Singapore’s Public Healthcare System
Less than a decade ago, Singapore’s healthcare system was ranked as the sixth best in the world and the best in Asia by the World Health Organization in 2000. Today, Singapore has clearly emerged even further as a major medical center for Asia Pacific and a world-class healthcare hub; comprised of not just high quality health services, but complimentary research and education capacities as well through world-class collaborations.
This story of a single nation’s achievements in this arena and continuing aspirations to being on the forefront of medical developments has earned it numerous accolades and recognition as a world-class healthcare hub. It is well-deserved, and there is more to come.
By way of background, this island country is one of several remaining city-states in the world. Known officially as the Republic of Singapore with a population under 5 million persons, it is the smallest nation in Southeast Asia. Yet, this city-state enjoys accomplishments far beyond this distinction as it has ranked as the best place to live amongst expatriates in Asia. Singapore is also the world’s 2nd freest and 2nd most competitive economy.
A vibrant English-speaking environment, the country also holds the honor of being the world’s easiest place to do business. Singapore is extremely modern and is comparatively the world’s best logistics hub reaching far beyond its ever-efficient transportation facilities. It is also Asia’s 2nd most technologically ready nation. Therefore, it is no surprise that Singapore’s multifaceted capabilities have in fact created the backdrop by which a healing environment coupling high tech capabilities with high touch service quality results in some of the highest levels of patient-focused healthcare services available in the world.
Singaporean citizens as well as regional and international patients have long enjoyed this access to world-class health services in the city-state’s public health system. Comprised of two clusters; the National Healthcare Group (NHG) and Singapore Health Services (SingHealth); are housed under MOH Holdings (MOHH) which is the holding company of Singapore’s public healthcare establishments.
Together, the two clusters provide 80% of Singapore’s tertiary care services. With 8,338 beds, over 100 clinical specialties and sub-specialties, 7 hospitals and 6 specialty centers, and over 3,505 internationally qualified doctors; Singapore’s public healthcare system receives approximately 4.6 million patient visits per year, and treats more than 160,000 international patients annually.
All 7 hospitals and 2 of these specialty centers are accredited by the Joint Commission International (JCI). Published pricing transparency is made available to the public at large. Currently, information on more than 70 medical treatments is available on the Singapore Ministry of Health’s website www.moh.gov.sg
In their oversight role, the Ministry of Health also maintains strict quality of care standards in their effort to keep patient-centered medical standards high and to uphold Singapore’s standing as a world-class healthcare center. Clinical outcomes are tracked and Singapore consistently benchmarks themselves against other world-class Centers of Excellence. Examples of clinical outcomes for orthopedic procedures such as knee replacements, hip replacements and spinal decompression are included as attached in Annex 1: Clinical Outcome Measures.
The healthcare industry’s emphasis on clinical outcomes and quality is also central to their measurement and evaluation systems. Given the importance of these metrics to U.S. based payers and insurers in evaluating treatment efficacy, this also serves to reinforce the attractiveness of Singapore as a medical tourism destination to Americans seeking treatment overseas. Singapore’s public healthcare institutions are regional training, research and referral centers. In light of that, specialists and healthcare professionals within these institutions work across functional expertise in managing clinical caseloads, and a collegial environment is fostered such that patients, local and international benefit from this cross-collaboration.
Singapore’s public hospitals and specialty centers services are at the forefront of medicine and there are many records of accomplishment to-date. A few notable ones include the first successful case of OOKP ‘Tooth-in-Eye’ surgery, performed in July 2004, by eye surgeons from the Singapore National Eye Centre together with a dental team from the National Dental Centre. This surgical procedure was the first of its kind within the Asia Pacific region.
Robot Assisted Minimally Invasive Cardiothoracic Surgery Program initiated by the National Heart Center. Advanced clinical treatment and high-risk complex surgeries are done using state-of-the-art cutting-edge medical technology that includes the Da Vinci machine, the first digitally-integrated Neuroscience Centre and a BRAINLAB’s integrated BrainSuite; a computer-guided neurosurgery system to improve the efficiency of healthcare delivery.
In the field of oncology, Singapore’s National Cancer Center is rapidly establishing itself as a regional referral center for complex cancer surgery. Today, new procedures include peritonectomy and intra-peritoneal chemotherapy for the management of advanced intra-peritoneal diseases. With some of the most established quaternary medical care facilities in Asia, Singapore’s public healthcare system provides high-end specialty care and complex surgical interventions in oncology, cardiology, cardiothoracic and vascular surgery and also advanced orthopedic procedures such as the use of stem cells in orthopedics.
As of this year, more than 100 patients have had a revolutionary stem cell treatment procedure whereby new cartilage is implanted into knee joints replacing worn-down cartilage. While this is truly a quality of life improvement; as persons just lived with the pain and discomfort unless it became so disagreeable that total knee replacement were performed, Singapore continues to go the extra mile, adhering to continued medical progress in cartilage implants.
National University Hospital orthopedic specialists are now involved in conducting clinical trials to determine if this cutting-edge cartilage implant procedure can be performed without the use of a scalpel. Clearly another world-first record, this process would not only save significant recovery time, but hospitalization and surgical expenses as well when cartilage implants are performed on patients on an outpatient and/or same-day surgery basis.
World Class Collaborations
Since 1990, Singapore’s world-class healthcare services reputation has expanded to include top-notch medical research and healthcare services. Many of the world’s big pharmaceutical and innovative life sciences companies have set up research facilities in this city-state. In addition to the state-of-the-art treatments delivered by highly skilled medical professionals, patients have access to new and emerging treatment options made possible by clinical research protocols underway right now in Singapore.
Singapore is Asia’s base to Duke University and Johns Hopkins University; two U.S. institutions that are world-renowned in all aspects of academic medicine. Duke University’s internationally renowned reputation provided Singapore with an opportunity to accelerate research and play an even bigger role in the global health arena. The establishment of the Duke-National University of Singapore Graduate Medical School (GMS) is poised to also increase the supply of physicians in Singapore.
In addition to clinical training, medical students and physicians in training will be widely exposed to clinically-related research. This in turn, will further increase Singapore’s capacity to develop both breadth and depth in escalating its world-class standing as a comprehensive healthcare hub.
Professor Tan Ser Kiat, Group Chief Executive Officer, Singapore Health Services (SingHealth) remarked that, “Our joint partnership with the prestigious Duke University is a strategic opportunity for Singapore to collaborate internationally, contribute to our vision of developing Singapore as a vibrant biomedical hub excelling in medical education, scientific and clinical research and adding value to its excellent clinical service.”
For Johns Hopkins, Singapore represented this institution’s first clinical facility collaboration beyond the shores of Baltimore, outside the United States. In setting up the Johns Hopkins Singapore International Medical Centre (JHSIMC), the joint venture was dedicated to continuing the Hopkins tradition of excellence in all three areas of research, education and patient care. First opened in 2000 as a state-of-the-art oncology medical centre within the National University Hospital, JHSIMC is now housed in Tan Tock Seng Hospital with 12 chemotherapy treatment beds and 30 inpatient beds.
Across the Pacific and Atlantic – East meets West
Recently, Hannaford, a grocery chain based in New England, began offering its 27,000 employees the option of getting a number of medical procedures done in Singapore rather than within the U.S. at a savings to the employee of several thousand dollars in co-payments and deductibles. Aetna, as the insurance provider linked up with National University Hospital (a facility under the National Healthcare Group) in a pilot scheme to offer Hannaford’s employees the option of having their procedures done overseas, in Singapore.
Singapore stands ready to partner across the industry in working with US employers and insurers to address the issue of rising healthcare costs and provide value purchase options in the area of healthcare. In the words of Professor Ivy Ng, Deputy Group Chief Executive Officer, Singapore Health Services (SingHealth) commented that, ‘”For decades, Singapore has been the preferred destination for regional patients seeking quality treatment for advanced and complex care.
With our network of JCI-accredited facilities, collegiate medical practice and excellent clinical outcomes, we are well-poised to serve international patients seeking top-class medical care that are on par with the best centers in the world yet at only a fraction of the costs.”
At the September 2008 World Congress on Medical Tourism and Global Health held in San Francisco, Judy Lim, a delegate and Director of Marketing at MOH Holdings provided this perspective about medical tourism in Singapore: “Our two main objectives in attending Congress were to learn from the medical tourism industry; and to participate in the networking opportunities. We came away having achieved both objectives. Because we brought our hospitals to San Francisco; that exhibition allowed delegates to get to know Singapore; our strengths and capabilities.”
“For us, it was also an opportunity to meet people in insurance companies, and medical facilitators. Looking ahead, Singapore has been involved in medical tourism for a long time. It is seamless in the sense that medical travel for persons coming from within Asia to Singapore for medical consult and procedures has been going on for decades.
We see it as part of Singapore’s natural expansion process to reach beyond the region, into the U.S. onto an international platform. Areas that may benefit from Singapore’s capacities include the United Kingdom, Russia, China and as previously mentioned, the U.S.”
Fast forward, it does appear that Singapore is advancing well into the US market, and will continue to capture mindshare, create partnerships and increase brand awareness. As the industry grows to an estimated $60 billion as noted by the Deloitte Center for Health Solutions report on Medical Tourism, Singapore’s reputation throughout the Asia Pacific region as a service, quality and cost-effective healthcare service provider serves as a firm foundation in extending this outreach across the Pacific and Atlantic; from East to West.
Fostering growth and market share may well be a natural extension to what Singapore is already doing, and doing well. This city-state has built a firm foundation in delivery, financing and access of healthcare services in such a way that it is truly poised to be a healthcare destination of choice for the global medical traveler seeking services.
Whether it be the insured, uninsured, underinsured, or elective procedure, Singapore’s public healthcare system is well-matched in offering the US affordable and viable alternatives to address the rising cost & concerns of healthcare here at home in the interim.
And here at home, in the U.S., as we wait on the winds of change and promises of healthcare reform, beyond the phenomena that is medical tourism, for an individual seeking treatment or locked out of healthcare services, Singapore represents choice. It is an alternative, an option, and a choice, for care and services now.
In the words of Newt Gingrich, former Speaker of the House of Representatives, he had this to say about Singapore as a medical travel destination: “The greater the degree that you’re going somewhere for something difficult, the more you’re going to want to know about quality… You look at a place like Singapore, which is very sophisticated—they’re going to have quality, they’re going to have information, they’re going to have electronic health records, they’re going to have metrics for outcomes.”