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.
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.
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.
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.
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.
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.
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.