Living in Singapore: An Expat's Guide

Living in Singapore: An Expat's Guide

Moving to or living in Singapore? What are my choices when it comes to healthcare? How is Singapore’s healthcare system compared to the rest of the world? How efficient is Singapore in controlling epidemics? Do I enjoy any medical subsidy? Do I need an international health insurance in Singapore? Does Singapore offer the type of treatment I require?

The objective of this article is to provide an expatriate a brief overview of Singapore’s healthcare system.

How is Singapore’s Healthcare System compared to the rest of the world

According to the World Health Organization’s ranking of the world’s health systems in 2000, Singapore was ranked 6th after France (1st), Italy (2nd), San Marino (3rd), Andorra (4th) and Malta (5th). This makes Singapore No.1 in the Asia-Pacific region.

As at September 2010, 17 hospitals and medical centres in Singapore have obtained Joint Commission International (JCI) accreditation. This accounts for one-third of all the JCI-accredited facilities in Asia. Beyond international certifications, the quality of healthcare and their success rates meet, if not exceed, international standards. Many of the world’s best-known medical centres, such as John Hopkins and The West Clinic, have set up in Singapore.

Singapore’s medical expertise made world’s headlines for many complex and innovative procedures such as the revolutionary "tooth-in-eye" surgical procedure to make a blind boy see again in 2004 and the successful separation of the 10-month-old Nepalese conjoined twins in 2001.

With many well-respected doctors trained in the best centres around the world, internationally-accredited hospitals and specialty centres, a global reputation as a medical convention and training centre, a fast-growing basic and clinical research hub, it is no wonder that Singapore has established itself as Asia’s leading medical hub.

Overview

The Singapore healthcare system aims to ensure affordability to all its people and requires the individuals to take ownership of their own health. To ensure affordability, the Government requires all medical institutions to submit their bills according to conditions, procedures and ward class. This in turn promotes transparency and competition.

How is the healthcare funded?

Singapore’s healthcare system is funded by both the government and by individuals and their employers. Government expenditure on healthcare is only 3.5% of its GDP, of which 68.1% comes from private sources. An average Singaporean is expected to live till 80 and retirement age will be raised to 65 from 62 by 2012. Like governments in developed countries with an aging population such as Germany and Japan, Singapore worries about the long-term implications.

Central Provident Fund

To assist individuals to save for their old age, the Government implemented the Central Provident Fund (CPF) whereby employees pay 20% of their wages into CPF while employers pay another 15%. The contribution is capped at a salary ceiling of S$4,500 and changes as one’s age advances. Out of the total contribution, 20% goes into Medisave and the rate increases with age.

Medisave

To pay for personal medical expenses, the Government implemented the ‘4M’ framework of Medisave, Medishield, Medifund and Medication Assistance Fund. Implemented in 1984, Medisave can be used to pay for hospital expenses incurred by the individual or his dependent(s). Limits are set and adjustments are made every now and then to ensure sufficient savings to last for a lifetime.

Medishield

As individuals can only use a limited amount from their Medisave to pay for hospital expenses, the balance will be paid out of their own pockets or from their local or international health insurance plans. Medishield, is a national health insurance plan to help individuals pay hospital bills incurred for serious illnesses in public hospitals. For a 45-year-old, medical insurance premium is S$114 p.a. and this amount can be paid from his Medisave account. Premiums for other government approved health insurance plans can also be paid using Medisave.

Medifund

If a Singaporean is still unable to pay for his subsidized medical expenses at public hospitals even with his Medisave or Medishield, Medifund will then be used.

Medication Assistance Fund

The Medication Assistance Fund is a new fund started this year, in 2010, to help the needy Singaporeans with their costs of expensive medication.

Healthcare services and costs in Singapore

Singapore is a leading destination, not only for business and leisure, but also for safe, affordable and world-class healthcare. Its well-established medical network means that seeking for medical treatment in Singapore is easy.

Pharmacies

To dispense non-OTC (over-the-counter) drugs, pharmacies require a prescription issued by a local registered doctor. If a patient already has a prescription from overseas, he/she needs to bring his overseas prescription and consult a local doctor in order to obtain a local prescription. Overseas prescriptions are not valid. Patient can decide to obtain medication from the doctor or at the pharmacy. If the specific drug is unavailable, an alternative drug may be recommended.

Primary healthcare: Polyclinics and private clinics

18 polyclinics, which make up 20% of the primary healthcare, are located at almost every housing estate, at every corner of the country. These state-run medical centres provide good quality medical and dental care at very affordable rate. They act as a one-stop health centre that provides outpatient medical care, follow-up of patients discharged from hospitals, immunization, health screening and education, investigative facilities and pharmacy services.

The other 80% of the primary healthcare is made up of some 2,000 private medical and dental clinics conveniently located at your doorstep.

Cost

At the polyclinics, an average outpatient consultation fee is about S$8, well within the means of every Singaporean. While Singapore citizens aged 65 and above, children up to 18 years of age and all school children are given up to 75% concession in their consultation and treatment fees. Other Singapore citizens are given a 50% concession. For Permanent Residents, however, they continue to enjoy a reduced rate compared to citizens paying an average of S$12.

For outpatient services, expatriates can choose between private clinics or polyclinics. As subsidies were withdrawn since 1 Jan 2006, basic consultation at polyclinics is average S$16. In considering the type of coverage when purchasing an international health insurance, some expatriates may choose to pay out of their own pocket when it comes to the occasional outpatient visits, thus having only inpatient coverage.

Public and private hospitals

There are currently 15 public hospitals and medical centres comprising 6 general hospitals, a women's and children's hospital, a medical centre, a psychiatry hospital and 6 specialty centres for cancer, cardiac, eye, skin, neuroscience and dental care. The general hospitals provide multi-disciplinary acute inpatient and specialist outpatient services and a 24-hour emergency department. These public sector hospitals are operated as private limited companies so as to ensure competitiveness against the private sector on service and quality. They are far more superior compared to the “government hospitals” in other countries. These public hospitals are well equipped to handle most complicated cases referred from other hospitals or neighboring countries. These services are provided and managed by 5 networks: Alexandra Health, Jurong Health Services, National Healthcare Group (NHG), National University Health System (NUHS) and SingHealth.

Due to the high level of standard set by the public sector, private hospitals in Singapore offer excellent service and a high level of medical care. The majority of the hospitals are JCI-accredited. The private sector is largely run by 3 groups: Parkway Holdings, Pacific Healthcare Holdings and Raffles Medical Group. There are 21 private hospitals and several specialist clinics, each specializing in and catering to the different needs, at varying costs.

Medical Costs and International Health Insurance

For expatriates, there is little difference between the costs of public or private healthcare as they directly compete against each other. Generally, most expatriates living in Singapore prefer to opt for private healthcare due to better service and shorter waiting period.

Though cost of medical procedures in Singapore is cheaper compared to, for instance, the USA, costs can still add up. Here is a comparison of the costs of medical procedures between the USA and Singapore.

Procedure (Cost in USD) USA Singapore % Savings
Coronary Angiography 6,000 1,500 75%
Coronary Angioplasty 42,000 11,500 73%
Coronary Artery Bypass 55,000 13,000 76%
Hip Replacement 24,000 16,000 33%
Note: These are rough figures in USD.

Medical Subsidy

Singaporeans and Permanent Residents (PRs) are entitled to medical subsidy through compulsory national saving scheme – CPF. In public hospitals, Singaporeans enjoy up to 80% subsidy while Permanent Residents (PRs) enjoy up to 70%. From 1 January 2011 onwards, maximum subsidy for PRs will be reduced to 65% and a further reduction to 60% from 1 July 2011 onwards.

Despite the subsidies, many Singaporeans have supplemental private medical insurance (often provided by employers) for services not covered by the government's programs.

International Health Insurance

Expatriates are exempted from CPF contributions and do not qualified for any subsidies except for services in Emergency Department. Thus, it is compulsory to have a good international health insurance. One can acquire such health insurance either through the employer or directly from an insurer, an agent or through an independent intermediary like Expatmedicare.

Be covered for at least Inpatient

Since outpatient services are fairly affordable in Singapore, many expatriates find it more economical and convenient to pay out of their own pocket for the occasional visits. However, it is absolutely essential that you include at least inpatient and critical illnesses in your expat health insurance coverage.

Generally, there are 2 categories of international health insurance coverage: Standard (inpatient) and comprehensive (in and outpatient). Premium for comprehensive coverage is higher compared to standard coverage. Under the standard plan, most insurers will provide coverage for the following:

  • in-patient: an insured person who stays in a hospital bed and is admitted for one or more nights solely to receive treatment
  • day-patient: an insured person who is admitted to a hospital bed but does not need to stay overnight
  • emergency treatments including accidental damage to teeth
  • medical evacuation: evacuation of an insured person to the nearest medical facility for treatment in the case of emergency and when it is not readily available at the place of accident. Cover is extended to the insured person’s escort.
  • home nursing by a qualified nurse immediately after discharge from hospital and on recommendation by a medical specialist
  • cancer: Oncology which is treatment for cancer, including diagnosis, therapy (radiotherapy, chemotherapy, surgery, etc)
  • reconstructive surgery administered immediately after an accident or disease, e.g. breast reconstruction after mastectomy and sometimes lumpectomy which may take place simultaneously during cancer-removing surgery, or months to years later

There are many internationally established insurers in Singapore like BUPA, AXA, Allianz, MSH, Aetna and GMC offering competitive solutions to suit your needs.

Work with an independent intermediary

More often than not, it can be extremely confusing and time consuming when looking for the best solution as there are many options in the market. It would be wise to engage the service of an independent intermediary who is knowledgeable and experienced to guide you through your research and decision-making process. Ensure that the insurance advisor is truly independent and that they have professional liability.

References:
(1) Statistics Singapore
(2) World Health Organization Statistical Information System: Core Health Indicators
(3) www.moh.gov.sg
(4) www.cpf.gov.sg

 

List of hospitals in Singapore

National Healthcare Group
Address: 6 Commonwealth Lane, Level 6, GMTI Building, Singapore 149547
Tel: +65 6779 2777
Note: Mondays to Fridays : 8:30am-6:00pm

Tan Tock Seng Hospital
Address: 11 Jalan Tan Tock Seng, Singapore 308433
Tel: +65 6779 2777
Note: Mondays to Fridays : 8:30am-6:00pm

Healthway Medical Group
Address: 2 Leng Kee Road, #06-07 Thye Hong Centre, Singapore, 159086
Tel: +65 6518-0164, (65) 6518 0159
Note: Clinics have their own operating hours

National University Hospital
Address: 5 Lower Kent Ridge Road, Singapore 119074
International Patient Liaison Centre,National University Hospital, Kent Ridge Wing, Level 3
Tel: +65 6779 2777
Note: Mondays to Fridays: 8:00am-5:30pm
- Saturdays: 8:30am-12:30pm

Alexandra Hospital
Address: 378 Alexandra Road, Singapore 159964
Tel: +65 6472 2000
Note: - Clinics have their own operating hours


Changi General Hospital
Address: 2 Simei Street 3, Singapore 529889
Tel: +65 68503333
Note: Mondays to Fridays : 8:30am – 8:00pm, Saturdays and Sundays: 8:30am – 12:30pm, Closed on Public holidays.

Khoo Teck Puat Hospital
Address: 90 Yishun Central Singapore 768828
Tel: +65 6555 8000
Note: Clinics have their own operating hours

Singapore General Hospital
Address: Outram Road, Singapore 169608
Tel: +65 6222 3322
Note: Mondays to Fridays: 8:00am to 9.00pm, Saturdays: 8.00am to 2.00pm, Closed on Sundays and Public Holidays.

KK Women's and Children's Hospital
Tel: +65 6-2255 554, 1900-556-8773
Note: 8:00am – 12:00 midnight

Johns Hopkins Singapore International Medical Centre
Address: 11 Jalan Tan Tock Seng, Singapore 308433
Tel: +65 6880 2222
Note: Clinics have their own operating hours

National Dental Centre
Address: 5 Second Hospital Avenue, Singapore 168938
Tel: +65 6324 8802   
Note: Clinics have their own operating hours.

National Skin Centre
Address: Mandalay Road Singapore 308205
Tel: +65 6253 4455 
Note: Clinics have their own operating hours

National Cancer Centre Singapore
Address: 11 Hospital Drive,Singapore 169610
Tel: +65 6436 8000
Note: Mondays to Fridays: 8:30am to 5:30pm, Saturdays : 8:30am to 12:30pm

National Heart Centre Singapore
Address: 17 Third Hospital Avenue ,Mistri Wing ,Singapore 168752
Tel: +65 6436 7800
Note: Mondays to Fridays: 8:00am - 7:00pm, Saturdays: 8:00am - 2:00pm, Sundays & Public Holidays: Close

National Neuroscience Institute - Milestones
Address: 11 Jalan Tan Tock Seng ,Singapore 308433
Tel: +65 6357 7153
Note: Clinics have their own operating hours

Singapore National Eye Centre
Address: 11 Third Hospital Avenue
Singapore 168751
Tel: +65 6227 7255
Note: Mondays to Fridays: 8.30am to 5.30 pm

Institute of Mental Health
Address: Buangkok Green Medical Park 10 Buangkok View, Singapore 539747
Tel: +65 6389 2000
Note: Call for appointments

Camden Medical Centre
Address: One Orchard Boulevard, Singapore 248649.
Tel: +65 6887 3210

Parkway East Hospital
Address: TripleOne Somerset,111 Somerset Road #15-01, Singapore 238164
Tel: +65 6735 5000, 6307 7880
Note: Call for appointments

Gleneagles Hospital and Medical Centre
Address: TripleOne Somerset,111 Somerset Road #15-01,Singapore 238164
Tel: +65 6735 5000, 6307 7880
Note: Call for appointments

HMI Balestier Hospital
Address: 221 Balestier Road, #03-04,,ROCCA Balestier, Singapore 329928
Tel: + 65 6258 8798
Note: Call for appointments

Mount Alvernia Hospital and Medical Centre
Address: 820 Thomson Road, Singapore 574623
Tel: +65 6347 6688, 6347 6210
Note: full day service

Raffles Hospital
Address: 585 North Bridge Road, Singapore 188770
Tel: +65 6311 1111 (24 Hours Hotline)
Note: Mondays to Fridays: 8.00am - 6.00pm, Saturdays: 8.00am - 1.00pm

Thomson Medical Centre
Address: 339 Thomson Road, Singapore 307677.
Tel: +65 6250 2222, 6250 1965
Note: Call for appointments

Ang Mo Kio – Thye Hua Kwan Hospital
Address: 17 Ang Mo Kio Ave 9, Singapore 569766
Tel: +65 6453 8033
Note: Mondays to Thursdays: 8.30am – 5.45pm, Fridays: 8.30am – 5.30pm

Bright Vision Hospital
Address: 5 Lorong Napiri, Singapore 547530
Tel: +65 62485755
Note: - Call for appointments

East Coast Medicare Centre
Address: 200 South Bridge Road, Singapore 058749
Tel: +65 6227 0722
Note: Mondays to Saturdays: 10:00am-7:00pm
- Sundays & Public Holidays: 10:00am-2:00pm

Kwong Wai Shiu Hospital
Address: 705, Serangoon Road, Singapore 328127
Tel: +65 6299 3747
Note: -Mondays to Fridays: 8.30am-5.00pm, Saturdays: 8.30am-1.00pm

Ren Ci Hospital and Medicare Centre
Address: 71 Irrawaddy Road ,Singapore 329562
Tel: +65 6385 0288
Note: Call for appointments


Saint Andrew's Community Hospital

Address: 8 Simei Street 3, Singapore 529895
Tel: +65 6586 1086

Note: Call for appointments

St Luke's Hospital, Singapore
Address: 2 Bukit Batok Street 11, Singapore 659674
Tel: 6563 2281

Note: Call for appointments