Singapore to expand health services

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments 10

Abstract

At a time when many countries are thinking of how to cut back on health expenditures, Singapore?s health planners are busy laying the groundwork for the expansion and upgrading of its health facilities over the next ten years, costing billions of dollars. More land would be opened up for the development of health facilities. This is in response to requests from the private health-care sector, which has indicated it needs more facilities to cope with the 20% annual growth in foreign patients. A

Purpose of health policy or idea

Growth in the number of foreign patients has been averaging 20% in the last few years, thanks to stepped-up efforts by Singapore Medicine, a government-industry partnership established in 2003 to turn Singapore into a leading medical hub. Foreign patient figures doubled from 200,000 in 2002 to 400,000 in 2005. Four out of five were treated at private clinics and hospitals.  

The private sector presently accounts for 21% of hospital beds, the majority belonging to for-profit, investor-owned, listed companies. The Ministry of Health is actively working with the Ministry of National Development and the Urban Renewal Authority to identify possible sites for the building of private hospitals. Specifics are still under discussion but it is understood that foreigners would be allowed to bid and operate new private hospitals here.

Additionally, MOH has indicated it is open to having private hospitals within the campuses of the public sector "restructured" or corporatized hospitals. So farv four possible plots have been  identified, 3 of which were near existing public hospitals (i.e. adjacent to the Tan Tock Seng Hospital, within the Singapore General Hospital and within the National University Hospital).

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Political and economic background

Demand for quality health care services, from both domestic and international patients, is expected to rise sharply. There are two reasons for this.  

• Firstly, in order to generate the human capital needed to sustain Singapore's dynamic economy, the population needs to grow by another two million and stabilizing at 6.5 million. This will have to be achieved largely through immigration, since natural births are woefully inadequate.
• Secondly, the Government is targeting 1 million foreign patients by 2012, reckoning that will generate $3 billion in revenue and create 13,000 new jobs in the process.  

A related, secondary policy that has been place for more than a decade now, is to expand the private sector. The Ministry of Health had as early as 1993 signaled that it would like to see the private sector share of hospital beds to grow from, 20% to 30%. But left to market forces and in the absence of attractive incentives in land-scarce Singapore (where property prices have been  skyrocketing), that figure has remained more or less stagnant, and now stands at only 21%.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

• Providers

• Patients, Consumers

• Private Sector or Industry

Stakeholder positions

The private sector has welcomed the move. One private hospital has said it is thinking of converting a block of existing apartments into serviced apartments for patients' families. The idea of having private hospitals within the campuses of the public sector "restructured" or corporatized hospitals is not new, but had been resisted previously on grounds that it might not go down well with Singaporeans. It would appear that times have changed, and the government now thinks that Singaporeans are ready for such an idea. It even rationalizes that the push is not solely for the purpose for attracting  foreign  patients, but for the good of Singapore patients as well - explaining that doctors here may not have enough experience treating less common  diseases if they were  limited to just local patients.

So far, reactions from the public and the medical profession to these developments have been muted.

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Tourism Board	very supportive		strongly opposed
Economic Development Board	very supportive		strongly opposed
Trade Development Board	very supportive		strongly opposed
Providers
Public Hospitals	very supportive		strongly opposed
Private Hospitals	very supportive		strongly opposed
Patients, Consumers
Public	very supportive		strongly opposed
Private Sector or Industry
Hotels	very supportive		strongly opposed
Travel Agencies	very supportive		strongly opposed

Actors and influence

Government
Ministry of Health	very strong		none
Tourism Board	very strong		none
Economic Development Board	very strong		none
Trade Development Board	very strong		none
Providers
Public Hospitals	very strong		none
Private Hospitals	very strong		none
Patients, Consumers
Public	very strong		none
Private Sector or Industry
Hotels	very strong		none
Travel Agencies	very strong		none

Positions and Influences at a glance

Monitoring and evaluation

Asia's medical travel market is projected  to be worth S$7 billion within the next five years, boosted in  part  by  increasingly  affluent  consumers  in India and China. Singapore is already widely regarded to be among the best healthcare service providers in Asia (half of all JCI accredited hospitals are presently found in Singapore), but faces stiff competition, mainly from Thailand and India.

Singapore's manageably small size and nimbleness may prove to be an advantage. Various government agencies are already working in concert, each playing a distinct role in Singapore Medicine. For example, the Economic Development Board attracts healthcare and biomedical investments and co-funds developments in high-tech healthcare capabilities; International Enterprise Singapore (known formerly as the Singapore Trade Development Board) supports regionalization of the local healthcare players and the Singapore Tourism Board looks after international marketing and promotes people-oriented services, in collaboration with the Ministry of Health.   In August 2006, Singapore Medicine hired McKinsey & Company to draw up strategies to help Singapore Medicine attain its goals. 

Expected outcome

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

References

Author/s and/or contributors to this survey

Lim Meng Kin

Suggested citation for this online article

Lim Meng Kin. "Singapore to expand health services". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/sg/a10/4