Healthcare country profile: Singapore

Printed with permission: Source: EIU Healthcare Report February 2010

Despite the relatively low level of spending on healthcare in Singapore, the island state’s health indicators are good

Spending on healthcare in Singapore is relatively low as a percentage of GDP: at an estimated 4.1% in 2009, it is below the average of around 5.3% of GDP in the Asia and Australasia region. Spending will edge upwards in the next few years, rising to 4.3% of GDP in 2014. This represents a projected 50% rise on 2009 spending in local-currency terms. Healthcare spending by the public sector currently stands at around 0.9% of GDP, with most spending by the private sector coming through savings and insurance funds run by the government.

Average life expectancy at birth was 81.9 years in 2008; for males, it was an estimated 79.3 years, and for females 84.7 years. This compares favourably with average life expectancy of around 73 years in Malaysia and Thailand, 78.1 years in the US and 79.1 years in Germany. The rate of infant mortality stood at 2.3 per 1,000 live births in 2008, down from 3 per 1,000 in 2000. Singapore in general has a developed country profile for disease.

Spending

The majority of Singaporeans are covered by the three major government-operated healthcare financing schemes, known as the 3Ms: Medisave, Medishield and Medifund

Medisave is a simple national savings scheme designed to enable patients to save income for future healthcare expenses. At end-2008 there were 2.9m Medisave accounts, the average balance of which stood at S$14,900 (around US$10,600). Medishield is a low-cost insurance scheme, premiums for which can be paid out of Medisave accounts, and is aimed at providing patients with cover in the event that balances in Medisave accounts are insufficient to meet healthcare expenses. At the end of 2008, 84% of the population were Medishield members, with the ratio for the working-age population standing at 93%. Medifund is an endowment fund that is financed by the government to provide a safety net for those who cannot afford their part of subsidised healthcare expenses. The Private Medical Insurance Scheme, which allows private insurers to offer medical insurance to members of the Central Provident Fund (a compulsory savings scheme to finance pension payments) and is similar to that offered under Medishield, has around 500,000 members.

Demand for care for the elderly is expected to increase steadily, and the government is making progress in terms of managing this. In 2002 it introduced Eldershield, an insurance scheme aimed at providing payments to cover private nursing-home expenses, and by end-2008 there were 835,000 policyholders.

Direct government spending on healthcare has risen in recent years. In 2008/09 its recurrent healthcare spending amounted to S$2.4bn (around US$1.7bn) and its development healthcare spending to S$339m. This was equivalent to around 1.1% of GDP and 7.1% of the total public expenditure budget.At the onset of the 2009 economic recession the government sharply increased the 2009/10 budget allocation for the health ministry, raising it to S$3.7bn, nearly S$1bn more than the allocation for 2008/09.

Policy

The government’s healthcare policy aims to encourage self-reliance, keep healthcare affordable and involve community-based facilities.

Singapore had 29 hospitals in 2008, with 14 in the public sector and 15 in the private sector, according to the health ministry. The total capacity of these hospitals in 2008 was 11,457 beds. The public sector is more important than the data suggest: although there are slightly fewer public hospitals, their average size, at 590 beds, is greater than that of hospitals in the private sector (which have an average of 210 beds). There were 1.6 doctors and 4.8 nurses and midwives per 1,000 people in 2008. The ratios of doctors and hospital beds per 1,000 people are above the global averages.

Government figures for 2008 show that there were around 330,000 admissions to public hospitals in that year, compared with around 106,000 admissions to private hospitals. In addition, public-sector specialist outpatient clinics served 3.8m patients in 2008, while public-sector outpatient polyclinics (multipurpose clinics) had nearly 4m patients. The private sector accounts for over 75% of all primary healthcare services, with government primary-health clinics accounting for the remaining share. The government subsidises 50% of the treatment cost at public-sector clinics.

Expensive medical treatments, including non-essential cosmetic treatments, are not available in public hospitals. The health ministry determines the charges for any kind of medical treatment. The government introduced the Casemix system of funding in public hospitals in 2000, under which funds are distributed according to the type of medical condition and the difficulty of treating it, as well as the frequency of its occurrence.

Building on the world-class reputation of Singapore’s health services, bolstered by its growing clinical research and biomedical industries, the government is promoting the local healthcare industry as a regional centre of medical excellence. It is also keen to promote not only general surgery and medicine but also specialist services, including organ transplants and cardiology.

Diseases

Singapore in general has a developed-country profile for disease, with cancer, cardiovascular diseases
and strokes accounting for over 60% of deaths

Singapore struggled alongside many other countries worldwide in coping with outbreaks of influenza A(H1N1), often known as swine flu, in 2009, but by early 2010 concerns over the potential threat from the virus had diminished, with the health ministry stating that there were no signs of a significant rise in influenza prevalence in Singapore. The government has also established Pandemic Preparedness Clinics— in essence, primary-healthcare clinics—as a central part of the health ministry’s pandemic response framework. It also commenced a swine-flu vaccination campaign in late 2009. Singapore will remain vulnerable to highly contagious viruses owing to its position as a regional business and tourism hub.

Aside from the influenza threat, Singapore in general has a developed-country profile for disease, with cancer, cardiovascular diseases and strokes accounting for over 60% of deaths, according to the health ministry. Despite government health campaigns, there is no reason to believe that Singapore’s disease profile will change significantly in the coming years, although problems associated with obesity are expected to increase.