How To Register For Healthcare In Singapore
Singapore has a two-tier healthcare system consisting of a compulsory national health insurance scheme and private provision. Your entitlement to state healthcare depends on your residency status. If you are a citizen or a permanent resident, you will be covered by the state: this includes expats. If you are not a permanent resident, you will not be eligible for the national health system and will need to take out private cover. We will take a look at how to register below.
Health insurance in Singapore is divided into five categories including medical expense insurance and hospital cash insurance. The Singaporean Ministry of Health and the Central Provident Fund Board (CPF) operate a compulsory national programme, MediSave. As an employed expat, you will be registered with this by your employer (see below).
In addition, the state runs MediShield Life: this a catastrophic illness insurance scheme designed to protect clients against large hospital bills.
A recent initiative is CareShield Life: a long-term care insurance scheme providing basic financial support in cases of severe disability, especially during old age, which need personal and medical care for a prolonged duration (i.e. long-term care).
There are also a large number of private healthcare providers in Singapore. Both state and private provision are of an extremely high quality and Singapore is a destination for medical tourism.
How to register for healthcare in Singapore
MediSave describes itself as a national medical savings scheme which helps members put aside part of their income into their MediSave Accounts to meet their future personal or approved dependent’s hospitalisation, day surgery and certain outpatient expenses. Your employers must register you with the compulsory scheme and will pay contributions into MediSave from your salary. If you earn an annual Net Trade Income (NTI) of more than SGD$6,000 (USD$4500) as a self-employed person, you will also need to contribute to MediSave.
Once you have been registered, you will be given a national security (NRIC) card which is used in the state medical system: you will need to take this with you when you are seeking treatment.
For enquiries about the scheme, call the Healthcare Hotline at 1800 222 3399 (or +65 6222 3399) from Mondays to Fridays, 8am to 5.30pm (GMT+8), or visit the website. The website also has a list of contribution rates, shown as percentages of your income.
MediShield Life operates via a deductible scheme, in which you must make a series of payments before being eligible to claim, but once this is in place the scheme will then make co-payments for medical treatment, reducing your out of pocket costs by 50 – 80%. However, there are other government-approved policies.
If you are a permanent resident you will also be automatically enrolled in the government’s ElderShield policy from the age of 40. You can opt out of this if you wish, but can also opt back in again later on. Premiums will depend on your income and age bracket, as well as your gender: a 40 year old woman, for example, would pay on average SGD$200 per annum for 26 years. Premiums for men are lower due to lower life expectancy. Aviva, Great Eastern, and NTUC Income provide ElderShield care and are government-approved.
You can use your MediSave at all public healthcare institutions, and approved private hospitals and medical institutions, for yourself or your approved dependants (your spouse, children, parents, grandparents and siblings, who can be of any nationality, except for grandparents and siblings who must be Singapore Citizens or Permanent Residents).
You can find a list of participating clinics on the Community Health Assist Scheme (CHAS) website.
Medical insurance in Singapore operates on a reimbursement scheme and you will need to pay upfront and then put in a claim. You must inform the medical institution that you want to claim from MediSave during billing, or when you are being discharged.
You will then need to sign a Medical Claims Authorisation Form (MCAF), which authorises the institution to use your MediSave account to pay the bill. After the payment has been processed, you will be sent a MediSave Claims Statement.
Cost caps can be found on the MediSave website. If you do not have enough ‘savings’ to cover a particular treatment, you can draw on a relative’s MediSave account or pay the difference in cash.
Dental surgery is covered to some extent by MediSave, but you should look into the conditions of this: extractions, for example, are not covered under the scheme, but implants are. You can claim between SGD$250 to $2,850 for dental care from MediSave.
As with medical clinics, Singapore’s dental clinics are both public and private: Polyclinics (government-subsidised healthcare centres) may include dental care and you can also access the National Dental Centre, which works with a number of community partners. If you choose your local clinic, check whether they are covered by MediSave.
If you choose to go fully private, then contact your health insurance provider for a list of approved local clinics. Private health plans will cover a full range of inpatient and outpatient care. You will also need to take out private cover for non-surgical dental treatment.
Singapore Health Insurance
How To Move To Singapore
How To Open A Bank Account In Singapore
The banking industry is a key player in Singapore’s financial market segment, which has been emerging as one of the strongest in the world. The city-state is considered an international finance centre – the third largest in the whole of Asia, after Japan and Hong Kong. There are roughly 117 foreign banks and six local banks that dominate the banking scene in Singapore.The flourishing success of Singapore’s banking industry can be attributed to a number of factors, including the liberalisation of the domestic banking market, strengthened regional presence from local banks through mergers and acquisitions, and a (government initiated) highly competitive landscape.
Banking options for expats
Firstly, it’s always a good idea to leave enough money in your bank account back home to keep it from being closed due to inactivity. You may wish to continue paying off some bills or direct debits from that account.
Singapore has a vast selection of different accounts when it comes to banking, covering every circumstance and catering to every requirement. Some examples of the different account types that are available in Singapore are:
Current account
Current accounts are quite similar to savings accounts. Although they typically pay little to no interest on your deposits, they are easier to withdraw money from. For example, if you’re running low on funds, you can usually overdraft a current account, whereas not all savings accounts will allow this. Current accounts also come with a cheque book.
Multi-currency account
These accounts enable you to store savings in various currencies, rather than specifically limiting you to one currency. This is often a great option for expats, who may not wish to exchange their money and keep it in their account until the next time they visit home.
Savings account
No matter what your income level or employment status is, you will need a basic bank account for your day-to-day expenses. Some savings accounts offer higher interest rates than others, so that you can grow your savings, but they may come with an annual cap.
Investment account
Investment accounts are offered by banks and brokerages, and they enable you to invest in a range of vehicles, such as unit trusts, equities, and so on. If your goal in Singapore is to maximise your earning potential, then it is well worth considering an investment account.
Offshore account
In addition to the above, Singapore is one the world’s leading offshore financial centres, with a stable political environment. This often means that expats wish to hold a Singapore-based offshore account long-term, in addition to their day-to-day account.
How to open a bank account in Singapore
Due to tightening anti money laundering laws, opening a bank account in Singapore as a non-resident is a little more complicated than it used to be. However, if you are working or studying in Singapore and are over the age of 18 years old, the process should be quite straightforward. It is still possible, with the right paperwork, to open an account as a non-resident, but not every bank will accept your application.
To open an account, you will first need to make an appointment with a local branch. You can submit the application online, but you will still need to go to a face-to-face appointment to finalise the account. For those wishing to open a joint account, both account holders need to be present at the appointment. However, each of the account holders can visit the bank separately, if necessary.
Documents required: non-resident
The standard documents that non-residents will be required to present include:
• Valid photo ID, such as a passport or national ID card
• Proof of current residence (addressed phone bills, utility bills, official correspondence, etc.)
• Valid employment pass or In Principle Approved (IPA) from the Ministry of Manpower
• Tax or national insurance number
In addition to the standard documentation, you may also be required to supply:
• Copy of your current rental agreement and government issued proof of address
• Proof of employment (such as a copy of your employment contract or a payslip)
• Bank statements from your home country
• Tax returns from your home country
• Reference or introduction letter from your home country bank
• Minimum of six months’ validity on your passport and/or four blank passport pages
These requirements do vary from one bank to another, so it is always best to contact an agent at your chosen bank prior to your appointment, in order to clarify precisely which documents you will need.
More about banking in Singapore
It may be worth noting that, in order to obtain a credit card, as an expat, you will usually need to put a small deposit in the bank and provide a salary confirmation slip. Most major international credit cards are accepted in Singapore, but they come with exchange and transaction fees. Another noteworthy tip is: don’t forget that not all bank cards can be used in all ATMs. In Singapore, you will need to find an ATM that is on the same network as your card.
Most major retail banks in Singapore open from 9.30 a.m. to 3.00 p.m., although some open as early as 8.30 a.m. and others extend their closing time to 5 p.m. The banks are typically open at these times from Monday to Friday. Some banks open for half days on Saturdays, whilst others do not, and nearly all remain shut on Sundays.
Many of the local Singaporean banks are considered good by global standards. Singapore has only six local banks: Bank of Singapore (part of OCBC Bank), DBS Bank Limited, POSB (part of DBS Bank), OCBC Bank, and United Overseas Bank Limited (UOB). Notably, DBS has been rated as the safest bank to bank with in Asia. It is the largest local bank by market value, and it also has the largest number of branches in the country.
There are far more foreign and international banks than local ones in Singapore, the best of which are widely regarded to be the Bank of America, Bank of China, Citibank Singapore, and HSBC.
What Quality Of Healthcare Can You Expect In Singapore?
There are a number of ways to measure the quality of healthcare, and different people place emphasis on different elements. For example, some might consider good bedside manner a particularly important factor, while others may be more concerned with the knowledge and qualifications of medical personnel.Generally speaking, regulatory authorities tend to focus on several key determinants, when considering how good a healthcare system is. For example, they look at how efficient it is, how patient-centred it is, its equitability, and the safety and effectiveness of the care it provides.
This article will take you through what quality of healthcare you can expect to find in Singapore.
Healthcare in Singapore
A quick overview of the Singapore healthcare system in terms of global positioning.
Singapore is considered to have a highly efficient healthcare system, both in terms of financing and results, and has been ranked sixth in the world by the World Health Organisation (WHO), and second out of 166 countries for healthcare outcomes by The Economist Intelligence Unit. The Bloomberg Global Health Index named Singapore as the fourth healthiest country in the world, and the most healthy in Asia. Singaporeans also enjoy one of the longest average life expectancies in the world – 87.6 years for women and 75.8 for men.
The Singaporean government regularly adjusts policies to actively regulate ‘the supply and prices of healthcare services in the country’, in an attempt to keep costs in check. This contributes to the efficiency and cost effectiveness of the healthcare system.
Consultancy firm Towers Watson has claimed that the specific features of the Singapore healthcare system are unique and ‘very difficult to replicate.’ However, this hasn’t stopped other countries from conducting studies and trying to emulate some aspects of the system.
Quality and management
Management, regulations, and quality criteria measurables in Singapore public hospitals.
The Singaporean government regulates a large portion of the buying, selling, and distributing process when it comes to imported medicines. They regulate and instruct hospitals around how much they can sell.
About 80% of all hospitals in Singapore are public hospitals, and they all provide an exceptional quality of care, even when held up in comparison to the private sector. Public hospitals in Singapore are divided up into five groups, and they are required to be competitive with their prices against one another, which lowers the average medical costs for patients.
Singapore uses a National Health System Scorecard, which uses international standard criteria indicators to compare and improve performance. The Public Acute Hospital Scorecard measures institution-level performance, and all public healthcare providers in the country are monitored to ensure their compliance with the key deliverables set out on them.
Financing
Singapore’s unique financing model for public healthcare explained.
The Singaporean government, as well as utilising bulk buying power to keep medication costs low, adopts a sustainable approach to financing. For example, implementing tax measures that pay for the accessible public healthcare and cover of indigent healthcare costs, combined with a tiered subsidy model, ensures that those on a low income still receive the necessary basic medical care that they need. Mandatory government savings accounts for the sole purpose of medical costs are implemented for all workers. The government supplements or covers higher costs and ‘catastrophic care’.
Subsidies
A look at Singapore’s tiered medical subsidy model.
Singaporean citizens and permanent residents staying in public hospitals receive government subsidised medical fees, which are scalable depending on level of insurance cover, class of ward, and household income. For example, in some cases, the level of subsidy may be based on a patient’s monthly income over the last year. In other circumstances, usually in the instances of day surgery, accident & emergency, and specialist care, patients receive a standardised subsidy regardless of income.
Patients with no personal income, such as pensioners or stay-at-home spouses, will usually have a subsidy rate that is worked out according to the value of their homes. Those requiring medical assistance who have no income at all (i.e. those who are unemployed) will be entitled to the highest level of the tiered subsidies.
Whilst it may seem overly complex to some, it is an intricate system that is designed to be as fair as possible, whilst ensuring that those of low income households do not struggle to pay necessary medical fees. This is in stark contrast to some systems that are in place, such as in America.
Issues
What issues has the Singaporean healthcare system experienced?
All healthcare systems have some room for improvement. For Singapore, the main struggle in the public healthcare sector has been with the ongoing shortage of available hospital beds. In some extreme circumstances, patients have had to be temporarily located in air-conditioned tents, along ward corridors, or in rented premises outside of the hospital campus.
The issue of overcrowding in hospitals is not unique to Singapore. Many countries around the world are suffering from the same problem, largely due to ageing populations. The Singaporean government has been working towards fixing this issue for the last decade, by opening more hospitals and community centres, and there are more in the pipeline. Additionally, the government has invested heavily in developing and extending existing hospitals, in order to increase room and subsequently the numbers of beds.
Patient-centric practices
How patient-centred are the healthcare services in Singapore?
Interestingly, the government in Singapore consults health system stakeholders and patients prior to implementing new policies and practices. This is to ensure that public sentiment, concerns, and feedback are all taken into careful consideration. The diverse perspectives help test and refine ideas, before they are progressed to implementation. This is an excellent example of how unique and patient-centred the Singaporean healthcare system is.
Singapore’s Ministry of Health (MOH) conducts annual patient satisfaction surveys, which ask patients to rate facility waiting times, care coordination, and other health service attributes, so that they can be revised and improved upon if needed.
Another excellent component of the integrated healthcare system is Singapore’s “Agency for Integrated Care”. The agency promotes patient-focused integration of primary care for intermediate and long-term care cases. It operates at patient, provider, and system levels, coordinating and advising patients, families, and caregivers on the most appropriate healthcare services for each patient.
How To Register With The Health System In Singapore
The healthcare system in Singapore is one of the best in the world, currently ranking in sixth place globally, according to the World Health Organisation (WHO). It was also voted as ‘the most efficient healthcare system in the world’ by Bloomberg in 2015. The healthcare system in Singapore is supervised by the Ministry of Health. The Singaporean healthcare system comprises a government-run and subsidised healthcare system, in addition to the private healthcare sector.The healthcare system in Singapore is financed in various ways, from direct government-run subsidies to national healthcare insurance, cost sharing, and deductions from compulsory saving plans or Central Provident Funds (CPF). In this article, we will look at the healthcare system in Singapore and walk you through how to register.
Healthcare payments in Singapore
Before registering for healthcare in Singapore, it would probably be handy to understand a bit more about how the system works, particularly in regards to payment for medical costs. Read this section to learn more.
Paying for healthcare in Singapore as a non-resident
If you are not officially registered as a permanent resident of Singapore, then you won’t be entitled to any sort of government subsidised healthcare payments. This may result in higher medical bills than you were expecting. You will have to pay more than someone who is a citizen or permanent resident of Singapore.
For example, a subsidised non-emergency consultation at a clinic would likely cost approximately SG$20 to S$30, whereas a similar appointment without subsidised payment or private insurance would probably cost in the region of SG$120 to SG$200.
Hence why it is very important that, if you are on a short-term contract in Singapore, you check whether your employer handles employee healthcare payments. Otherwise, you may want to purchase a private health insurance policy for the duration of your stay.
Paying for healthcare in Singapore as a citizen or permanent resident
If you are a citizen or permanent resident of Singapore, then there are different types of payment you should be aware of:
Publicly financed healthcare
The universal healthcare that Singapore provides consists largely of government subsidies, which cover up to 80% of the total cost of medical care provided in public hospitals and primary care polyclinics. It is also supported by what is often referred to in Singapore as “the 3M’s”. These are Medisave, Medishield and Medifund, which are a collection of savings and insurance schemes.
Medisave
Medisave is a medical savings programme in Singapore that requires mandatory contributions from citizens and permanent residents. These contributions are taken as a percentage directly from workers’ pay packages and deposited into a Medisave account, along with matching contributions from employers. Contributions to (and withdrawals from) the Medisave accounts are tax-exempt.
The funds deposited in the account can only be used to pay for health services (such as hospitalisation, day surgery, and certain outpatient expenses) and health insurance for the account holder and family members (this is usually restricted to dependants only).
For enquiries on Medisave, call the Healthcare Hotline at 1800 222 3399 (or +65 6222 3399) from Mondays to Fridays, 8am to 5.30pm (GMT+8).
Medishield
Medishield is best described as a low-cost “catastrophic health insurance scheme” to help policyholders meet the medical expenses of major or prolonged illnesses that their Medisave balance is not sufficient to cover. Singaporeans are automatically enrolled on the Medishield scheme, and permanent residents are also covered, provided that they have a Medisave account. The only case in which someone residing in Singapore would not have a Medisave account is if they are doing unregistered work or are an undocumented migrant or visitor/tourist.
Medifund
Medifund was established as financial aid for those receiving treatment from an approved institution, who would otherwise not be able to afford standard medical treatment costs. This can be despite government subsidies and the cover of Medisave and MediShield.
Private health insurance
Private health insurance is available from a wide range of providers and is intended to be used as a supplement to your MediShield coverage. They are often referred to as “Integrated Shield Plans”, whereby the plan is purchased with your Medisave funds. You can also opt to purchase an entirely separate private health plan with your own money.
Registering with the healthcare system in Singapore
Now that you’ve had a crash course in how the healthcare system in Singapore is structured, we’ll walk you through the simple process of registering.
Singaporean citizens are automatically enrolled in the healthcare system and can often receive up to 70% subsidy on medical bills through this. Permanent residents are also automatically enrolled, usually after registering to the Central Provident Fund (CPF). Permanent residents also need to apply for a National Registration Identity Card (NRIC). This is a compulsory document for everyone intending to reside and work in Singapore.
You can then take your NRIC with you as identification, or you can provide a birth certificate, passport, employment pass, or dependant pass, when seeking medical treatment. You should clarify your payment terms with the medical staff and produce the necessary documents, such as your insurance card. Usually, following treatment, you will receive a bill asking for full insurance details (including the name of your insurance provider and ID or policy number). If you’re stuck footing the bill yourself, you’ll have to pay via cash, Network for Electronic Transfers (NETS), or debit/credit card.
If you are an expatriate but not a permanent resident, then it is highly unlikely that you will qualify for government subsidies. If this applies to you, then you need to either research the healthcare benefits that your employer offers, as some provide this within their contracts, or look at private healthcare insurance. Private healthcare insurance is vital in Singapore if you are not entitled to any government subsidies, savings, or discounts, as footing the entire price of a medical bill from your own pocket can be astronomically expensive.
Registering with a local doctor in Singapore
Registering with your local doctor is different to registering with the healthcare system, as the latter is based on your residency status. Even if you are an expatriate who is not a permanent resident, you are entitled to (and will likely wish to) register with a local GP for the duration of your stay in Singapore.
Before you can book a consultation or seek medical treatment from your general practitioner, you will need to register at your local clinic. This can be done with a document, such as your NRIC, or alternatively you could use your passport, birth certificate, or employment/dependant pass.
You can find a local GP clinic by searching online and reading the reviews, by looking at local listings, or by joining an expatriate community and getting first-hand recommendations. You can make appointments with doctors via online services, such as GetDoc or Practo.
How To Keep Your Health Insurance Costs Low In Singapore
It’s relatively easy to keep your health insurance costs low in Singapore, mostly due to the government’s medical subsidies. Every working citizen and permanent resident is automatically enrolled in a mandatory savings system. Through this, funds are deposited directly from employees’ pay cheques into savings accounts, which are specifically reserved for paying medical expenses. Supplemental health insurance is therefore advisable, but not a necessity.When considering your options, you should check whether your employer offers a health insurance package, as this may be able to save you money. You will need to clarify the intricacies of the policy, such as what exactly is covered, how much is covered, and who is covered. If your dependants are not mentioned in the policy, for example, then you may have to purchase either add-ons or separate policies entirely to ensure your family has adequate health cover.
Health insurance in Singapore: the basics
The basic health insurance that all workers pay into, which can be used for public hospital expenses, is called MediShield. MediShield is mandatory, and the money for it is taken directly from your monthly paycheck. You can further boost this with an optional integrated plan, usually referred to as MediShield IP (integrated plan). Integrated plans offer extended cover, and they also give you access to better wards in public hospitals or, in some cases, treatment in private hospitals. They typically work on a co-pay rider basis, where you pay up to 5% of the medical costs and the insurer pays the rest.
Keeping insurance costs down
Public hospitals
Perhaps the most obvious way to keep your health insurance costs low in Singapore is to opt for treatment in public hospitals. Public hospitals are regulated and subsidised by the government, so the rates are fixed and much lower than those of private hospitals, who can set their own prices.
Insurance policy comparisons and aggregators
Value Champion is an incredibly helpful resource for deciding on your health insurance plan. You can visit the website here. The Value Champion website advises you on the right policy for you, depending on whether you want the cheapest insurance policy, the best value for money, or the best option for families or for chronic illnesses etc.
Using insurance aggregators, such as Insurance Market Singapore, is also a helpful way to find the least expensive policy.
Purchasing a local insurance policy is going to cost you less than an international policy. If you’re living and working solely in Singapore, you don’t really need an international policy. You only really need to consider paying for an international policy if you travel a lot.
Lower your premiums
Almost every health insurance policy has various premiums, essentially meaning you will pay more for your policy if you have certain health conditions or meet certain criteria. Whilst you may be tempted to not mention pre-existing medical conditions, this is an extremely bad idea, as it can render your policy null and void later on. What you can do is lower your premiums by improving your criteria. For example, if you are a smoker then you could give up smoking. With many providers, smokers can end up being charged up to 50% more than non-smokers for the same policy.
Increase your deductible
Generally speaking, with most insurance policies, the greater the expenses you pay out of pocket, the lower your premiums. Pairing a high-deductible supplemental insurance with a health savings account (which is mandatory in Singapore anyway), then paying the expenses from said savings account or out of pocket, can reduce your private insurance premiums.
However, this approach only works in certain circumstances. You will need to sit down and crunch the numbers to see whether increasing your deductibles could save you money on your chosen policy or not. The higher your insurance costs, the more you will save by increasing your deductibles, because the discount for a higher deductible is usually a percentage. It might not be worth implementing this approach on an already low cost policy, as the savings would be minimal. If you do decide to go down this route, make sure that you are financially sound enough to be able to pay the higher deductible.
Change your co-insurance/co-payment ratio
This is basically the amount that you pay and the amount that your insurance pays. As mentioned earlier, the MediShield IP add-on requires you to pay up to 5% of costs, and then the insurance covers the rest. If you are looking to purchase further private health insurance, but want to keep the costs relatively low, then you can see whether changing the co-payment ratio reduces the price of the monthly payments. If it is not immediately clear whether you can achieve this, speak to a member of customer services to see whether they can help.
Choose an in-network doctor
You may find that some policy providers offer a discounted price compared to the larger corporations, under the caveat that you are tied to using their in-network doctors and facilities, as stipulated in the policy underwriting. More often than not, these types of policies are provided by medical groups that are co-owned by a group of doctors. Be sure to research the provider’s medical network before you agree to anything. If you are picky when it comes to choosing your doctor, then this probably isn’t the sort of policy that you should be looking at.
Regularly reassess your health insurance requirements
Sticking with the same plan year in and year out can sometimes mean that you miss out on savings. You should regularly be assessing your health insurance needs and whether your current plan is best suited to them. For example, some factors to regularly assess are whether you have children who often need to go to the doctor’s, whether you or anyone in your family requires prescription drugs, and so on.
What Quality Of Healthcare Can You Expect In Singapore?
It is difficult to define what makes healthcare high quality, as people place varying levels of emphasis on a range of different factors. For example, some would consider good bedside manner a key determinant, whereas others may put more weight on the knowledge or qualifications of healthcare staff. Regulatory authorities tend to measure the quality of healthcare on its efficiency, its provision of safe and effective care, its patient-centred service and its equitability, as well as some other factors.
Healthcare in Singapore
A quick overview of the Singapore healthcare system in global positioning.
Singapore is considered to have a highly efficient healthcare system, in terms of both financing and results. It has been ranked sixth in the world, by the World Health Organisation (WHO), and second out of 166 countries for healthcare outcomes, by The Economist Intelligence Unit. The Bloomberg Global Health Index named Singapore as the fourth healthiest country in the world, and the first healthiest in Asia. Singaporeans also enjoy one of the longest life expectancies in the world, which is 87.6 years for women and 75.8 years for men.
The Singaporean government regularly adjusts policies to actively regulate “the supply and prices of healthcare services in the country,” in an attempt to keep costs in check. This contributes largely to the efficiency and cost effectiveness of the healthcare system.
Consultancy firm Towers Watson has claimed that the specific features of the Singapore healthcare system are unique and “very difficult to replicate.” However, other countries have paid notice, conducted studies and, in some cases, tried to emulate some aspects of the system.
Quality and management
Management, regulations, and quality criteria measurables in Singaporean public hospitals.
The Singaporean government regulates a large portion of the buying, selling and distributing process when it comes to imported medicines. The government regulates and instructs hospitals on how much they can sell. About 80% of all hospitals in Singapore are public hospitals, all of which provide an exceptional quality of care, even when held up in comparison to the private sector.
Public hospitals in Singapore are divided up into five groups, and they are required to be competitive with their prices against each other, thus lowering the average medical costs for patients.
Singapore uses a National Health System Scorecard, which uses international standard criteria indicators to help improve performance. The Public Acute Hospital Scorecard measures institution-level performance, and all public healthcare providers in the country are monitored to ensure they comply with the key deliverables set out on these.
Financing
Singapore’s unique financing model for public healthcare explained.
The Singaporean government uses bulk buying power to keep medication costs low, and it also adopts a sustainable approach to financing. For example, it implements tax measures that pay for the accessible public healthcare and cover of indigent healthcare costs, which, combined with a tiered subsidy model, ensures that those on a low income still receive the necessary basic medical care that they need. Mandatory government savings accounts for the sole purpose of medical costs are also implemented for all workers. The government supplements or covers higher cost and ‘catastrophic’ care.
Subsidies
A look at Singapore’s tiered medical subsidy model.
Singaporean citizens and permanent residents staying in public hospitals receive government subsidised medical fees, which are scalable, depending on level of insurance cover, class of ward, and household income. For example, in some cases, the level of subsidy may be based on a patient’s monthly income over the last year. In other circumstances – usually in the instances of day surgery, accident and emergency, and specialist care – patients receive a standardised subsidy regardless of income.
Patients with no personal income, such as pensioners or stay at home spouses, will usually have a subsidy rate that is worked out according to the value of their homes. Those with no income at all, who require medical assistance, will be entitled to the highest level of the tiered subsidies.
Whilst it may seem overly complex to some, it is an intricate system that is designed to be as fair as possible, while still ensuring that those of low income households do not struggle to pay necessary medical fees. It is a very different model to what is used in some other countries, such as in America.
Issues
What issues has the Singaporean healthcare system experienced?
As is the case with any healthcare system, there are always things to be improved upon. For Singapore, the main struggle in the public healthcare sector has been with the ongoing shortage of available hospital beds. In some extreme circumstances, patients have had to be temporarily located in air-conditioned tents, ward corridors, or rented premises outside of the hospital campus.
The issue of hospital overcrowding is not unique to Singapore. Many countries around the world are suffering from the same problem, largely due to an ageing population. The Singaporean government has been working towards fixing this issue for the last decade, by opening more hospitals and community centres, and there are plans to open even more. Additionally, the government has invested heavily into developing and extending existing hospitals to increase room and subsequently the number of beds.
Patient-centric practises
How patient-centred are the healthcare services in Singapore?
Interestingly, the government in Singapore consults health system stakeholders and patients before they implement new policies and practises. This is to ensure that public sentiment, concerns and feedback are all taken into careful consideration. The diverse perspectives help test and refine ideas, before they are progressed to implementation. This is an excellent example of how unique and patient-centred the Singaporean healthcare system is.
Singapore’s Ministry of Health (MOH) also conducts annual patient satisfaction surveys, which ask patients to rate facility waiting times, care coordination, and other health service attributes, so that they can be revised and improved upon if needed.
Another excellent component of the integrated healthcare system is Singapore’s “Agency for Integrated Care”. The agency promotes patient-focused integration of primary care for intermediate and long-term care cases. They operate at patient, provider, and system levels, coordinating and advising patients, families and caregivers on the most appropriate healthcare services for the patient.
How To Register With The Health System In Singapore
In 2019, Singapore was ranked as having the sixth best healthcare system in the world. One of the many reasons for it being so popular with expatriates is its accessibility. High-quality health care with English-speaking specialists is quickly and easily accessible throughout the country. Singaporean citizens have the world’s fifth longest life expectancy (84 years old), so they’re obviously doing something right!
Health care, health insurance and health plans
Monetary contributions for health care in Singapore are typically taken automatically from employees’ wages, as part of the central provident fund (CPF). The CPF is a mandatory social security savings scheme that all working citizens and permanent residents pay into. Employees usually pay around 9% of their monthly wage towards Medisave. Medisave is a compulsory savings account, created specifically for healthcare, that every citizen and permanent resident will have. Part of your monthly CPF payments will go into it.
The money in your Medisave account is specifically set aside for medical costs, such as outpatient care, emergency hospitalisation, etc., and a basic health insurance plan. Since there is no free public healthcare system in place, you cannot “register” for free healthcare. You will need to purchase your own private health insurance policy, or speak to your employer to double check that you will be enrolled in one of the mandatory healthcare options once your employment commences.
There are three types of healthcare plans that Singapore permanent residents can contribute to:
Medisave
Medisave contributions are compulsory and are deposited into your specific individual Medisave account. Money from this account can only be used to pay for medical expenses. This includes most routine medical assistance and operations.
Medishield
You will be automatically opted in for Medishield, which is used to cover the more expensive procedures that are not included on Medisave.
Medifund
Medifund is a voluntary health plan, which you need to submit an application for. It is designed for people without sufficient funds to pay for medical care, or for those without insurance.
How does healthcare work in Singapore?
For non-emergency medical advice or treatment in Singapore, your first port of call should be your local GP. Singapore has numerous public and private GP clinics to choose from, and a quick Google search will show you the nearest clinics to you. For other non-emergency treatments, such as vaccinations, outpatient care, follow-up appointments, health screening etc., you will usually need to head to a polyclinic.
Prescriptions
It is worth noting that international prescriptions will not be considered valid in Singapore. Therefore, you will need to sign up with a local GP to get a new prescription, in order to obtain any regular medication that you require.
How to register with a GP
You don’t really need to worry about registering beforehand for a specific healthcare facility in Singapore, as on-site registration is usually pretty quick and straightforward. You’ll be able to find forms in English, as well as English-speaking staff, without any difficulty. You simply need to find your local GP clinic, go to reception, request a form, fill it in and hand it back. Your details will be entered into the system for future reference.
The fees you will need to pay at GP clinics, polyclinics, hospitals, etc. will depend on your residency status and your health insurance plan. For example, the government offers subsidised medical costs at many facilities if you are a citizen or permanent resident contributing to the CPF. If you are an expat in Singapore, but you are not contributing to the CPF, then you will not receive subsidised medical treatment, and will need to ensure you have a private medical policy.
Some policies will either partially or fully cover costs of GP visits, so you need to have a policy in place, and know what it covers, before you register with your local GP. You will find in many cases that you will have to pay the medical costs out-of-pocket and then seek reimbursement from your insurance after you have been treated. Therefore, it is a good idea to make sure that you get a receipt for any medical costs incurred.
Specialists
Your local GP can refer you to specialist healthcare services if and when necessary. You can research a specialist doctor and/or facility and pay privately if you so wish. Expatriates usually choose to do this independently, so that they can find someone who speaks their native language. People who require extensive healthcare treatment or regular specialist appointments/treatment should research private medical insurance well in advance.
Singapore HealthHub
You can access the Singapore HealthHub website here. You will need a Singpass in order to register, and then you will be able to access multiple resources and manage your healthcare, as well as your family’s. On HealthHub, you can make appointments, view medical notes and medical history, get lab test results and more. You can track your and your family’s health vitals, your children’s vaccinations and growth charts, and even manage your medical payments.
There is also a “Caregiver Access” section, allowing your loved ones to grant you access to their own HealthHub account as a caregiver, so that you can check any medical information, and manage appointments and payments on their behalf.
Register for a Singpass
You can register for a Singpass easily on the website here.
The registration process only takes about three minutes. Those eligible for application include: Singapore citizens and permanent residents, various pass holders (such as employment passes, dependants’ passes, and long-term visit passes), and other select permit holders. You can find out more about who exactly is eligible for a Singpass here.
You will need an up-to-date registered address before you register for your Singpass, as you can only make the application once and the login/password details will be mailed to your registered address.
Alternatively, you can apply for a Singpass at your nearest Singpass counter and receive the pass immediately. You can find Singpass counter locations here.
How To Keep Your Health Insurance Costs Low In Singapore
It’s relatively easy to keep your health insurance costs down in a country like Singapore, mostly because of the government’s medical subsidies. Every working citizen and permanent resident is automatically enrolled into a mandatory savings system, through which funds are deposited directly from pay cheques into savings accounts, which are specifically reserved for the purpose of paying medical expenses. Supplemental health insurance is therefore advisable, but not a necessity.You should check whether your employer offers a health insurance package, as this could save you a fair chunk of money. You will need to clarify the intricacies of the policy, such as what exactly is covered, how much is covered, and who is covered. If your dependants are not mentioned in the policy, for example, then you may have to purchase either add-ons or separate policies entirely, to ensure your family has adequate health cover.
Health insurance in Singapore: the basics
Before jumping into health insurance plans and savings, it’s probably best to quickly familiarise yourself with the basic mandatory plans that are in place in Singapore.
The basic health insurance that all workers pay into, which can be used for public hospital expenses, is called MediShield. MediShield is mandatory, and the money is taken directly from your monthly paycheck. You can further boost this with an optional integrated plan, usually referred to as MediShield IP. Integrated plans offer extended cover, and also allow you access to better wards in public hospitals, or, in some cases, treatment in private hospitals. The integrated plans typically work on a co-pay rider basis, where you pay up to 5% of the medical costs and, if covered, the insurer pays the rest.
Keeping insurance costs down
So what can you do to bring your health insurance costs down? There are a few things you can tweak that may make you better off in terms of insurance plan payments.
Public hospitals
Perhaps the most obvious way to keep your health insurance costs down in Singapore is to opt for treatment in public hospitals. Public hospitals are regulated and subsidised by the government, so the rates are fixed, and much lower than in private hospitals, who can set their own prices.
Insurance policy comparisons and aggregators
Value Champion is an incredibly helpful resource for deciding on your health insurance plan. You can visit the website here.
The Value Champion website advises you on which policy is right for you, depending on whether you want the cheapest insurance policy, the best value for money, the best option for families, or the best option for chronic illnesses.
Using an insurance aggregator, such as Insurance Market Singapore, is also a helpful way to find the least expensive policy.
Purchasing a local insurance policy is going to cost you less than an international policy. You only really need to consider paying for an international policy if you work away and travel a lot.
Lower your premiums
Almost every health insurance policy has various premiums, essentially meaning you will pay more for your policy if you have certain health conditions or meet certain criteria. Whilst you may be tempted to not mention pre-existing medical conditions, this is an extremely bad idea, as it can render your policy null and void later on. What you can do is lower your premiums by improving your criteria. For example, you could give up smoking. Smokers can end up being charged up to 50% more than non-smokers for the same policy by many policy providers.
Increase your deductible
Generally speaking, with most insurance policies, the greater the expenses you pay out of pocket, the lower your premiums. Pairing a high-deductible supplemental insurance with a health savings account (which is mandatory in Singapore anyway), then paying the expenses from said savings account or out of pocket, can reduce your private insurance premiums. However, his approach only works in certain circumstances. You will need to sit down and crunch the numbers to see whether increasing your deductibles would save you money on your chosen policy or not. For example, the higher your insurance costs, the more you will save by increasing your deductible, because the discount for a higher deductible is usually a percentage. Comparatively, it might not be worth implementing this approach on an already low cost policy, as the savings would be minimal. You also need to be financially sound enough to be able to pay the higher deductible.
Change your co-insurance/co-payment ratio
This is basically the amount you pay, and the amount your insurance pays. As mentioned earlier, the MediShield integrated plan add-on requires you to pay up to 5% of costs, and then the insurance covers the rest. If you are looking at purchasing further private health insurance, but looking to keep the costs relatively low in terms of monthly payments, then you can see whether changing the co-payment ratio affects your monthly payment cost. If it is not immediately clear, speak to a member of customer services to see how they can help.
Choose an in-network doctor
You may find that some policy providers offer a discounted price compared to the larger corporations, under the caveat that you must use their in-network doctors and facilities, as stipulated in the policy underwriting. More often than not, these types of policies are provided by medical groups that are co-owned by a group of doctors. Be sure to research the provider’s medical network, before agreeing to anything. If you are picky about doctors, then this probably isn’t the sort of policy that you should be looking at.
Regularly reassess your health insurance requirements
Sticking with the same plan year in and year out can sometimes stop you from finding opportunities to save money. You should regularly assess your health insurance needs and whether your current plan is best suited to them. For example, some factors to regularly assess are: whether you have children, whether your children often need to see a doctor, whether you or anyone in your family requires prescription drugs, and so on.