CONTENT FAQS
What is the healthcare philosophy in Singapore?
The Singapore healthcare philosophy emphasises the building of a healthy population through preventive healthcare programmes and the promotion of healthy living. The population is encouraged through the public health education programme to adopt a healthy lifestyle and be responsible for their own health. The public is made aware of the adverse consequences of harmful habits like smoking, alcohol consumption, bad dietary intakes and sedentary lifestyles.
The government ensures that good and affordable basic medical services are made available to all Singaporeans through the provision of subsidised medical services at the public hospitals and government clinics. The Singapore healthcare delivery system is based on individual responsibility, coupled with government subsidies to keep basic healthcare affordable. Patients are expected to pay part of the cost of medical services which they use, and pay more when they demand a higher level of services. The principle of co-payment applies even to the most heavily subsidised wards to avoid the pitfalls of providing 'free' medical services. For those who choose to be accommodated in the lower classes or types of wards in the public hospitals, their hospitalisation expenses are subsidised up to 80% by the government.
Individuals are encouraged to take responsibility for their own health by saving for medical expenses. Under the Medisave scheme, every working person is required by law to set aside 6 - 8% of his income into his personal Medisave Account which can be used to pay for the hospitalisation expenses incurred by himself or his immediate family members. MediShield, a catastrophic illness insurance scheme, is designed to help individuals meet the medical expenses from major or prolonged illnesses. Medifund acts as a safety net of last resort for those who are truly indigent. Therefore, no Singaporean will be denied access into the healthcare system or turned away by the public hospitals because of the inability to pay.
How have the hospital services evolved over time in Singapore?
In 2005, there were a total of about 11,850 hospital beds in the 29 hospitals and speciality centres in Singapore, giving a ratio of 3.6 beds per 1,000 total population. About 73% of the beds are in the 13 public hospitals and speciality centres with bed complements between 185 to 2,370 beds. On the other hand, the 16 private hospitals tend to be smaller, with capacity ranging from 20 to 500 beds. The government's role as the dominant healthcare provider allows the government 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.
As of 2006, the seven public hospitals comprise five acute general hospitals (SGH, NUH, CGH, TTSH & AH), a women's and children's hospital (KKH) and a psychiatry hospital (IMH). The general hospitals provide multi-disciplinary acute inpatient and specialist outpatient services and a 24-hour emergency department. In addition, there are six national specialty centres for cancer, cardiac, eye, skin, neuroscience and dental care.
Within the public hospitals, patients have a choice of the different types of ward accommodation on their admission. 75% of the public hospitals' beds (class B2 and C) are heavily subsidised with the remaining 25% with lower subsidy at 20% for class B1 and no subsidy for A class wards. As at June 2006/ the average length of stay in the acute care hospitals is about 4.8 days while the average occupancy rate is around 76%.
The government has restructured all its 13 acute hospitals and speciality centres to be run as private companies wholly-owned by the government. This is to enable the restructured hospitals to have the management autonomy and flexibility to respond more promptly to the needs of the patients. In the process, commercial accounting systems have been introduced, providing a more accurate picture of the operating costs and instilling greater financial discipline and accountability. The restructured hospitals are different from the other private hospitals in that they receive an annual government subvention or subsidy for the provision of subsidised medical services to the patients. They are to be managed like not-for-profit organisations. The restructured hospitals are subject to broad policy guidance by the government through the Ministry of Health.
The government has also introduced community hospitals for intermediate healthcare for the convalescent sick and aged who do not require the care of the general hospitals.
What is the 3Ms Framework in Singapore?
To help Singaporeans pay for their medical expenses, government subsidies are provided in public hospitals (in particular Class B2 and C wards, and subsidised specialist outpatient clinics) and polyclinics. Patients pay part of the cost. The '3 Ms' framework - comprising Medisave, MediShield and Medifund - help individuals pay for their share of their hospitalisation costs after government subsidy.
What is Medisave?
Medisave, introduced in April 1984, is a national medical savings scheme which helps individuals put aside part of their income into their Medisave Accounts to meet their future personal or immediate family's hospitalisation, day surgery and certain outpatient expenses.
What is MediShield?
MediShield and MediShield Plus are low-cost medical insurance schemes managed by the Central Provident Fund (CPF) Board which help you and your dependants pay for your hospital bills. CPF members (Singapore Citizens or Permanent Residents) up to 75 years old can be covered under MediShield or MediShield Plus.
MediShield covers a large portion of the daily hospitalisation expenses in Class “B2” or “C” wards. MediShield Plus meets a significant portion of the hospitalisation expenses in Class “A1” or “B1” wards, but costs more. Both MediShield and MediShield Plus work on a co-insurance arrangement, where you pay 20% of the claimable amount and MediShield or MediShield Plus pays the remaining 20%.
All CPF members are automatically covered under the MediShield, unless they have earlier decided not to participate.
What is co-payment (co-insurance) in MediShield and how does it work?
Co-payment (or co-insurance) refers to an arrangement whereby MediShield will pay between 80% - 90% of the claim amount that exceeds the deductibles (if applicable), and you the insured, pay the remaining 10% - 20%. Therefore, the larger your bill, the lower the co-insurance that you need to pay.
Deductibles and co-insurance are necessary to avoid excessive demand for medical services, which fully pre-paid insurance schemes tend to encourage.
How does the co-insurance work under the reformed MediShield?
For example, if you are a C-class patient with an $8,000 amount eligible for claim*, you will first pay the deductible of $1,000.You then pay 20 per cent on the next $2,000 ($400); 15 per cent of the subsequent $2,000 ($300), and 10 per cent of the rest of the bill ($300). This works out to $2,000 that you have to pay, with MediShield paying the other $6,000. The $2,000 can be paid using your Medisave.
*The amount eligible for claim is computed as the lower of either the actual patient bill, or the sum of the claimable limits (e.g. $250 a day).
What is means testing?
Means testing is compulsory for Singapore Citizens or Permanent Residents who require government subsidies from the government. This "Means Testing" is a method to calculate the healthcare subsidies that an older person will get if he/she requires step-down care services.
What is meant by the restructuring of public sector hospitals?
'Restructuring', which started in 1985 with the newly built National University Hospital, refers to the granting of autonomy to public sector hospitals in the hope that the adoption of business and financial discipline will result in greater efficiency and improved quality of service. Restructuring is not the same as privatization, although the latter term was initially used but later changed to avoid public misperception that public sector hospitals are transferred wholesale out of the Government's hands. The restructured hospitals remain wholly owned by the Government through a 100 per cent government-owned Ministry of Health Holdings (MOHH). Matters such as recruitment and remuneration of staff, as well as the hospitals' strategic directions, are decentralized. But sensitive issues such as increases in fees would require governmental approval. This is to ensure that, although the hospitals enjoy flexibility of operations, they continue to fulfil their social mission.
The healthcare institutions within MOHH are divided into six broad clusters. They include National University Health System, National Healthcare Group, Singapore Health Services, Alexandra Health System, Jurong Health Services, and Eastern Health Alliance.
What is Medifund?
Medifund is an endowment fund set up by the government in April 1993 to help needy Singaporeans who are unable to pay for their medical expenses. This fund acts as a safety net for those who cannot afford the subsidised bill charges despite Medisave and MediShield coverage. Medifund was established with an initial capital of S$200 million and capital injections will be made when budget surpluses are available. The capital sum currently stands at S$101 billion. The interest income from this capital sum are being utilised to finance the needy.
What are the aims of the National Healthy Lifestyle Campaign?
The National Healthy Lifestyle Programme was launched in 1992 by Mr Goh Chok Tong, then the Prime Minister of Singapore.
The Programme aims to raise awareness among Singaporeans of the importance of a healthy lifestyle, maintaining healthy body weight and to equip them with the knowledge and skills to practice healthy lifestyle. The Programme promotes four components of a healthy lifestyle - regular exercise, healthy eating, no smoking and managing stress. The Programme also endeavours to make the social and physical environment more supportive of healthy living.
Target Audience
The target audience is the general population. Efforts are made to customise our outreach programmes to cater to special groups such as the various ethnic groups, working population and senior citizens.
Annual Campaign
A month-long National Healthy Lifestyle Campaign is held annually to raise greater awareness among Singaporeans of the need to adopt a healthy lifestyle. The campaign launch involves mass participation and usually incorporates a mass physical activity. Following the launch, the entire month is filled with face-to-face activities to reach different sectors of the population. The campaign is also supported by a mass media campaign to further drive home the message.
What are Voluntary Welfare Organisations (VWOs)?
The community provides healthcare support to meet the needs of Singaporeans. It is not possible for the government to run all the healthcare services.
Patients who are discharged may still need medical care, especially the elderly and those who are diagnosed with a particular illness or disability. The government Ministries that play significant roles are the Ministry of Community Development and the Ministry of Health.
Some examples of organisations include National Kidney Foundation, Singapore Cancer Society, Chung Hwa Medical Institution (which provides free medical treatment) and Singapore Cheshire Home.
Voluntary welfare organisations (VWOs) in Singapore play a vital role in the health care of the elderly. The government’s policy in the provision of elderly services is to provide the direction, and to encourage and support VWOs to provide the majority of these services rather than for the government to provide the services. This is because of 2 main reasons:
What are the types of health services provided by VWOs?
The VWOs have a long tradition of providing health services in Singapore which include the following:
Community hospitals
(e.g. St. Andrew’s Community Hospital)
Community hospitals are for patients, especially elderly patients, who require longer inpatient care, but who do not require the high technology and sophisticated care of acute hospitals. The patients admitted should also have rehabilitation potential.
Chronic sick hospitals
(e.g. Ren Ci Hospital & Medicare Centre)
Chronic sick hospitals admit long stay patients who have no rehabilitation potential but require medical and nursing care.
Nursing homes & hospices
(e.g. Home Nursing Foundation founded by Dr. Toh Chin Chye in 1976)
Nursing homes provide primary nursing care, with little or no medical care. Hospices are for the terminally ill and they provide medical and nursing care as well as social support (religious support and bereavement counselling). There are nursing homes both run by the VWO and private sectors.
Day Care Centres
These are rehabilitation centres for the elderly suffering from senile dementia, the terminally ill and frail elderly.
Home care
These are home nursing services, home medical and home help services available to the home-bound elderly.
What are some of the major concerns and future challenges of healthcare in Singapore?
Although Singapore has come a long way in improving its health status and standard of medical service, it still faces many concerns and challenges. These include:
The Singapore healthcare philosophy emphasises the building of a healthy population through preventive healthcare programmes and the promotion of healthy living. The population is encouraged through the public health education programme to adopt a healthy lifestyle and be responsible for their own health. The public is made aware of the adverse consequences of harmful habits like smoking, alcohol consumption, bad dietary intakes and sedentary lifestyles.
The government ensures that good and affordable basic medical services are made available to all Singaporeans through the provision of subsidised medical services at the public hospitals and government clinics. The Singapore healthcare delivery system is based on individual responsibility, coupled with government subsidies to keep basic healthcare affordable. Patients are expected to pay part of the cost of medical services which they use, and pay more when they demand a higher level of services. The principle of co-payment applies even to the most heavily subsidised wards to avoid the pitfalls of providing 'free' medical services. For those who choose to be accommodated in the lower classes or types of wards in the public hospitals, their hospitalisation expenses are subsidised up to 80% by the government.
Individuals are encouraged to take responsibility for their own health by saving for medical expenses. Under the Medisave scheme, every working person is required by law to set aside 6 - 8% of his income into his personal Medisave Account which can be used to pay for the hospitalisation expenses incurred by himself or his immediate family members. MediShield, a catastrophic illness insurance scheme, is designed to help individuals meet the medical expenses from major or prolonged illnesses. Medifund acts as a safety net of last resort for those who are truly indigent. Therefore, no Singaporean will be denied access into the healthcare system or turned away by the public hospitals because of the inability to pay.
How have the hospital services evolved over time in Singapore?
In 2005, there were a total of about 11,850 hospital beds in the 29 hospitals and speciality centres in Singapore, giving a ratio of 3.6 beds per 1,000 total population. About 73% of the beds are in the 13 public hospitals and speciality centres with bed complements between 185 to 2,370 beds. On the other hand, the 16 private hospitals tend to be smaller, with capacity ranging from 20 to 500 beds. The government's role as the dominant healthcare provider allows the government 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.
As of 2006, the seven public hospitals comprise five acute general hospitals (SGH, NUH, CGH, TTSH & AH), a women's and children's hospital (KKH) and a psychiatry hospital (IMH). The general hospitals provide multi-disciplinary acute inpatient and specialist outpatient services and a 24-hour emergency department. In addition, there are six national specialty centres for cancer, cardiac, eye, skin, neuroscience and dental care.
Within the public hospitals, patients have a choice of the different types of ward accommodation on their admission. 75% of the public hospitals' beds (class B2 and C) are heavily subsidised with the remaining 25% with lower subsidy at 20% for class B1 and no subsidy for A class wards. As at June 2006/ the average length of stay in the acute care hospitals is about 4.8 days while the average occupancy rate is around 76%.
The government has restructured all its 13 acute hospitals and speciality centres to be run as private companies wholly-owned by the government. This is to enable the restructured hospitals to have the management autonomy and flexibility to respond more promptly to the needs of the patients. In the process, commercial accounting systems have been introduced, providing a more accurate picture of the operating costs and instilling greater financial discipline and accountability. The restructured hospitals are different from the other private hospitals in that they receive an annual government subvention or subsidy for the provision of subsidised medical services to the patients. They are to be managed like not-for-profit organisations. The restructured hospitals are subject to broad policy guidance by the government through the Ministry of Health.
The government has also introduced community hospitals for intermediate healthcare for the convalescent sick and aged who do not require the care of the general hospitals.
What is the 3Ms Framework in Singapore?
To help Singaporeans pay for their medical expenses, government subsidies are provided in public hospitals (in particular Class B2 and C wards, and subsidised specialist outpatient clinics) and polyclinics. Patients pay part of the cost. The '3 Ms' framework - comprising Medisave, MediShield and Medifund - help individuals pay for their share of their hospitalisation costs after government subsidy.
What is Medisave?
Medisave, introduced in April 1984, is a national medical savings scheme which helps individuals put aside part of their income into their Medisave Accounts to meet their future personal or immediate family's hospitalisation, day surgery and certain outpatient expenses.
What is MediShield?
MediShield and MediShield Plus are low-cost medical insurance schemes managed by the Central Provident Fund (CPF) Board which help you and your dependants pay for your hospital bills. CPF members (Singapore Citizens or Permanent Residents) up to 75 years old can be covered under MediShield or MediShield Plus.
MediShield covers a large portion of the daily hospitalisation expenses in Class “B2” or “C” wards. MediShield Plus meets a significant portion of the hospitalisation expenses in Class “A1” or “B1” wards, but costs more. Both MediShield and MediShield Plus work on a co-insurance arrangement, where you pay 20% of the claimable amount and MediShield or MediShield Plus pays the remaining 20%.
All CPF members are automatically covered under the MediShield, unless they have earlier decided not to participate.
What is co-payment (co-insurance) in MediShield and how does it work?
Co-payment (or co-insurance) refers to an arrangement whereby MediShield will pay between 80% - 90% of the claim amount that exceeds the deductibles (if applicable), and you the insured, pay the remaining 10% - 20%. Therefore, the larger your bill, the lower the co-insurance that you need to pay.
Deductibles and co-insurance are necessary to avoid excessive demand for medical services, which fully pre-paid insurance schemes tend to encourage.
How does the co-insurance work under the reformed MediShield?
For example, if you are a C-class patient with an $8,000 amount eligible for claim*, you will first pay the deductible of $1,000.You then pay 20 per cent on the next $2,000 ($400); 15 per cent of the subsequent $2,000 ($300), and 10 per cent of the rest of the bill ($300). This works out to $2,000 that you have to pay, with MediShield paying the other $6,000. The $2,000 can be paid using your Medisave.
*The amount eligible for claim is computed as the lower of either the actual patient bill, or the sum of the claimable limits (e.g. $250 a day).
What is means testing?
Means testing is compulsory for Singapore Citizens or Permanent Residents who require government subsidies from the government. This "Means Testing" is a method to calculate the healthcare subsidies that an older person will get if he/she requires step-down care services.
What is meant by the restructuring of public sector hospitals?
'Restructuring', which started in 1985 with the newly built National University Hospital, refers to the granting of autonomy to public sector hospitals in the hope that the adoption of business and financial discipline will result in greater efficiency and improved quality of service. Restructuring is not the same as privatization, although the latter term was initially used but later changed to avoid public misperception that public sector hospitals are transferred wholesale out of the Government's hands. The restructured hospitals remain wholly owned by the Government through a 100 per cent government-owned Ministry of Health Holdings (MOHH). Matters such as recruitment and remuneration of staff, as well as the hospitals' strategic directions, are decentralized. But sensitive issues such as increases in fees would require governmental approval. This is to ensure that, although the hospitals enjoy flexibility of operations, they continue to fulfil their social mission.
The healthcare institutions within MOHH are divided into six broad clusters. They include National University Health System, National Healthcare Group, Singapore Health Services, Alexandra Health System, Jurong Health Services, and Eastern Health Alliance.
What is Medifund?
Medifund is an endowment fund set up by the government in April 1993 to help needy Singaporeans who are unable to pay for their medical expenses. This fund acts as a safety net for those who cannot afford the subsidised bill charges despite Medisave and MediShield coverage. Medifund was established with an initial capital of S$200 million and capital injections will be made when budget surpluses are available. The capital sum currently stands at S$101 billion. The interest income from this capital sum are being utilised to finance the needy.
What are the aims of the National Healthy Lifestyle Campaign?
The National Healthy Lifestyle Programme was launched in 1992 by Mr Goh Chok Tong, then the Prime Minister of Singapore.
The Programme aims to raise awareness among Singaporeans of the importance of a healthy lifestyle, maintaining healthy body weight and to equip them with the knowledge and skills to practice healthy lifestyle. The Programme promotes four components of a healthy lifestyle - regular exercise, healthy eating, no smoking and managing stress. The Programme also endeavours to make the social and physical environment more supportive of healthy living.
Target Audience
The target audience is the general population. Efforts are made to customise our outreach programmes to cater to special groups such as the various ethnic groups, working population and senior citizens.
Annual Campaign
A month-long National Healthy Lifestyle Campaign is held annually to raise greater awareness among Singaporeans of the need to adopt a healthy lifestyle. The campaign launch involves mass participation and usually incorporates a mass physical activity. Following the launch, the entire month is filled with face-to-face activities to reach different sectors of the population. The campaign is also supported by a mass media campaign to further drive home the message.
What are Voluntary Welfare Organisations (VWOs)?
The community provides healthcare support to meet the needs of Singaporeans. It is not possible for the government to run all the healthcare services.
Patients who are discharged may still need medical care, especially the elderly and those who are diagnosed with a particular illness or disability. The government Ministries that play significant roles are the Ministry of Community Development and the Ministry of Health.
Some examples of organisations include National Kidney Foundation, Singapore Cancer Society, Chung Hwa Medical Institution (which provides free medical treatment) and Singapore Cheshire Home.
Voluntary welfare organisations (VWOs) in Singapore play a vital role in the health care of the elderly. The government’s policy in the provision of elderly services is to provide the direction, and to encourage and support VWOs to provide the majority of these services rather than for the government to provide the services. This is because of 2 main reasons:
- Anything provided by the government is considered a "right" by the people. This invariably leads to more being demanded by the people.
- These services often require a level of motivation and compassion by caregivers for which money cannot harness. In addition, VWOs can garner voluntary support, and because there is "heart" in the provision of care, there is more warmth and better service. Recipients of care provided by VWOs are grateful for the public service provided. The government’s assistance to VWOs and some private organisations is in funding and other areas, to co-ordinate with other government agencies, and to facilitate the provision of such services.
What are the types of health services provided by VWOs?
The VWOs have a long tradition of providing health services in Singapore which include the following:
Community hospitals
(e.g. St. Andrew’s Community Hospital)
Community hospitals are for patients, especially elderly patients, who require longer inpatient care, but who do not require the high technology and sophisticated care of acute hospitals. The patients admitted should also have rehabilitation potential.
Chronic sick hospitals
(e.g. Ren Ci Hospital & Medicare Centre)
Chronic sick hospitals admit long stay patients who have no rehabilitation potential but require medical and nursing care.
Nursing homes & hospices
(e.g. Home Nursing Foundation founded by Dr. Toh Chin Chye in 1976)
Nursing homes provide primary nursing care, with little or no medical care. Hospices are for the terminally ill and they provide medical and nursing care as well as social support (religious support and bereavement counselling). There are nursing homes both run by the VWO and private sectors.
Day Care Centres
These are rehabilitation centres for the elderly suffering from senile dementia, the terminally ill and frail elderly.
Home care
These are home nursing services, home medical and home help services available to the home-bound elderly.
What are some of the major concerns and future challenges of healthcare in Singapore?
Although Singapore has come a long way in improving its health status and standard of medical service, it still faces many concerns and challenges. These include:
- The increasing cost of providing healthcare as a result of advances in medical knowledge and technology, leading to increased specialisation and sub-specialisation and greater use of medical technology.
- The rising expectations and demand for better and more sophisticated healthcare services by an increasingly well-informed and more affluent public.
- The rapid ageing of the population where the proportion of those 65 years and above is estimated to increase. It is known that the aged will incur a higher healthcare expenditure.
- The shortage of nurses and allied health professionals such as dieticians and nutritionists.
