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Health Care in Singapore

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Being one of the most competitive in Asia and the whole world, Singapore’s premium healthcare is the result of titanic efforts of the government and private clinics. For years, they were adopting the best global medical practices through collaboration and joint research with honourable healthcare institutions like Massachusetts General Hospital or Pennsylvania University Medical Center.

Over the last few decades, Singapore has turned into an excellent medical hub boasting the healthcare level of top-tier countries. World’s rankings say for themselves: in 2014, Bloomberg praised Singapore’s healthcare as the world’s most efficient while back in 2000 Singapore was the 6th according to the WHO’s research (the US was ranked the 37th). Its infant mortality rate is the planet’s lowest in the WHO’s opinion.

Singapore is an ultimate medical destination in Asia when it comes to complex operations like join replacement, assisted reproductive technologies, or organ transplantation. New constantly developing technologies and high-end equipment helped Singapore to win the trust of not only proud natives but also expatriates and foreigners. Overseas patients from neighbouring Asian countries such as India, Indonesia, or Malaysia give their preference to Singapore private clinics for their excellent service, friendly attitude, and affordable medical solutions.

Benefits of Singapore’s Medical Service

  • First-class medical expertise & professionalism. It is honourable to be a doctor in a society that values knowledge and experience. Singaporean doctors are being constantly audited as well as clinics undergo regular inspection to detect and avoid any unfitness.
  • Cutting-edge equipment. Singapore readily adopts state-of-the-art technologies and invests in medical informatics encouraging medical staff to be open to innovative solutions.
  • Central Provident Fund is a comprehensive insurance program that enables employed Singaporeans to accumulate funds on their personal accounts for covering their needs in healthcare (Medisave), insurance (MediShield), retirement (Medifund), and other purchases.
  • Multilingual environment. International patients who undergo treatment in Singapore adjust better and do not face language barriers because Singapore is a melting pot of Asian cultures. There are high chances that you’ll get the medical service in your native language.
  • Safety. Singapore maintains very high safety standards in blood transfusion. For great management of this service, Centre of Transfusion Medicine was avowed as the WHO’s Collaborating Centre.

Medical Services in Singapore

Today’s Singaporean health care is the result of constant development in 3 directions:

  • promoting healthy lifestyle and preventive measures;
  • encouraging personal financial responsibility (instead of giving the Singaporeans cheap or free medical services, the government introduces the Central Provident Fund: you regularly contribute a part of your earnings to your personal account and then you can spend these accumulated funds on high-quality medical services all across the country).
  • government’s subsidies and control of costs and supply.

Medical facilities in Singapore are governed by the Ministry of Health that claims to believe in assured quality and affordable medical services for everybody. All medical facilities (including laboratories) are obliged to follow professional regulations issued by 5 boards: Singapore Medical council, Pharmacy Board, Nursing Board, Laboratory Board, and Dental Board.

A wide range of private and governmental general and specialty clinics provide all kinds of medical services catering to the needs of various strata of society: everyone is protected on its level of income and contribution to the state. Most of the Singaporeans (up to 80%) undergo treatment in public medical facilities. The yearly government’s expenditure on every public patient is over 1k SGD (no more than 3.9% of the GDP). This is much less than other developed countries (such as the U.K. or the U.S.) spend on their patients yearly. Every Singaporean patient (from the B2 and C class ward) undergoes means testing to determine the level of subsidy he/she deserves (in some cases, not only the salary is being assessed but also the value of their houses).

The quality of services and prices for them in public facilities are government-regulated. Standards for the private medical sector are regulated by the market itself. The cost of services is quite high, but the affordability is achieved mainly by compulsory savings (via Central Provident Fund), government’s cost controls, and subsidies. However, Singapore’s healthcare system isn’t fully subsidised: no medical service is provided free of charge here even in the public medical facilities. This way the country protects its medical potential from overuse, wear and tear.

Singapore has built a solid network of outpatient polyclinics, inpatient hospitals, emergency services, and private healthcare practitioners covering all niches of medicine. Since the 1990s when the restructuring took place, public facilities aren’t government-owned but are run by 5 healthcare groups such as Eastern Health Alliance, National Healthcare Group, SingHealth, Alexandra Health Pte Ltd, and so on. Among private providers, the leaders are Raffles Medical Group and the Parkway Health.

Singapore Insurance System

Central Provident Fund is a huge purse with 3 sections: Medisafe (healthcare & retirement), Medishield (insurance), and Medifund (extra needs) in which a working Singaporean contributes a part of the salary every month. Logically, the public medical sector is more involved in this strategy of 3”M” than the private one.

Medisave – Singapore’s national health insurance program – enables able-bodied individuals to accumulate funds on their personal accounts through compulsory deductions from their salaries (7-9% depending on the employee’s age). These funds can be used for necessary medical services not only by the worker himself but also within his family. Based on the amount of funds accumulated, the patient is able to choose the comfortable subsidy level when undergoing treatment: from the highest level when most of the medical expenses are covered by the Medisave savings to the lowest when patients are treated as private ones for their own funds. But what is even more overwhelming is that these accumulated funds draw interest that isn’t taxed in the country and are added to the person’s estate after this person dies.
Funds from the Medisave can also be used for purchasing insurance, for example, premium programs by Medishield (CPF’s insurance part) or private insurance schemes (integrated shield plans approved by the Medisave). The Medisave program is available only for locals (citizens or permanent residents). In average, every member of the Medisave program withdraws around 700 SGD yearly while the total balance of the program exceeds 50 billion SGD.

Medishield is a mandatory insurance against serious and chronic diseases or prolonged treatment. It is designed for people no older than 85 years old, and the cost of annual premiums depends on the age ranging from approximately 30 SGD for younger people to over 1k SGD for older ones. The Medishield (the same as the Medisave) doesn’t cover 100% of the needs but requires individuals to co-pay from their pockets.

Eldershield is an insurance plan for cases of severe disability or chronic diseases and is designed for older patients. Medifund is an alternative way for the citizens and PRs to cover their medical expenses when the needs exceed the available funds on both Medisave and Medishield.

Except the Medisave, Singaporeans readily buy additional insurances, for example, for a total or a permanent disability and subscribe to the dread disease policy or a life insurance.

Facts Foreigners Should Know About Medical Service in Singapore

  • Foreigners working in Singapore on working visas cannot make compulsory contributions to the CPF or the Medisave, and, therefore, they should rely on their private health care insurances (either maintained by themselves or by their employers). The same refers to foreigners who pursue treatment in Singapore. There are lots of facilities in Singapore who cater to the needs of the private sector (individuals with private insurances, overseas patients or just locals who can afford treatment irrespective of the level of their subsidy). Very often, treatment in government clinics is costlier than the same treatment in the private medical facilities as governmental establishments usually require the in-patients either to provide a credit card or to make a significant deposit before undergoing any therapy.
  • As foreigners aren’t allowed to the CPF and the Medisafe, they still can benefit from various non-governmental insurance schemes such as iMedicare provided by the National Trades Union Congress that eases access to health providers in Singapore or make it much cheaper.
  • Locals and foreigners are free to choose any medical facility either public or private for treatment or consultation. Accident and Emergency Departments that are open 24/7 at the governmental hospitals are responsible in emergency cases. There are 6 public facilities in Singapore: 6 general facilities (like Singapore General Hospital or Tan Tock Seng Hospital) and 2 specialised centres (the psychiatry hospital and KK Women’s and Children’s Hospital).
  • Different working visas have different healthcare provisions: while PEP and EP holders can rely only on private insurances (either local or international), holders of the S Pass and Work Permit are provided with the medical insurance by their employers (such insurance is actually a mandatory condition for issuing or renewing these visas). The insurance covers annual medical expenses worth 15k SGD (including inpatient treatment and day surgery) and expenses on treating illnesses that can be work-related.
  • Not all female foreigners are allowed to give birth in Singapore and leave the child in the country. These options depend on the working visa type and the monthly salary. As the child is a dependent, according to today’s Singapore legislation, the foreigner working in Singapore can keep dependents only if his/her salary is over 5k SGD. It means that after the child is born, at least one of the parents (both working in Singapore) must have an appropriate salary. There is only one working visa that doesn’t allow getting pregnant and giving birth to a baby in Singapore – the Work Permit. The only exception for this working pass is when its holder (a woman) is married to the Singapore citizen or a permanent resident (a special approval is needed for such marriage).
  • A foreign woman delivering a child in Singapore have a right for the maternity leave, but its conditions vary for different categories of foreigners. Common requirements are: being legally married with the baby’s father and having worked for the employer during at least 3 months before the delivery. If the baby is a Singapore citizen, the maternity leave would be 16 weeks long. If the baby isn’t a citizen or the mother is a permanent resident or a foreigner (covered by the Employment Act), the leave would be 12 weeks long.

Delivery of Baby in Singapore

Pregnant women from neighbouring countries often choose Singapore for giving birth to their children due to a top-notch delivery and gynaecological services and effective policies friendly to the mother and child. The cost varies depending on the clinic preferred, as well as the method of delivery, type of the ward, and the period of stay after the delivery.

To give birth in Singapore, a foreign pregnant  woman needs:

  • to submit the application for permission to give birth in Singapore to the Immigration and Registration office;
  • to have a local sponsor (either a Singaporean or a permanent resident) who will pay the security bond (1k-5k SGD depending on the mother’s nationality; it is refunded to the sponsor after the mother and the baby leave Singapore);
  • to provide such documents:
    1. Forms 14, V39, and IMME 555;
    2. woman’s marriage certificate;
    3. sponsor’s ID or re-entry permit (for the PR) – provided by the sponsor;
    4. medical officer’s letter describing the expected due date and possible complications;
    5. letter from the Embassy of the mother’s country stating that the baby will get his/her mother’s nationality and the travel document;
    6. copy of the mother’s valid passport (or another travel document).

If the child wasn’t born in any hospital, the doctor/ambulance staff must give the mother the Notification of Live Birth which must be submitted for the registration along with other documents (original marriage certificate, parents’ entry permits and passports, and so on).

After delivering the child, the mother has 14-42 days to register her child with the Birth Registration Centre in the hospital or – if there is no such centre in the facility she gave birth in – in the ICA (Immigration and Checkpoints Authority). In case of delay, the mother needs to provide an explanation of such delay. After the authority approves, the mother obtains the Birth Certificate.

Medical Personnel in Singapore

With the population of 5.5 million people (locals and foreigners), Singapore has brought up over 10,000 doctors most having postgraduate degrees and wide medical practice. Doctors working in public facilities must undergo continuing postgraduate training under the Health Manpower Development Program and overseas practice at the centres of worldwide recognition. Over 1.6 thousand dentists and over 35 thousand nurses work in both private and public sectors. In the Singapore private sector, doctors are independent and don’t follow any schedules of fees, and, therefore, they usually set their own prices. Taking into account high bed cost, the treatment can be very expensive.

Medical Service: Singapore vs Other Developed Countries

Being on the top of medical excellence, Singapore is often compared with other well-developed countries, for example, the United States. The latter practises similar government schemes for insuring different categories of people, but, unlike in Singapore, they cover only a small sector of the population (elderly people, children, disabled, or low-incomes); the rest of the population especially the employed part basically rely on private insurances. The U.K.’s National Insurance has lots of similar features with the Singapore’s Medisave, but Singaporean scheme was designed much bigger to be able to cover not only health care needs but also the need for retirement.

Despite Singaporeans spend less on healthcare than the Americans and British who “enjoy” larger expenditure, they live 2 and 3 years longer than the British and the Americans respectively: 79 years for men and 84 for women (WHO’s report, 2009). Unlike the U.S., Singapore stands on the position of personal responsibility and relies mainly on out-of-pocket expenditure rather than prepaid private insurance schemes.

Weak Points of Singapore Healthcare

  • The CPF revealed insufficiency of coverage for the elder people’s healthcare needs (Medishield doesn’t cover Singaporeans older than 85 years old).
  • No resource transferring (social risk pooling) between people is provided. Everyone is responsible financially for himself. When somebody isn’t capable of taking care of himself, the burden lies on the state/society.
  • Singapore climate is very conducive to spreading various respiratory diseases. In 2003, the population suffered from SARS (severe acute respiratory syndrome) while in the May 2010, influenza H1N1 (bird flu) stroke the island. Now the threats seem to be gone, and the government fights any potential risks with perfect hygiene everywhere and health-awareness programs.

Today’s Singapore healthcare is the result of mutual efforts of the government, private initiatives and citizen’s personal responsibility. The state created the situation when you are interested in being healthy in this country because it’s much cheaper. Singapore doesn’t sell unqualified medical services, and, therefore, irrespective of your budget will get a high-quality and state-of-the-art treatment that won’t disappoint you. From premium clinics with 5-star wards to public subsidised establishments, Singapore proves its medical excellence.

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