitals is very similar. Please refer to the Ministry of Health’s website for more details on the charges of various Singaporean hospitals.
Major surgery costs
Singapore provides a unique mixture of value and quality of care to patients from around the world. Our city is able to provide some of the world’s finest healthcare service at a relatively affordable cost. The table below provides a rough comparison of the costs for common medical procedures in Singapore compared to Thailand and the United States.
The above table shows that for the same (and in some cases, a superior) level of treatment as the United States, patients in Singapore pay drastically less.
The video below highlights many of the most important features of the Singaporean healthcare system, helping to explain why it has been so successful while maintaining a high level of cost efficacy.