The illustrious journey of Singapura- the Malay name for ‘Lion City’ to Singapore is known to all. History speaks of the nation’s valour which was clearly reflected in its battle for independence. The country gained freedom in 1965 and then on, in one generation metamorphosed itself into a phenomenally successful economy. One can call it the causatum of a constant quest to self-actualisation or the country’s outstanding futuristic trajectory. From a malarial swamp island, Singapore has transformed into a high-tech power house with much-admired world class infrastructure, internationally talked about economic policies and academic circles as well as incredible security systems. Another feather in Singapore’s cap is its highly-effective and efficient healthcare system.
Holding internationally acclaimed medical standards, Singapore’s healthcare sector scores a 10/10, both for its primary healthcare services and specialised care facilities. This charismatic nation is also known for providing unbiased care to all patients, be it a poor Singaporean or an elite class citizen, or people who flock to Singapore from countries such as Indonesia, Malaysia, Brunei, Cambodia, Vietnam, Middle East, Indochina, Greater China, as well as the US to seek medical care. Here is a sneak peek into its healthcare sector, to analyse why winds of success are blowing towards the Lion City.
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Singapore healthcare sector at a glimpse
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Singapore’s healthcare structure
 “Novena, located in the heart of Singapore, has grown to become a premier medical hub with a cluster of medical services and institutions.”Kamaljeet Singh Gill Chief Marketing Officer, Parkway Health, Singapore |
Being a small island country that sprawls over 137 kilometres (85 miles), all healthcare institutions here are evenly spread and are widely accessible. However, most primary care providers are located in housing estates and tertiary medical care centres in more central areas of Orchard and Novena. Kamaljeet Singh Gill, Chief Marketing Officer, Parkway Health, Singapore, states, “Novena, located in the heart of Singapore, has grown to become a premier medical hub with a cluster of medical services and institutions, such as Mount Elizabeth Novena Hospital, Tan Tock Seng Hospital, Novena Medical Centre, and Singapore’s upcoming third medical school, Lee Kong Chian School of Medicine. Mount Elizabeth Novena Hospital (MNH), Parkway Pantai Group’s new flagship hospital is the latest addition to this area this year.”
The well-established healthcare system within Singapore comprises close to 13 private hospitals, 10 public (government) hospitals and several specialist clinics, each specialising in and catering to different patient needs, at varying costs.
 “The healthcare financing system for Singaporeans is ably supported by government funding.” Anurag Dubey Asso. Director, Health IT & Healthcare Delivery Practice, Frost & Sullivan, South Asia & Middle East |
“Singapore is considered a benchmark of healthcare delivery in Asia with an overall healthcare expenditure in excess of $8 billion. The industry comprises both public and private healthcare systems wherein the key components of healthcare i.e. primary care services are undertaken largely by the private practitioners (approximately 2,000) and hospital services are dominated by the public system. The Joint Commission International (JCI) has accredited 11 hospitals and three medical centres in Singapore,” informs Anurag Dubey, Associate Director, Health IT & Healthcare Delivery Practice, Frost & Sullivan, South Asia & Middle East.
Healthcare in Singapore is mainly under the responsibility of the Singapore Government’s Ministry of Health. The ministry primarily focusses on ensuring that favourable and affordable basic medical services are available to all Singaporeans. All efforts by the Ministry of Health are directed towards following this principle. That is why the healthcare sector here has received much praise, both locally as well as internationally.
According to the Ministry of Health, Singapore, the country’s healthcare begins with building a healthy population through preventive healthcare programmes and promoting a healthy lifestyle. Good, affordable basic healthcare is available to Singaporeans through subsidised medical services at public hospitals and clinics. All hospitals and healthcare system within the country never refrain from offering help to a Singaporean because of financial limitations. The Ministry’s philosophy also promotes individual responsibility towards healthy living and medical expenses.
Government healthcare facilities are fundamentally designed to provide subsidised healthcare services to Singaporeans. These facilities consist of a number of government hospitals namely: Singapore General Hospital, National University Hospital, Tan Tock Seng Hospital, Changi General Hospital, Khoo Teck Puat Hospital and so on. Additionally, the public healthcare facilities in Singapore are further divided into two clusters, which are the National Health Care Group (NHG) and Singapore Health Services (SingHealth). These clusters were made to foster vertical integration of services, enhance synergy and economies of scale in-line with the government’s aim to spur innovation and improve the quality of healthcare while keeping medical costs affordable. NHG and SingHealth, although wholly-owned by the government, are public sector hospitals operated as private limited companies in order to compete with the private sector on service and quality. A very progressive market indeed!
Market watch
 “The sector is strongly backed by the government which contributes approximately five per cent of its GDP to the healthcare sector.”Dr Rana Mehta Exe. Director-Leader Healthcare Practice, PwC India |
It is said to be one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes. Giving an observer’s view, Dr Rana Mehta, Executive Director-Leader Healthcare Practice, PwC India, says, “Healthcare services in Singapore are one of the best services in the world. The sector is strongly backed by the government which contributes approximately five per cent of its GDP to the healthcare sector. The healthcare system here is mainly dominated by the public sector. However, the private sector in Singapore has also played a significant role in boasting the healthcare system.”
 “EDB supports healthcare organisations’ meet their objectives by supporting their presence in Singapore.”Vishal Bali Group CEO, Fortis Healthcare |
Acknowledging the same, Vishal Bali, Group CEO, Fortis Healthcare, opines, “Home to world-class medical talent, cutting-edge healthcare technology, and modern patient-centric facilities, Singapore is widely recognised as a benchmark in healthcare delivery in Asia, and a trusted leading regional medical hub. Singapore has a very well developed public and private healthcare delivery system. It is one of the few countries globally where the two systems exist with an equally competent technology and clinical acumen.”
Bali adds, “With a per capita GDP of $ 43,867, in 2010, among the highest in the region, Singapore has a highly developed, market-based economy and demand for quality healthcare is on the high. The pool of highly well-informed patients also signals an increasing need for healthcare providers to focus not only on surgical outcomes, but also a comprehensive and holistic patient experience for anyone receiving medical treatment.”
Financing for the better
As mentioned above, Singapore has a very interesting healthcare financing system as well. This system consists of the innovative medical financing frameworks such as Medisave, Medishield, ElderShield and Medifund. Introduced by the government, these schemes have grabbed global attention. These are mainly administered by the Central Provident Fund (CPF) board for its smooth functioning.
Medisave: This is a national healthcare savings scheme, wherein every month a portion of the citizens’ CPF savings goes into their Medisave Account to help them build it up for healthcare purposes. According to this scheme, one can use their Medisave to pay for their own and their immediate family members’ hospitalisation, day surgery and certain outpatient treatment expenses. This fund can also be used to pay the premiums of MediShield and Medisave-approved Integrated Shield Plans.
MediShield: This is a medical insurance scheme introduced by the government to help economic class patients to meet the cost of medical treatment for serious illnesses or for prolonged hospitalisation. An added advantage to this scheme is that the premiums for MediShield are kept low and affordable to encourage participation of citizens in this scheme.
Medifund: This is an endowment fund set up by the government as a safety net to help needy people of Singapore who are unable to pay their medical expenses. This scheme helps those who are unable to afford the subsidised charges at restructured hospitals, even with their Medisave and MediShield schemes.
Apart from these innovative healthcare financing schemes, many Singaporeans also have supplementary private health insurance (often provided by employers) for services not covered by the government programmes. On the same lines, Dubey, elaborates, “A larger proportion of healthcare expenditure in Singapore is out of pocket and accounts for approximately 55 per cent of the total healthcare spend (2010). The healthcare financing system for Singaporeans is ably supported by government funding and has gained momentum post liberalisation of the medical insurance sector for private players.” With all these healthcare financing frameworks in place, it isn’t a tall task for the country to maintain a regular healthcare surplus while reducing taxes.
A haven for private players too
Looking at the efforts taken by the Singapore government in fostering the healthcare system, it may seem that the private sector here has hardly any role to play. This isn’t true! Private players such as Parkway Group consisting of Gleneagles Hospital and Medical Centre, Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital and the Raffle Medical Group having its Raffles hospitals are the star performers of the sector. These players with their high-tech and luxurious medical service with minimum waiting time are like magnets for medical tourists from all around the world. This environment provides an attractive opportunity for private healthcare service providers to initiate or expand their presence in the marketplace.
Adding to the list of opportunities that stimulate growth for the private healthcare service providers, Dubey highlights that the Ministry of Health is also beginning to look at how it could engage the private sector further. It has initiated programmes such as the Community Health Assist Scheme (CHAS), which provides subsidised treatment at private General Practitioners (GP) clinics for needy, elderly and the disabled. The Singapore Tourism Board is also promoting the country as a regional centre of medical excellence to strengthen its image as a world class healthcare destination. He further informs that as per government statistics, Singapore’s world class healthcare infrastructure treated more than 600,000 foreign patients in 2009 and is expected to reach one million mark by 2012.
The India connect
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| Singapore has strategic business partnerships with many countries around the world and India is one of the major business partners for the country |
While Singapore hooks medical tourists with its world class medical services, does it open doors for countries to do healthy business?
Yes of course! Singapore has strategic business partnerships with many countries around the world and India is one of the major business partners for the country.
Says Kevin Lai, Director, Biomedical Sciences, Singapore Economic Development Board, “Singapore can be a strategic and trusted location for Indian companies to access regional and global markets, manufacture for global markets as well as improved R&D productivity.”
He further elaborates it as:
Commercial: Currently, there are more than 4,000 Indian enterprises in Singapore. Of these, a growing number have leveraged on Singapore as their regional and international headquarters to coordinate their overseas operations. These include Fortis Healthcare, Tata Consultancy Services and Punj Lloyd. As a global hub in Asia, Singapore is an excellent platform from which Indian enterprises can launch their expansion into global markets. Indian companies can also tap the strong pool of multi-disciplinary talent, business friendly policies and taxation regime in Singapore to drive their growth. For example, Fortis Healthcare, India’s second largest healthcare company has established its international headquarters in Singapore.
Manufacturing: Singapore is a trusted location with proven manufacturing track record for speed and quality, where companies can manufacture high quality drugs across various modalities. To date, there has been zero negative observations from international regulators like the FDA and EMEA for seven leading pharmaceutical companies having their global manufacturing plants located in Singapore. Various options for ready infrastructure and access to contract manufacturing partners help to provide flexibility and ensure quick ramp up of operations. Beyond chemical drugs, Singapore has also built up strong capabilities in the manufacturing of biologic drugs and vaccines. Companies like Roche, Lonza and GSK Biologicals have established large scale manufacturing facilities in Singapore. Lonza is also establishing its first Asia cell therapy facility in Singapore.
R&D: Singapore is a location that attracts top global scientific talent. The country has built up a strong scientific foundation with seven biomedical research institutes and five research consortia in key fields that include genomics, molecular and cellular biology, bioprocessing technologies, immunology, and bio-imaging. It has a growing base of clinician scientists, with deep knowledge of clinical needs and disease biology, as well as key infrastructure such as the investigative medicine units in hospitals that are dedicated to complex early phase trials. Indian companies can improve R&D productivity and cost efficiency by establishing new models of collaboration with Singapore public research institutes, hospitals and CROs.
Opportunities are galore but are there any alliances in the healthcare space between the two countries? Well, the answer is an obvious yes.
Fortis Healthcare, Singapore is one of the most successful Indo-Singapore business alliances that one can confidently quote. The leading healthcare group from India, in the last one year, has firmly ensconced itself in the Singapore healthcare space. Giving further information on the business plans between Fortis and Singapore’s Ministry of Health, Bali reveals that the group is currently in the midst of discussions with the Ministry of Health to explore how the company can be a part of the National E-Health Record System (NEHR). Besides the NEHR, Fortis is also actively exploring how the group can also integrate the CMIS, particularly for patient drug allergies and medical alerts.
This isn’t just a one-way traffic lane with just Indian healthcare groups entering the Singapore market. On the contrary, Singapore’s giant healthcare group, Parkway Pantai in a joint venture with Apollo Group, has already established the Apollo Gleneagles Hospitals, Kolkata, a 425-licensed bed multi-speciality tertiary hospital, which is currently in the process of increasing its licensed beds to 510, with a focus on cardiology, general surgery, orthopaedics and transplants. “Parkway has been targetting the Indian market for the past few years as there is an increasing group of high net worth individuals in India due to its fast economic growth. Indian patients are willing to travel for high quality healthcare and there is an increasing demand for high end medical services and complex procedures such as transplants (kidney, liver and bone marrow transplants) and complicated neurosurgical and spine disorders. Privacy is also a big factor why these high net worth individuals choose to fly to Singapore for treatment. We provide additional security so that they can relax and recover in peace without public attention”, adds Gill. The Parkway Group will soon be launching their Gleneagles Khubchandani Hospital in Mumbai which is a joint-venture between Parkway Pantai and Koncentric Investments. The hospital will have 450 beds, of which the majority are single suites. The hospital is set to commence its operations by the end of this year. It will provide specialities in heart and vascular, general surgery, orthopaedics, neurosurgery and transplants.
The trade pillar
These successful business engagements are possible because of the strong support from the Singapore Economic Development Board (EDB). The EDB plays a pivotal role in identifying and pioneering economic opportunities for Singapore. “The Singapore EDB is the leading government agency for planning and executing strategies to enhance Singapore’s position as a global business centre. EDB dreams, designs and delivers solutions that create value for companies in Singapore. Their mission is to create sustainable economic growth for Singapore with vibrant business and good job opportunities. It is about extending Singapore’s value proposition to help organisation’s meet their innovation and talent objectives in Asia and globally. In this respect EDB supports healthcare organisations’ meet their objectives by supporting their presence in Singapore,” updates Bali.
Lessons to learn
After understanding the potential of the Singapore market, the question that arises is – Can similar healthcare policies work in the Indian system? Well, only time can tell.
Comparing the two healthcare systems would be inappropriate at this point, as the Indian healthcare system works on a complete different level. With a population exceeding that of Singapore by several times, it becomes very difficult for the Indian government to organise its healthcare structure. Moreover, red tapism and bureaucratic impedance hampers the progress of healthcare in the country. But, like the light that shines at the end of the dark tunnel, India too will override these obstacles. But how?…
Picking up good things from others is always considered as a smart move. Singapore’s healthcare system definitely sets a good precedent for us. Its healthcare financing policies is something that India should draw inspiration from. Gathering lessons from these polices will help us to formulate an uniform insurance policy for Indian citizens that can be backed by the government. Furthermore, it will also help us organise our public sector offerings in the healthcare space, which currently seems to be the need of the hour.
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