Singapore's Healthcare System

Singapore is recognized as having one of the leading healthcare systems within Asia.

Within the country there are a large group of private hospitals, as well as public hospitals, that are considered to be on par with western standards; given the state of the art medical facilities that are widely available with experienced, well trained Doctors

The healthcare system in Singapore is very expat-friendly. With over 200,000 tourists flocking to the country every year for medical treatment at a cheaper price, hospitals in Singapore are increasingly catering their services to target the large foreign patient population. Various International Patient Service Centres (IPSC) are specifically designed to assist foreign patients navigate their way around the healthcare system in Singapore. Private hospitals primarily cater their services to foreign patients who are either expats or medical tourists; a small group of public hospitals will also cater for foreign patients. Expat patients can expect Doctors in Singapore to speak adequate English in Private Hospitals and generally Public Hospitals too.

All Private Hospitals in Singapore have received international accreditation, mainly through the Unites State's JCI (Joint Commission International). Private Hospitals are also commonly certified by the ISO (International Organisation for Standardization), a leading publisher of International Standards. A small group of Public Hospitals in Singapore have also received JCI accreditation and ISO certification.

Medical tourism is emerging in countries where medical care is available at a cheaper cost than in locations such as the US and UK. The medical-tourism market in Asia is estimated to be valued at US$4.53 billion a year, with countries including Singapore, Japan, India and Thailand accounting for the majority of that amount. Although the cost of healthcare in Singapore is higher than its medical tourism competitors, the standard of medical facilities are generally more advanced, and standard of English within the medical community is usually much higher. To ensure ease of access to Singapore’s health care facilities, a Singapore health insurance plan  is strongly encouraged for expats living in Singapore.

Neighboring countries in Asia also depend on Singapore in the event of a medical evacuation, if adequate services are not available within their own country.

Finding a Doctor in Singapore

Expats living in Singapore can allocate healthcare services with ease by contacting an International Patient Service Centre (IPSC), which exclusively serve the needs of international patients. These centres have been established to cater for the increasingly large medical tourist population, as well as the expat population living in Singapore. Expats can obtain information about specific healthcare services and Doctors available within Singapore by contacting an IPSC. The Ministry of Health (MOH) lists nine IPSCs within Singapore. Most IPSCs are provided by large private medical organizations that manage groups of private hospitals and clinics within Singapore and overseas, including Raffles Medical Group and ParkwayHealth.

IPSCs in Singapore as listed by the Singaporean Ministry Of Health:

• Raffles International Patients Care
• ParkwayHealth Patient Assistance Centre
• National Healthcare Group International Patient Liaison Centre
• Singapore Health Services (SingHealth) International Medical Service
• Pacfic Healthcare International Medical Assistance Centre
• Mount Alvernia's International Patients Service Centre
• Thomson Medical International Patient Centre
• NUH International Patient Liaison Centre
• TTSH International Patient Liaison Centre

Raffles has an estimated 10 per cent of the private hospital market in Singapore and is continuously targeting further growth, both in Singapore and overseas. Raffles aims to invest millions of dollars to increase its number of general practice, dental and specialist clinics to more than 100 locations over the next few years. They offer an IPSC called the Raffles International Patients Care.

ParkwayHealth are a private organisation that manage a group of privately run hospitals in Singapore, as well as other hospitals across the globe. There are four ParkwayHealth hospitals in Singapore including the Gleneagle Hospital, Mount Elizabeth, Parkway East hospital and Parkway Novena. They too offer an IPSC, called the ParkwayHealth Patient Assistance Centre.

A number of Public Hospitals in Singapore are recognised as having medical facilities on par with western standards. Public Hospitals with JCI accreditation and ISO certification include the National University Hospital, Alexandra Hospital, Changi General Hospital, Singapore General Hospital, Tan Tock Seng Hospital. Expats with cardiac conditions can visit the National Heart Centre Singapore, a JCI accredited Public Hospital, that caters for both local and foreign patients. Expats starting a family in Singapore can attend the KK Women's and Children's Hospital, a JCI accredited public hospital offering maternity and pediatric services.

Are all Hospitals Safe in Singapore?

To ensure you are seeing a genuine, well trained Doctor in Singapore, it is important to select a hospital that is JCI or ISO certified, as well as ensuring your Doctor is registered with the Singapore Medical Council (SMC). Patients can search for registered medical practitioners and specialists by going to the SMC website where they are listed in alphabetical order. Patients can also visit the SMC website for press releases including disciplinary inquiries of practicing Doctors in Singapore. To feel completely at ease, expats are encouraged to use an International Patient Service Centre (IPSC) listed on the Ministry of Health (MOH) website such as Raffles International Patients Care and ParkwayHealth Patient Assistance Centre.

The Singapore Medical Council (SMC), a statutory board under the Ministry of Health (MOH), governs the Register of Medical Practitioners in Singapore. The SMC regulates the ethics and practice of registered medical practitioners by handling and investigating patient complaints as well as implementing continuing professional development programmes of registered members.

To ensure Doctors are practicing up-to-date medicine and offering good quality care, the SMC administers the Continuing Medical Education (CME) programme which was made compulsory for all registered practitioners from January, 2003.

To comply with the Medical Registration Act, the SMC established the Complaints Committee, which serves to investigate any complaint made against a medical practitioner, or any information received by the Medical Council concerning the professional conduct or ethics of any medical practitioner. From 2008, the MOH and the SMC have enforced stricter regulations and guidelines on its medical practitioners, which has resulted in a considerable drop in its complaints from patients. In 2008, there were 138 complaints in total reported by patients over the year. This number has now dropped to less than 100 complaints annually.

'Comparison shopping' for treatment in Singapore

Patients in Singapore can now refer to the Ministry of Health website for 'comparison shopping', where a list of treatment costs are provided by various public and private hospitals in Singapore. Expat patients can enter the website and compare the costs for common treatments such as routine delivery, knee replacement or heart surgery procedures. Each hospital also lists the average length of hospital stay for the certain procedure, as well as price percentile bands to indicate the typical bill size patients can expect to pay.

According to the Ministry of Health, private hospital bill sizes are generally higher than public hospitals. The figures quoted are based on actual bill size data submitted by the hospitals, but there are exceptions. The data for private hospitals may not be complete as not all doctors' professional fees may be fully accounted. Public hospitals however include all charges on their bill sizes and therefore are considered to be more accurate and complete.

In order to promote bill size transparency, Singapore started to publish bill size data of all its public hospitals for the top 70 medical conditions on the Ministry of Health website in 2003, including monthly updates. Only up until recently Private Hospitals were also allowed to publish their bill size data on the MOH website. A hospital can only publish their average bill size data on the MOH website if the number of patients receiving the specific medical condition exceeded 30 for the year. Private hospitals were able to publish their data for around 40 medical conditions. Whereas public hospitals, given their high patient volumes, publish their data for all medical conditions listed.

Health Insurance for Expats in Singapore

A Singapore medical insurance plan  is highly recommended for expats living in Singapore.

Although healthcare in Singapore is relatively cheaper compared to the US and UK, in the event of an accident or serious health condition medical costs will add up and be substantially expensive for the expat patient. Further to this, the demand for healthcare services in Singapore is increasing as medical tourism attracts more patients to its hospitals every year. With the medical-tourism competition in favor of Singapore, healthcare costs are expected to rise.

Expats living in Singapore typically spend their leisure time traveling overseas, especially within Asia. Hospitals within Asia are not always on par with western standards and are generally not adequate or virtually non existent in remote areas. Expats may require repatriation or emergency evacuation to a hospital in Singapore or nearby country with adequate medical facilities. The costs involved in covering hospitalization and emergency evacuation are highly expensive and can add up to around US$50,000-$100,000, or even more depending on the circumstances. As such, expats in Singapore are strongly encouraged to obtain some form of Singapore medical insurance, that includes air transportation services.

Paying for healthcare services in Singapore Hospitals

Hospitals and healthcare organizations in Singapore generally require a letter of guarantee from the insurance company prior to admission or registration for medical services. A letter of guarantee which does not have payment arrangements with the hospital is generally not accepted. A National Registration Identity Card (NRIC) is required when registering as a patient, and this information should be clearly stated on the letter of guarantee from the insurer. The NRIC is an identity document used in Singapore and is compulsory for citizens as well as permanent residents living in the country. If you are a permanent resident it is important to carry this card on you when visiting health care facilities in Singapore.

Expats will be treated immediately in the event of an emergency and will be held liable for medical costs until the letter of guarantee is issued from the insurer. With no letter of guarantee, patients are required to pay upfront and claim for reimbursement directly from their insurance company. Most hospitals accept cash and international credit cards.

By law, hospitals must inform the patient of the total, estimated cost of treatment prior to hospital admission. On discharge, every patient must also be presented with a bill that lists every service received and the amount that the patient is being charged for.

Public Health in Singapore

Singapore's Ministry of Health has established the Communicable Disease Division that aims to control the risk of an epidemic by enforcing policies, such as immunization programs and implementing surveillance systems.

During the 2009 H1N1 pandemic, surveillance measures were practiced including temperature checks at public places. Local and foreign travelers were checked prior to entering the country at airports, as well as public facilities such as museums and hospitals. The Singapore government quarantined individuals who showed signs of the H1N1 virus, as well as individuals who may have been in contact with those infected.

The number of HIV/AIDS cases have steadily increased in the last decade, however this is also due to increased testing among Singapore's population. On average, more than 450 HIV/AIDS cases are reported annually. Around 60 per cent of HIV/AIDS cases are transmitted via heterosexual intercourse, 30 per cent via homosexual intercourse, and the remaining number among intravenous drug users or uncertain. Over 90 per cent of HIV/AIDS cases are also among males. A number of males in Singapore travel on weekends to Batam, a nearby Indonesian island, to find commercial sex workers. This trend has in turn increased the spread of HIV/AIDS among these population groups. Through Government action, including the distribution of condoms and HIV/AIDS awareness, the situation is expected to improve.

The Ministry of Health lists cancer as the leading cause of death in the country, accounting for around 29 per cent of deaths reported annually in Singapore (approximately 5000 deaths per year) with Heart Disease, Pneumonia, and Stroke ranking in that order. Ranking 5th, and contributing to around 6 per cent of annual deaths (around 100 deaths per year) are accidents, poisoning and violence. While there is a relatively low violent crime rate in Singapore, there is a high rate of suicides. Suicides at MRT stations occur so regularly that half-length platform screen doors will be installed at MRT stations over the next few years as a preventive measure.

Emergency services in Singapore

Emergency protocols should be adopted by residents during the event of an accident, serious illness or criminal offense. To call an ambulance service, police department, or fire brigade dial 9-9-9.

Emergency services a efficient in Singapore. A 9-9-9 call will be answered within 10 seconds, and in urgent cases, emergency assistant will be at the scene within 15 minutes. An ambulance responding to a call will usually take you to a government hospital unless otherwise advised by the patient. Emergency transportation services can be costly, as well as the medical costs involved in covering hospitalization. As such, expats living in Singapore are encouraged to obtain a Singapore health insurance plan.