Singapore’s government hospitals are major players in the country’s push for a larger share of international patients, by Kenny Coyle
In most parts of the world services for overseas medical visitors are a natural extension of the private healthcare sector.
Singapore provides a rather different picture. While the private healthcare sector is well established and has a strong profile, with names such as Raffles and Parkway, the role of the government health sector is less well known. Yet all six of Singapore’s government hospitals, plus other specialist centres, are JCI accredited, an unprecedented global achievement.
Indeed, the Singaporean experience could well be something of a model for other nations, seeking to balance the demands of maintaining or developing a national healthcare system within tight budget constraints.
Edward Oh, Group Director of Business Development, SingHealth, says: “Groundbreaking medical breakthroughs and research performed within the public sector here have led to larger numbers of international patients coming to Singapore for treatment due to greater awareness. The successful separation of the Nepalese conjoined twins at Singapore General Hospital in 2001, captured international attention and awareness of the expertise in Singapore. The Singapore National Eye Centre also gained international attention for its successful stem cell cornea transplants. Cases like these help to boost the numbers of international patients seeking treatment in Singapore.”
For Singapore the need to bring in overseas patients is driven by two factors, financial and demographic.
Singapore has been praised by health economists for its ability to generate excellent health outcomes while keeping public expenditure on health relatively low. According to World Health Organisation 2004 statistics, Singapore spent 3.7 percent of its GDP on health, compared with Australia’s almost 10 percent of GDP. Yet while Singapore’s per capita health spending is one-third that of Australia, it records broadly similar health outcomes.
Singapore’s citizens enjoy living standards that are among the highest in the world. This is reflected in high life-expectancy figures of 79.9 years (78 for men and 81.8 for women), and low infant-mortality rates of 2.6 per 1,000 live births.
Bringing in paying international patients helps subsidise the high-quality services available to Singaporeans.
Singapore faces other demographic challenges. There is a potentially dangerous gap between the island state’s small population and the high levels of skills and expertise of Singapore’s medical practitioners.
Singapore’s population currently stands at just under 4.7 million, although this includes almost 1.1 million non-residents, such as temporary workers and expatriates without permanent residence in the city. Although there are plans to expand the population gradually to about 5.5 million, this would still be too small a base to support a world-class health system on its own.
This is true not just in the sense of capital investment in facilities and equipment but in human capital too. With a limited domestic population, there is not a strong enough throughflow of cases needed by the top specialists to keep their skills at the highest level.
The Singaporean government has also decided that the island should strategically position itself as a knowledge centre in healthcare, through its support for research and development in the bio-sciences. Bringing in international patients makes sense in helping to keep and attract skilled surgeons and specialists, who can be sure of continuous flow of cases and the support of a wide research base.
According to statistics from the Singapore Tourism Board, the island will soon reach the half million mark in the total number of international patients coming to the city state. The plan is to reach 1 million by 2010.
In 2000, the Singaporean government oversaw the restructuring of the public sector, splitting its facilities into two clustered groups.
SingHealth is based on the eastern side of the island, comprising three hospitals, five specialist centres and seven polyclinics. The National Healthcare Group (NHG) operates three hospitals, six specialist centres and eight polyclinics (see box).
Each cluster has its own dedicated international patient centre with specially trained staff. SingHealth’s International Medical Service (IMS), is situated at the 1,500-bed Singapore General Hospital, while the NHG’s International Patient Liaison Centre is located at the 943-bed National University Hospital.
Kamaljeet Singh Gill, general manager of the international business development unit of the NHG, explains: “The aim of the restructuring in 2000 was to improve efficiency and share costs, while remaining a non-profit healthcare provider.”
He stresses that the arrangement is a major asset in the areas of research. The National University Hospital has an international reputation for its innovative methods, allowing patients to experience cutting-edge treatments and procedures as they are developed.
“We talk about a ‘from-the-bench-to-the-bedside’ approach,” Gill says.
Currently the NHG treats 1,267,000 patients a year, of whom around 65,000 are from overseas. The aim is that by the year 2010, when Singapore hopes to be hosting 1 million overseas patients, the NHG will be handling around 15 to18 percent of them, says Gill.
He also points out that using public sector hospitals in Singapore is often considerably cheaper than the private institutions on the island.
SingHealth’s Oh also stresses that Singapore is costcompetitive says: ”SingHealth institutions have also developed some ‘bundled’ service packages to assure international patients of transparent pricing ahead of admission. Patients will be pleasantly surprised at our highly competitive rates and comparable, if not better standards of healthcare, compared to what they would receive in other major markets for medical treatment such as the US and UK.”