Singapore - Health Care Services - Summary - ISA990401
Summary
Singapore has built a sound healthcare infrastructure since its
independence in 1965. Despite this success, the Singapore
Government continues to face many challenges. These include:
- a rapidly ageing population
- changing health needs of the population
- increasing cost of providing healthcare
- rising expectations/demand for better and more sophisticated
health services
Singapore's health care service is comparable to those of
developed countries. With a population of 3.1 million (1997),
the per capita government health care expenditure in 1997 was
US$300. In 1996, the per capita total health care expenditure
(public and private) was US$745. This is above the average for
countries in the surrounding region. Singapore's high standard of
health care service is renowned in Asia. Patients from the
region have used Singapore's facilities although the current
economic downturn has affected the inflow by 10%. Names like
Singapore General Hospital, National University Hospital, Mount
Elizabeth Hospital, and Gleneagles Hospital are well known in the
region.
The Ministry of Health (MOH) plays a dominant role in developing
the health care service in Singapore. It is instrumental in
establishing standards and ensuring that the industry is
financially sound. Singapore hospitals, both public and private,
are assured of healthy balance sheets due to the MOH's prudent
planning for health care financing.
Because of rising medical costs and an ageing population, the
Singapore government drew up guidelines on health care to address
the increasing burden. Based on the "1993 White Paper on
Affordable Health Care", the MOH has implemented several policies
on health care financing over the past few years. One of the
policies (known as CASEMIX), announced in November 1998, was a
system of monitoring subsidies for public hospitals and private
hospital fees.
Singapore has 23 hospitals, of which 10 are operated by the MOH
and 13 by the private sector. The total number of beds as of
July 31, 1998 was 11,276, of which 9,091 were under the MOH and
2,185 under the private sector.
Six of the MOH's tertiary hospitals have been 'restructured' and
run like private hospitals. Ownership of these hospitals is under
the Health Care Corporation of Singapore which is 100%-owned by
the MOH.
Parkway Healthcare Group, owner of Mount Elizabeth Hospital,
Gleneagles Hospital and East Shore Hospital, accounts for
two-thirds of the private hospital beds in Singapore.
Other major healthcare providers are:
- Raffles Medical Group
- Shenton Medical Group
- Beng & Ooi
- Healthway Medical Group
- Vista Healthcare
The most common diseases affecting Singaporeans are cancer and
cardiovascular diseases. Diagnostic and treatment services for
these diseases are advanced and are being continually upgraded.
To improve their expertise, both government and private hospitals
are eager to link up with reputable health care management
companies, foreign hospitals and medical centers. Over the past
years, various major hospitals have teamed up with well-known
institutions such as Johns Hopkins University Hospital,
Pennsylvania University Medical Center, Stanford University
Hospital, Massachusetts General Hospital and Kaiser Permanente.
MARKET PROFILE
The MOH competes with private healthcare operators to provide for
Singapore's healthcare service. However, the MOH plays a pivotal
role in planning and developing the framework of Singapore's
healthcare service.
Role of Ministry of Health
The MOH regulates the standard and practice of health care
services. It works closely with the Ministry of Environment in
the maintenance of environmental hygiene and control of
communicable diseases. It also works with the Ministry of Labor
in improving the industrial and occupational health of workers.
The MOH is in charge of the following five professional boards:
1. Singapore Medical Council
This is a corporate body established under the Medical
Registration Act. The Council registers qualified medical
practitioners for practice and maintains a Register of Medical
Practitioners. It also determines and regulates the conduct and
ethics of medical practitioners.
2. Singapore Nursing Board
This was established under the Nurses and Midwives Act 1975. The
Board registers qualified nurses, midwives and enrolled nurses
for practice and is responsible for regulating and improving
their standard of practice and conduct. It is also responsible
for the standards of training for nurses and midwives.
3. Singapore Dental Board
The Board regulates the practice of dentistry and oversees the
professional conduct of dentists.
4. Pharmacy Board
The Board maintains the Register of Registered Pharmacists and
oversees the professional conduct and practices of pharmacists.
5. Laboratory Board
The Board is responsible for regulating and improving the
standards of clinical laboratory practice. It maintains a
register of laboratory technologists and advises the Medical
Audit & Accreditation Unit on the licensing and accreditation of
clinical laboratories.
The MOH provides preventive, curative and rehabilitative health
services. Preventive health care comprises health education,
mass vaccination/immunization against infectious diseases and
selective health screening. The curative and rehabilitative
services are provided through the Government hospitals and a
network of Government polyclinics for general outpatient care.
Primary Health Care Services
Primary health clinics run by the MOH provide about 20% of
primary health care in Singapore. About 1,250 private general
practitioners provide the rest of the 80% in the form of private
clinics spread over the country.
Parkway has formed a consortium with the Guardian Pharmacy chain
and Shenton Medical Group in March 1999 to set up 40 neighborhood
clinics in Singapore and more in the region. The clinics, each
having an area of 300 sq ft instead of the normal 1,000 sq ft,
will be set up adjacent to Guardian's pharmacies.
Beng & Ooi Holdings owns 13 medical clinics, two dental surgeries
and a diagnostics center in Singapore while Healthway Medical
Group owns 14 clinics, in conjunction with
Vista Healthcare Asia (Vista). Vista owns three clinical
laboratories and provides integrated healthcare services through
partnerships with physicians, clinics, hospitals and diagnostic
centers.
The MOH has a network of 16 polyclinics, four outpatient
dispensaries and two maternal and child health clinics.
Polyclinics are one-stop health centers providing a wide range of
services. These include medical treatment of patients with
acute/chronic illnesses, follow-up management of patients
discharged from hospitals, maternal/child health care, health
screening, health education, patient counseling and diagnostic
services such as laboratory/ X-ray services. Dental care and
rehabilitation services for the elderly are also provided.
About 21% of women who give birth in Singapore receive pre-natal
care in the MOH clinics. A shared pre-natal care program is
carried out by KK Women & Children Hospital and Toa Payoh/Ang Mo
Kio polyclinics and between Singapore General Hospital and Bukit
Merah /Jurong polyclinics. This program allowed pre-natal
patients to see the polyclinic doctors as well as hospital
obstetricians at different times during the pregnancy, for
improved and better-coordinated pre-natal care.
Children are immunized against tuberculosis, diphtheria,
pertussis, tetanus, poliomyelitis, measles, mumps, rubella and
hepatitis B. Diphtheria and measles immunizations are compulsory
by law. The Central Immunization Registry monitors the
immunization status of children. On average, two-thirds of
immunizations were carried out by MOH clinics and one-third by
private clinics.
The School Health Service provides periodic health screening to
about half a million school children. The general health of
students is good. The most common health problems among school
children are defective vision, obesity and spinal problems.
Health education seminars and workshops reach out to about a
quarter of a million students annually.
Health Care Reforms
The MOH has been instrumental in structuring health care services
over the years. Since 1980, the MOH has made the following
reforms to improve the standard of healthcare services:
National Health Plan 1983
Compulsory Savings Scheme (Medisave) 1984
Catastrophic Illness Insurance (Medishield) 1990
Medical Endowment Fund (Medifund) 1993
Public Hospital Restructuring 1985 onwards
Review Committee on National Health Policies 1991-1992
White Paper on "Affordable Healthcare" 1993
CASEMIX 1998
In November 1998, the MOH announced that hospital subsidies would
be based on a new financing mechanism, known as CASEMIX funding,
similar to the Australian model. It will be implemented in all
public hospitals by the year 2000 and extended to private
hospitals in three to five years' time. Public hospitals will be
funded according to the type and difficulty of medical conditions
treated and the number of patients seen with each condition. At
present, government funding is based on the number of days a
patient stays in a hospital; so the longer the stay, the more the
hospital receives. With the new system, patients can expect a
better quality of health care and, as a result, will not be
subjected to unnecessary treatment or longer-than-necessary stays
which increases their medical bills.
Each hospital will have its own CASEMIX, depending on the type of
specialties that it has and the types of patients it serves. The
consistency across the board is in the treatment given by doctors
for similar conditions. By working out the amount of resources
used, treatment costs can be determined.
With the new system, all hospitals will receive the same amount
of subsidy for the same condition. This will encourage hospitals
to search for more cost-effective treatment while maintaining a
benchmarked quality. The MOH assured that the system would have
enough flexibility to cater for conditions which require more
than the recommended treatment.
The MOH is currently collecting information from all hospitals to
draw up a set of "best treatment" guidelines for 667 conditions,
from childbirth to brain surgery. Comparisons will then be made
between hospitals and doctors on the treatment given and the
resources used. This is not possible at the present moment.
Hospital Services
Singapore has 23 hospitals with a bed complement of 11,276.
Hospital admissions total approximately 369,456 in 1997.
The MOH operates five hospitals for acute health care, and four
hospitals with special functions. The hospitals are as follows:
Acute Care:
Alexandra Hospital
Changi General Hospital
National University Hospital
Singapore General Hospital
Tan Tock Seng Hospital
Special Functions:
KK Women & Children Hospital - maternity
Woodbridge Hospital - mental
View Road Hospital - mental
Communicable Disease Centre - infectious disease
Ang Mo Kio Community Hospital - sub-acute care
Singapore General Hospital, Tan Tock Seng Hospital, KK Women &
Children Hospital, Ang Mo Kio Community Hospital, National Skin
Centre and Singapore National Eye Centre were privatized by the
MOH under the umbrella of Health Corporation of Singapore (HCS)
to give these hospitals management autonomy. This enables the
hospitals to compete effectively against private hospitals.
These hospitals are also commonly referred to as "restructured
hospitals", and they account for about 74% of public specialist
outpatient consultations in Singapore.
The National University Hospital is also an autonomous hospital
directly reporting to the MOH instead of the HCS. It is also a
teaching hospital for the National University of Singapore.
There are 13 private hospitals in Singapore with a bed complement
of 2185. The largest private health care operator in Singapore
is Parkway Group Healthcare, the health care division of Parkway
Holdings Limited which is listed on the Singapore Stock Exchange.
Parkway, which owns Gleneagles Hospital, Mount Elizabeth Hospital
and East Shore Hospital, accounts for two-thirds of private
hospital beds. Gleneagles and Mount Elizabeth are the two
largest private hospitals providing acute care.
Raffles Medical Group (RMG) which owns Raffles SurgiCentre is in
the process of building a 428-bed hospital in the central
business district. It will be completed by end of 1999 and will
be the second largest private hospital after Mount Elizabeth.
RMG also manages medical service centers at the Singapore Changi
International Airport and Hong Kong's Chek Lap Kok Airport.
The other seven private hospitals are:
Adam Road Hospital
HMI Balestier Medical Centre
Kwong Wai Shiu Hospital
Mount Alvernia Hospital
Raffles SurgiCentre
Ren Ci Hospital
St. Andrew's Community Hospital
Thomson Medical Centre
Westpoint Family Hospital
Youngberg Hospital
Wards in the MOH hospitals are segregated into single-bed rooms,
two-bed rooms, four-bed rooms, six-bed rooms and ten-bed rooms.
Non-resident patients are not eligible to stay in the six-bed and
ten-bed wards as these wards are subsidized by the MOH. Private
hospital wards offer single-bed rooms, two-bed rooms and four-bed
rooms.
Health Care Expenditure
Government health care expenditure in 1997 was US$1.196 billion
or about US$300 per capita. The per capita total health care
expenditure (public and private) was US$745 in 1996 or 3.0% of
Singapore's Gross Domestic Product (GDP).
Health Care Financing
The financing philosophy of Singapore's health care delivery
system is based on individual responsibility, coupled with
government subsidies to keep basic health care affordable. To
help Singaporeans in the co-payment for hospitalization expenses,
the Singapore Government introduced the following health care
financing plans:
MEDISAVE: a compulsory savings plan to help individuals save and
pay for their health care expenditure.
MEDISHIELD: a catastrophic insurance plan to help meet the cost
of large medical bills; and
MEDIFUND: a health endowment fund which provides a safety net for
the poor and needy.
Under Medisave, Singaporeans pay between 6.0-8.0% of their
salaries into a medical savings account managed by the Central
Provident Fund (CPF, a Government trustee pension fund). This
percentage is part of the mandatory 40% of income which all
resident Singaporeans contribute to the CPF. Medisave is used
for hospitalization expenses including day and convalescent
hospitals as well as hospices. Certain expensive outpatient
treatments are included such as day surgery,
radiotherapy/chemotherapy, renal dialysis, in-vitro fertilization
and hepatitis B vaccination.
Medisave withdrawal is subject to the following limits:
- S$300 (about US$170) per day for daily hospitalization charges;
and
- a fixed limit for the various surgical procedures listed under
Medisave's guidebook "Using Your Medisave".
Medisave also allows payments to approved health insurance
schemes such as MediShield Plus, Incomeshield and Managed
Healthcare System.
As of December 31, 1996, there were 2.6 million Medisave accounts
totalling US$9.3 billion. The amount of Medisave withdrawn was
US$204 million for 1996. The average Medisave balance per account
was US$3,612.
MediShield was implemented in 1990 as a supplement to Medisave,
to cover expenditure for any serious or major illness. Medisave
was designed to cover average medical expenditures. As a
catastrophic insurance plan, MediShield reimbursements are only
for expenditures that exceed a "deductible" (technical term used
by MediShield). MediShield will pay only 80% of the excess.
Amounts which are not reimbursed by MediShield are deducted from
MediSave or the patients' health insurance plans.
MediShield Plus, an extension of MediShield since July 1994,
includes a second tier optional plan to cover hospitalization
expenses in higher-class wards. This plan is targeted at
patients using private hospitals or Class A and B1 wards in the
public sector.
Medifund is an endowment fund set up specially to help poor and
needy Singaporeans pay for their medical care. Medifund was
started in April 1993 with an initial endowment of US$140 million
from the Singapore Government. Only interest income from the
endowment fund which is distributed by the MOH hospitals is used
to pay hospital bills for the needy. Every MOH hospital has a
Hospital Medifund Committee appointed by the Government to
consider applications and allocate funds. |
发表于 2004-6-1 08:39:21