Singapore has a world-class health care system, where low costs and excellent quality of service coexist. It is currently being studied by Barack Obama’s health team and has been ranked by the World Health Organization (WHO) as the best in Asia, ahead of Hong Kong and Japan. We review its main features below.

World-class Health Care System

In 2012, the Political and Economic Risk Consultancy (PERC) ranked Singapore’s health system as the third best in the world, a ranking reinforced by the Joint Commission International (JCI) that has accredited 12 hospitals and medical centers in the country, representing a third of all JCI-accredited medical institutions in Asia. In addition, in 2014 Bloomberg ranked Singapore’s health system as the most efficient one in the world. Why is this system so well qualified? Mainly because despite being composed of public and private health institutions, it offers in both a high quality of medical care, at low prices and varying — in general terms — only in the level of facilities provided.

With respect to health plans, insurance and benefits, these do vary widely and generally depend on the “immigration status” and employer of the patient. Thus, citizens and permanent residents are entitled to government-subsidized health services through a mandatory national savings plan, while foreigners are required to obtain health coverage through their employer or pay privately on their own. As a general rule, the larger the company, the more likely it is that the company will provide some form of health insurance for its employees.

The system is based on private contributions from citizens, coupled with state management and oversight plans for greater efficiency and effectiveness. In fact, the percentage of public spending on the health sector in Singapore is about 33%, while in Western European countries it averages 75%.

The three private contribution schemes are:

Medifund

Medifund is a public fund that uses resources collected through taxes and is dedicated to serving as a safety net for those who are in a delicate financial situation that prevents them from paying for medical services. It guarantees universality and requires a study of the patient’s financial situation.

Medisave

Medisave is mandatory, and serves to provide each individual or family with a private fund to cover the possible needs they may have as a result of hospitalization, surgery or different tests with specialists. It consists of compulsory contributions made by employees and the companies they work for (by way of retention or salary supplement). Therefore, each worker and their family contributes money to their fund, and when they need medical care, the service is provided from the patient’s fund.

Medishield

This plan is a national fund reserved to cover catastrophic situations, exceptional, or chronic or long term diseases not covered by the Medisave.

Government Health Centers

Government health centres are designed primarily to provide subsidised health services to Singaporeans. These facilities consist of a number of public hospitals for inpatient services and numerous polyclinics offering outpatient services. Although fully controlled by the government, the public sector hospitals operate as limited liability companies in order to compete with the private sector for service and quality. In part because of this, they are far removed from what is generally known as a public hospital in other countries.

The public health centers were divided into two groups — the National Health Group (NHG) and the Singapore Health Services (SingHealth) — to encourage vertical integration of services and improve synergy in line with the government’s goal of stimulating innovation, improving the quality of medical care and keeping medical costs affordable. The government’s guidelines also set a benchmark for the private sector around professional medical standards and fees. In particular, the influence on issues such as the provision of hospital beds, the introduction of high-tech/high-cost medicine and the rate of cost and price increases for the private sector is decisive.

Such is the quality of government health centres that they not only provide good general health services, but also deal with the more complicated cases referred from other hospitals and from neighbouring countries. Among the major and most renowned public centres and hospitals are KK Women’s and Children’s Hospital, Tan Tock Seng Hospital, Singapore General Hospital, Institute of Mental Health/Woodbridge Hospital, National Cancer Centre Singapore, National Heart Centre and National Neuroscience Institute.

Private Health Centres

They also have an excellent level of medical care and services. The cost differences between government and private health centres are negligible, as they compete directly with each other, although private health centres naturally have minimal waiting times. Most of these centers have numerous outpatient clinics that are accredited by JCI. These include Mount Elizabeth Hospital, Camden Medical Centre, Gleneagles Hospital and Medical Centre, Thomson Medical Centre, and Johns Hopkins Singapore International Medical Centre.

About Government “Health Insurance

Both Singaporeans and permanent residents are entitled to subsidized health services provided through government health centres. Depending on several factors, the percentage of subsidy can vary from approximately 50% to 80%. In addition to assisting in the co-payment of the medical account balance, there are other factors that reduce costs such as the mandatory savings plan called the Central Providence Fund (CPF). Depending on factors such as age and income, a percentage of each worker’s monthly salary goes into the CPF.

Private Health Insurance

In the case of foreigners working in Singapore, being exempt from CPF contributions means that they do not have access to the government-subsidized health insurance system, although they do have access to fairly affordable private health services, even for those without any health insurance. However, it is recommended that they take out some private insurance to manage costs in the event of serious illness. There are a variety of options and competition among internationally recognized health insurance companies is considered by experts to be “healthy”. Depending on age, lifestyle and type of policy, the monthly cost of private health insurance to protect against serious illness can vary from S$75 to S$400 per insured.

Health care costs

Health services are very affordable in Singapore. For example, a routine check-up is likely to cost the patient about S$20 or S$30, while an x-ray will cost about S$50 or S$80. Approximately 20% of primary health care is provided through government polyclinics, while the remaining 80% is provided through some 2,000 private clinics. In that case, a specialist consultation in a private clinic can cost between S$75 and S$125.

Hospitalization costs

Hospitalization costs vary depending on the type of room chosen. For example, in Singapore you can choose between an open room that does not have air conditioning or a private room that can be compared to a real suite in a 5-star hotel. As a result, daily ward costs can vary from S$30 to S$3,000, with charges between government and private hospitals for unsubsidized patients being very similar.

Costs for surgery

Singapore also stands out for offering unique value for surgeries at very low prices. For example, a “coronary bypass” that in the U.S. can cost US$140,000, in Singapore only reaches US$25,000; a hip surgery that in the U.S. costs US$45.000, in Singapore only US$13,000 and a knee operation that in the US can cost US$40,000, in Singapore it costs no more than US$15,000.

The Singapore formula

The success of the Singapore formula is based on the individual responsibility of patients, who have no incentive to abuse it because the costs are borne by their private fund. No one is left without care, whether by a plan or not, their situation is covered. In addition, the patient has the protection of state authorities from any possible medical malpractice and, most importantly, the companies that run the hospitals have no interest in giving bad care, because the patient can decide not to go back to that hospital and go to one where the care is better.

All of the above has led several countries, including the United States, to turn their attention to the Singaporean system. However, it should be noted that despite its success it is very difficult to replicate since it has been forged simultaneously with the country’s development over several years, in the context of political stability and a line of government that has implemented measures relating to individual responsibility, mandatory savings and regulatory control of health services and their costs.

If we add to this that Singapore has a small population of only four million people and concentrated in only 660 square kilometers, it can well be assumed that planning for health infrastructure has been a little simpler than would be the case in larger countries. But “it has to be tried” and today there are not a few countries that intend to take Singapore as their example to follow.