Healthcare is high on the Singaporean government’s agenda. Indeed, the country has created one of the most efficiently performing healthcare systems according to Bloomberg’s Most Efficient Health Care report in 2014. As with many countries in the world, Singapore includes both public and private healthcare facilities. Many expatriates prefer private facilities due to the better quality of care and lower waiting times. Yet there are only few differences between the two sectors.
Managing and financing healthcare in Singapore
One of the biggest differences between public and private healthcare in Singapore is how it’s managed and financed.
The Singaporean government manages public healthcare on the basis that every Singaporean should be able to access the healthcare they need regardless of their ability to afford it. In order to achieve this, the government employs a mixture of subsidies, mandatory savings schemes (Medisave), basic health insurance (Medishiled Life) and endowment funds for the needy.
However, these government-run savings schemes and health insurance plans are only available to Singaporean nationals and permanent residents, with the majority of subsidies also being reserved for citizens. Expatriates are ineligible for these schemes or any government subsidies and must cover the full cost of care themselves.
Public healthcare is organised into 3 regional clusters, National University Health System in the west, National Healthcare Group in the centre and SingHealth in the east. Each cluster contains a full suite of healthcare facilities, from primary care to emergency facilities. Their objective is to provide patients with high quality treatment at the best possible price.
Private hospitals in Singapore are run largely independently as companies. Some are owned by larger healthcare conglomerates such as Parkway Holdings, which owns and operates a number of private hospitals in Singapore such as the Mount Elizabeth hospitals and Gleneagles as well. Many of these are full services hospitals, operating emergency rooms as well as the full suite of medical specialties. However, there are also a few specialist hospitals such as Johns Hopkins Singapore which is focused on oncology treatment, research and education.
Private doctors and clinics actually make up the majority of primary care facilities in Singapore, providing approximately 80% of the city-state’s primary healthcare needs.
In terms of financing, private facilities are free to set their own prices for their services and are frequently more expensive than public options. Singaporean citizens and permanent residents are free to use their government health insurance or health savings accounts to pay for services, however there is usually a limit of how much these public financing schemes will cover for a certain treatment. This may mean that these government schemes will not fully cover treatment in a private healthcare facility as they are often more expensive than public options.
For Singaporeans who want to take advantage of the lower waiting times and superior amenities of private hospitals and clinics, most will take out supplementary insurance, either through what’s called an Integrated Shield Plan, which provides additional benefits to the government’s Medishield Life scheme, or other forms of private medical insurance such as international health insurance.
Private hospitals frequently cater to expatriates or international patients, in which case the costs of care are covered by their health insurance or out of pocket.
Admission and Patient care
Admission is one of the main differences between the two sectors. You will get an appointment very quickly at a private hospital (sometimes the day you call or the day after) whereas it takes about 3 to 6 days at a public hospital. You may also wait longer at a public hospital for an accident and emergency department (this depends on the type of emergency, and how busy the accident and emergency room is) simply because lower fees generate more demand in public facilities. In fact, a recent survey of public hospitals showed that over a week, only Khoo Teck Puat Hospital had a median wait time for admission to an emergency department below 1 hour.
A private hospital may offer you additional services such as a shuttle to pick you up at home and take you to the hospital. Note that in case of an accident or an emergency, if you call an ambulance it will always drive you to the nearest public hospital to your location. If you want to go to a private hospital, you will have to call them directly to arrange transportation.
Facilities are of very good quality in both private and public sector. Rooms are clean and comfortable in a public hospital; however, they have different types of wards that vary in price based on the amount of people in the room and other creature comforts. The different types of wards are labelled class C, B2, B1 and A with some public hospitals also having deluxe wards.
While specifics vary from hospital to hospital, in general lower class wards will have more patients per room and may lack air-conditioning and televisions. Higher class wards will have fewer patients per room, may offer single patient room options, provide a greater choice of meals and may include amenities such as free WiFi, cable television, safes to store your belongings and mini fridges.
Private hospitals focus on providing a more comfortable experience, with even their shared rooms being on par with a B1 class ward. Private hospitals usually come with electric beds as standard, widescreen TVs, and free WiFi as well as your choice of meals. Like public hospitals private hospitals offer a variety of rooms, ranging from comfortable two- or four-person room to luxury suites which can include an extra room for anyone staying with you, a 24-hour private nurse or a butler service.
However, the public sector is better equipped as the government operates a number of specialised facilities outfitted with state-of-the-art medical technology. Some of the specialised hospitals include the KK Women’s and Children’s hospitals, the National Heart Centre of Singapore and the National Neuroscience Institute, to name just a few. When it comes to major surgery, Singapore’s public hospitals are more than capable of providing the best care.
Both sectors employ highly qualified and experienced personnel. At the National University Hospital of Singapore, you will encounter many doctors who are also professors and/or researchers at the university and known as experts in their field. In both public and private facilities, you will find highly-trained doctors who have studied and practiced in both Singapore and around the world, including Australia, the United States and the United Kingdom. The only difference is that in private hospitals doctors are independent and set their own prices.
Cost is the main distinction between the private and the public sector in Singapore. The gap on your bill can be extraordinary for the same surgery and the same quality of treatment. Public facilities charge you a basic price covering their costs whereas private hospitals and clinics set their own prices and margin, given that they are not subsidised they are thus free to choose their pricing framework.
Even for a treatment such as a hemorrhoidectomy or a tonsillectomy the price different between receiving an operation in a class A public ward and a private hospital can be around S$2-3000.
Where should I go then?
All in all, it depends on what you need and what your major concerns are. For outpatient consultations, private doctors are perfectly fine. For a serious treatment or an intensive care unit stay, it is recommended to choose a public hospital, where you’ll be well taken care of while not breaking the bank. However, if your concerns are less about cost and more about waiting times and amenities then a private hospital may be worth considering.