Singapore's Health Care System

The following sections are included:

• Preface
• Contents

Singapore's healthcare system is recognised today as being one of the best in the world. The World Health Organisation ranked it 6th best among 191 countries in 2000, based on eight criteria; Bloomberg declared Singapore as the healthiest country in the world in 2012, second among 51 countries in health efficiency in 2013 and first in 2014. Indeed the statistics tell the story: the infant mortality rate in 2013 was 2 per thousand live births, maternal mortality was 0.025 per 1000 births and life expectancy was 82 years. Per capita expenditure on healthcare in 2013 was US$2426. In all these measures Singapore has, over many years, consistently ranked among the best in the world in terms of health outcomes and health efficiency…

By nature, public health is a multi-disciplinary and inter-sectoral field that must be seen in the context of the history and development of a country. It is closely tied to socio-economic changes, especially in the case of Singapore, a relatively young nation. The dramatic transformation of this small island nation from a fishing village to a first-world metropolis in less than 200 years is a clear example of this comprehensive development, driven almost entirely by sheer human effort and hard work…

The following sections are included:

• Introduction
• Corporatisation
• Two Clusters
• Reforming Governance
• Six Regional Health Systems
• Strengthening the Horizontals
• Conclusion

One of the foremost public policy challenges around the world is ensuring population access to affordable and good quality healthcare that is sustainable for the country. The unique nature of healthcare makes financing it challenging. Healthcare needs vary greatly over one's lifetime and across individuals; it is unpredictable when illness will strike. Hence, costs need to be socialised or risk-pooled across the population to ensure affordability for the patient. Instead of the patient paying, the payer may be the government, in instances where taxes collected are used to subsidise healthcare services; or an insurer, who collects premiums to pay for the insured's healthcare. The objective is the same — for others who are not ill to pay for the bulk of the patient's treatment cost and ensure affordability, with the government or insurer playing the role of intermediary…

The following sections are included:

• Introduction
• Licensing and Regulation of Healthcare Services
• Regulation of Aesthetic Practices
• Regulation of Human Organ Transplantation
• Regulation of Biological Agents and Toxins
• Development of Enforcement Capabilities in MOH
• Regulation of Health Products
• Developments in Good Manufacturing Practice (GMP)
• Regulation of Clinical Trials
• The Health Products Act and Medical Devices
• Strengthening of Pharmacovigilance Activities
• Moving Ahead
• Acknowledgements
• References

The following sections are included:

• Regulation of Professional Standards
• Quality Assurance Programmes
• Sentinel Events
• Clinical Audit
• Clinical Performance Indicators
• Decade of Learning
• Institutional Initiatives, Clustering and Quality

A critical element that drove Singapore's healthcare standards and achievements was its professional workforce. When the nation began self-government in 1959 and then gained independence in 1965, much of the infrastructure for healthcare professional training was already in place…

Singaporeans in general enjoy good dental health. Factors that contribute to this include our water fluoridation policy and School Dental Health Services as well as dental services provided by both our public and private dentists…

Much of the infrastructure to train physicians for the nation's needs was already in place when the nation gained independence in 1965. The medical school (now the Faculty of Medicine, National University of Singapore (NUS)) founded in 1905, had been operating for 60 years and had sufficient expertise to continue to train doctors…

Pharmacy in Singapore has undergone metamorphic changes over the last five decades. The pharmacy practice model has both evolved slowly and changed rapidly, keeping in pace with the growth of Singapore's medical and healthcare sectors…

The following sections are included:

• The Allied Health Professions in Singapore — An Overview
• Development of the Allied Health Professions in Singapore
• Training and Education of Allied Health Professionals
• Regulation of the Allied Health Professions
• References

Nursing as a profession started in Singapore in 1885 and has since touched the lives of many sick and infirmed. Today, 130 years later, nurses form the backbone of the public healthcare system, comprising more than 60% of the healthcare workforce. Nurses journey with patients through various life stages — from conception, to child health, to school health, to adulthood, and to end-of-life or palliative care. This chapter will look at how nursing started in Singapore and how, over time, it envisioned its role for the future as it continued to play a vital role in Singapore's healthcare system.

The following sections are included:

• Introduction
• Challenges to the Health System
• The Early Years (From 1950s–1960s) — Getting the Basics Right
• School Health Service
• School Dental Service
• The Formative Years (From 1970s–1990s) — Creating Awareness Through Public Education and Use of Legislation
• National Healthy Lifestyle Programme
• National Nutrition Campaigns
• Anti-Smoking Campaign
• 2000s — The Expansion Years — From Public Education to Influencing Choices to Achieve Better Health for Singaporeans
• Formation of the Health Promotion Board
• Conclusion
• Acknowledgements
• References

The following sections are included:

• The Early Years — Before 1965
• Initial Efforts Developing Primary Healthcare
• Post-War Challenges: Rebuilding and Consolidating
• Post-War General Practice
• Nursing, the Stalwarts of Care
• From General Practitioners to Family Physicians
• The Journey to Recognition for Family Medicine
• The Enlarging Demand on Public Sector Primary Care
• The Polyclinics Refined: Bigger and Better to Meet Modernised Demands
• Rise of HIV and AIDS
• A Hazy Situation
• Fighting the Unknown — Severe Acute Respiratory Syndrome (SARS)
• New Wave — Influenza A (H1N1) and What's Next?
• Primary Care Master Plan — Changing the Care Delivery
• Vision for the Future
• Acknowledgement
• Bibliography

Hospitals are a key resource and also the key consumer of resources in health systems around the world. The role of hospitals extend beyond the care of patients include the fields of education and research. Singapore has a hybrid healthcare delivery system. The State continues, from the very early years, to play a dominant role, currently providing close to 80% of all acute care hospital services with the private sector providing the remaining 20%…

With a history of nearly 200 years, Singapore General Hospital (SGH) arguably has had a head-start in advancing medicine and healthcare. However, staying at the forefront of medicine was not pre-destined — nor did it happen by chance…

Changi General Hospital (CGH) is Singapore's first purpose-built regional general hospital serving the population in eastern Singapore, in line with the government's master plan for healthcare…

The history of Tan Tock Seng Hospital (TTSH) spans nearly two centuries, from a humble makeshift shack in 1844, caring for the destitute and poor, to today's 7500-strong established multi-disciplinary hospital, caring for the masses.

The following sections are included:

• Not so Humble Beginnings
• From Caterpillar to Butterfly
• Taking Charge in the North
• Shaping the Future of Healthcare, the Alexandra Health Way

The following sections are included:

• The Early Days and Close Links with the University
• Our Trailblazers and their Contributions to Medicine
• Contributing to Healthcare in Singapore and Beyond
• Celebrating the Best Talents
• Nurturing Future Generations of Healthcare Professionals
• Shaping Medicine for the Future

Dedicated to the advancement of women's and children's health, KK Women's and Children's Hospital (KKH) has evolved, since its founding in 1858, into a leader in obstetrics, gynaecology, paediatrics and neonatology. Today, the 830-bed referral centre provides tertiary care for high-risk conditions in women and children. It is also a major teaching hospital for the nation's medical schools, leading in education for obstetrics and gynaecology, and paediatrics in Singapore, as well as continuing to train generations of midwives, nurses, and allied health professionals…

Mental healthcare in Singapore has come a long way. The evolution of the Institute of Mental Health (IMH), the country's only tertiary psychiatric care hospital, mirrors the progressive shift in attitudes towards mental health, and the approach to mental healthcare system and services…

A successful and thriving private healthcare system is the hallmark of a mature and developed country. In emerging economies, the development of core pillars such as infrastructure and property, logistics, financial services, telecommunications, and education often takes precedence over healthcare development. Private sector-funded healthcare provision is usually one of the last pillars to be developed…

The following sections are included:

• The Beginning
• Hospital Development

Raffles Medical Group (RMG) was founded in 1976 by two young doctors — Dr. Loo Choon Yong and Dr. Alfred Loh — who had the vision of starting their own private practice to give of their best to their patients. They laid the foundation for an institution based on a group practice model, pooling together talented doctors and leveraging their strengths to provide quality care for the patients…

In 1961, the Bukit Ho Swee fire displaced some 16,000 people. It happened two years after the 1959 fire at Kampong Tiong Bahru in which about 5000 lost their homes. Ironically, these fires were then considered a “blessing in disguise” whereby an enlightened government rehoused the “inert community” of squatters after a disaster and set the country on the right path towards progress and modernity.” These incidents “cleansed” the path and set the direction in how our young nation would proceed. These series of disasters tested the then newly convened Singapore Council of Social Services (SCSS), which was a statutory body and the predecessor of the National Council of Social Services (NCSS), formed to coordinate and promote the roles and contributions of Voluntary Welfare Organisations…

The following sections are included:

• The Evolution of Health IT
• The Early Years
• Restructuring and Administrative Systems
• Clinical Systems
• Ministry and Stat Board Systems
• National Clinical IT Initiatives
• The Future
• Acknowledgements

Singapore's healthcare system is largely based on modern medicine with Traditional Chinese Medicine (TCM) playing a complementary role. Treatment modality in TCM includes herbs, acupuncture, and Tuina. Despite the accessibility and advances in modern medicine, TCM is popular and well accepted by Singaporeans. A survey conducted by the Ministry of Health (MOH) in 2004 showed that 53% of the population had consulted a TCM practitioner (TCMP) in the previous one year. The figure was 45% in 1994. More recently, data collected from the National Health Survey 2010 in Singapore showed that 39.6% surveyed had visited a TCMP, 26.0% sought treatment for general well-being, 25.8% for acute minor injuries such as sprains, 20.6% for chronic aches and pain like headaches, back pain and rheumatism, and 17.5% for acute minor illness, for example, the cough and the flu…

The following sections are included:

• Introduction
• What is Global Health?
• A Flight Away — Importance of Global Health Diplomacy to Us
• Soft Diplomacy in Health
• Forging Stronger Relationships Bilaterally
• Our Engagement at the World Health Organisation (WHO)
• Association of South East Asian Nations (ASEAN)
• Asia Pacific Economic Cooperation (APEC)
• Conclusion
• References

While we have done well in the last 50 years and have evolved to become one of the better health systems in the world, there are several issues ahead that threaten to disrupt the system's capability to serve Singaporeans well. Some issues, such as the management of chronic diseases, are surfacing now because of our success thus far, such as in managing communicable diseases. These issues are complex and are not easily solved. They are also not unique to Singapore and arise from an interplay of both international and local factors, including those outside of healthcare. We are already working on addressing most of these issues, some more definitively than others.

The following sections is included:

• Index